warfarin and Hypotension

The stereoselectivity of the pharmacokinetic interaction between warfarin and cimetidine was investigated in eight healthy volunteers. The warfarin enantiomers were given separately as single doses (15 mg) alone and during chronic administration of cimetidine (1 g day-1). Cimetidine did not interact with S warfarin but there was an interaction with the R enantiomer of warfarin. Cimetidine caused a significant increase in the mean plasma half-life of R warfarin (from 47.8 h to 57.8 h) and a significant decrease in its mean plasma clearance (from 2.3 to 1.7 ml h-1 kg-1) (P less than 0.02). Administration of a pharmacological dose of vitamin K1 together with the enantiomers of warfarin was necessary clinically and resulted in elevation of vitamin K1 2,3-epoxide concentrations, which were similar in each case.

Topics: Administration, Oral; Bradycardia; Cimetidine; Drug Eruptions; Drug Interactions; Half-Life; Humans; Hypotension; Injections, Intravenous; Kinetics; Protein Binding; Prothrombin Time; Random Allocation; Stereoisomerism; Vitamin K 1; Warfarin

Topics: Aged; Anticoagulants; Blood Coagulation Factors; Coagulants; Fatal Outcome; Humans; Hypotension; Intracranial Hemorrhages; Male; Warfarin

Bilateral adrenal hemorrhage resulting in acute adrenal insufficiency is a rare complication of anticoagulant therapy. We present the case of a patient who came to the Emergency Department with unsuspected adrenal insufficiency, followed by a second visit within 1 month with shock, to demonstrate the importance of early detection and treatment.

Topics: Adrenal Gland Diseases; Adrenal Insufficiency; Aged; Anticoagulants; Hemorrhage; Humans; Hypotension; Kidney; Male; Warfarin

We report here the successful treatment of a 16-year-old female who ingested 20 tablets of digoxin each containing 0.25 mg (total dose ingested equivalent to 0.1 mg/kg), 32 tablets of warfarin each containing 5mg (equivalent to 3.2 mg/kg), and approximately 15 tablets of propafenone each containing 300 mg (equivalent to 90 mg/kg). The patient developed hypotension and sinus bradycardia necessitating external cardiac pacing 17 hours after drug ingestion. In addition to gastric lavage, activated charcoal, blood alkalinisation, administration of vitamin K and temporary cardiac pacing, the authors performed plasma exchange for drug removal and administered rifampicin in order to increase the metabolism of digoxin, propafenone and warfarin. The patient was discharged without any sequelae. Plasma exchange may be lifesaving in drug ingestions where there is a low volume of distribution and high plasma protein binding. Rifampicin, an inducer of cytochrome p450, may be used in intoxications for elimination of drugs with inactive metabolites.

Topics: Adolescent; Anti-Arrhythmia Agents; Anticoagulants; Bradycardia; Cytochrome P-450 Enzyme System; Digoxin; Drug Overdose; Enzyme Induction; Female; Humans; Hypotension; Plasma Exchange; Propafenone; Rifampin; Warfarin

Lateral abdominal wall hematomas are rare. We describe a patient with a delayed rupture of a femoral artery pseudoaneurysm, who presented with such a hematoma. In contrast to other types of abdominal wall hematomas, which are often managed conservatively, a ruptured femoral artery pseudoaneurysm frequently requires emergent surgical intervention. Rupture of a pseudoaneurysm can be catastrophic. Due to the rising incidence of femoral artery pseudoaneurysms and shorter hospital stays, it is useful for the emergency physician to be familiar with the diagnosis and management of femoral artery pseudoaneurysms and their potentially life-threatening complications.

Topics: Abdominal Wall; Aged; Aneurysm, False; Anticoagulants; Atrial Fibrillation; Diagnosis, Differential; Emergency Medicine; Enoxaparin; Female; Femoral Artery; Heart Septal Defects, Atrial; Hematoma; Humans; Hypotension; Radiography; Rupture, Spontaneous; Treatment Outcome; Warfarin

Topics: Amiodarone; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Cardiac Output, Low; Echocardiography, Doppler; Echocardiography, Transesophageal; Electrocardiography; Female; Heart Atria; Heart Diseases; Heart Valve Prosthesis Implantation; Heparin; Humans; Hypotension; Middle Aged; Mitral Valve; Postoperative Complications; Thrombosis; Time Factors; Warfarin

Topics: Adrenal Gland Diseases; Adrenocorticotropic Hormone; Combined Modality Therapy; Female; Hemorrhage; Humans; Hydrocortisone; Hypotension; Leiomyosarcoma; Middle Aged; Thrombophlebitis; Tomography, X-Ray Computed; Uterine Neoplasms; Vena Cava Filters; Warfarin

Pulmonary embolism remains a frequent and often fatal disorder. For the majority of patients, anticoagulation with heparin followed by warfarin represents the primary mode of treatment. Thrombolytic therapy is recommended for the patient with massive pulmonary embolism that has produced hypotension. Embolectomy is reserved for the patient with post embolic systemic hypotension who has an absolute contraindication to thrombolysis or who deteriorates despite thrombolytic therapy. Following successful embolectomy the surgeon must treat the complications of the surgery and prevent recurrence. Complications include cerebral infarction, pulmonary infarction and endobronchial hemorrhage, right ventricular failure, local or systemic bleeding and venous stasis. A case of successful pulmonary embolectomy with a complicated postoperative course is presented and the pathophysiology and treatment of the complications are discussed.

Topics: Adrenal Gland Diseases; Chest Pain; Dyspnea; Female; Heparin; Humans; Hypotension; Middle Aged; Pain; Postoperative Complications; Pulmonary Embolism; Syncope; Warfarin

Topics: Alcoholism; Anesthetics; Anti-Anxiety Agents; Anticonvulsants; Antidepressive Agents; Antihypertensive Agents; Antipsychotic Agents; Aspirin; Disulfiram; Drug Interactions; Ethanol; Ethylene Dibromide; Hemorrhage; Humans; Hypoglycemia; Hypotension; Methotrexate; Narcotics; Procarbazine; Sulfonylurea Compounds; Warfarin

A case of Bjork-Shiley mitral valve dysfunction is presented. The patient has not responded to anticoagulant therapy and had hypotension, dyspnea, chest pain, and a pulse deficit but normal sinus rhythm. Simultaneous echocardiogram, ECG, and arterial pulse tracing were used as noninvasive means of monitoring. Nonsurgical correction of a clinical emergency restored the patient to prior normal baseline cardiovascular function. This case illustrates the possibility of restoring normal prosthetic function by supporting the patient medically while undertaking diagnostic testing and arranging surgical intervention. To our knowledge, this is the first reported case of a malfunctioning Bjork-Shiley mitral valve corrected without surgery.

Topics: Aspirin; Cardiomegaly; Dipyridamole; Echocardiography; Female; Furosemide; Heart Murmurs; Heart Valve Prosthesis; Humans; Hypotension; Middle Aged; Mitral Valve Prolapse; Phenylephrine; Prothrombin Time; Warfarin

Topics: 1-Propanol; Acute Kidney Injury; Aged; Albumins; Antidepressive Agents; Antihypertensive Agents; Benzyl Compounds; Cephaloridine; Coumarins; Digitoxin; Diuretics; Drug Interactions; Ethacrynic Acid; Guanethidine; Guanidines; Heart; Heart Block; Heart Conduction System; Humans; Hypoglycemia; Hypotension; Kidney; Pancreas; Phenylbutazone; Salicylates; Sympathetic Nervous System; Tolbutamide; Warfarin