warfarin and Hypoxia

To report a case of bilateral spontaneous hyphaema in a patient on warfarin sodium for atrial fibrillation and COPD. A case report and literature review. A 76-year-old man presented with bilateral spontaneous hyphaema. There was no anterior chamber pathology known to predispose for spontaneous bleeding except for a history of paroxysmal atrial fibrillation treated with a daily dose of 3 mg of warfarin sodium. In addition, he was also suffering from severe COPD and was on oxygen supplementation. This is a rare case of a bilateral spontaneous hyphaema. Although the patient was on warfarin sodium, his INR was only 2.6 at the onset of his symptoms. It may be possible that the combined action of anti-coagulant properties of warfarin sodium and hypoxic vasodilatation of iris vessels may be responsible for bilateral hyphaema in this case.

Topics: Aged; Humans; Hyphema; Hypoxia; Iris; Male; Pulmonary Disease, Chronic Obstructive; Vasodilation; Warfarin

Topics: Aged; Aged, 80 and over; Anticoagulants; Australia; Chest Pain; Female; Heart Diseases; Hospital Mortality; Humans; Hypoxia; Male; Neoplasms; Neurodegenerative Diseases; Nursing Homes; Pulmonary Embolism; Retrospective Studies; Sex Distribution; Syncope; Warfarin

A right-to-left shunt in the presence of normal pulmonary artery pressure is an unusual cause of hypoxemia in an adult who has a patent foramen ovale. We report a rare case of such a shunt-the result of a right atrial thrombus that formed in a hypercoagulable patient after placement of an indwelling central venous catheter for chemotherapy. In order to ascertain the nature of the right atrial mass and to decrease the risk of systemic embolization, the thrombus was surgically removed with the patient on cardiopulmonary bypass.

Topics: Anticoagulants; Blood Pressure; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Catheterization, Central Venous; Coronary Circulation; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Heart Atria; Heart Diseases; Heart Septal Defects, Atrial; Humans; Hypoxia; Male; Middle Aged; Protein C Deficiency; Pulmonary Artery; Thrombectomy; Thrombosis; Treatment Outcome; Warfarin

Endothelial dysfunction has been reported in hypoxaemic patients with the Eisenmenger syndrome, but a direct correlation between levels of endothelial markers and the severity of hypoxaemia has not been explored. With this in mind, we compared the levels in the plasma of tissue-type plasminogen activator, thrombomodulin, and von Willebrand factor in 25 patients with the Eisenmenger syndrome. They had a median age of 31 years, and were divided into 2 groups according to their recent clinical history. Thus, 18 patients were stable, being in functional class II or III, seen as outpatients, and having peripheral saturations of oxygen of 89 plus or minus 5 percent. In contrast, 7 patients were unstable, showing episodes of symptoms placing them in functional class IV, requiring care in hospital, and manifesting saturations of oxygen of 77 plus or minus 5 percent. We were able to follow 12 patients, 8 who were stable and 4 unstable, for 24 months. At baseline, levels of von Willebrand factor were higher in the unstable patients when compared to those who were stable, at 142 plus or minus 29 and 110 plus or minus 25 units per decilitre, respectively (p equal to 0.013). This correlated positively with oxygen desaturation (p less than 0.020). The structural abnormalities also correlated positively with the magnitude of hypoxaemia (p less than 0.020). Levels remained higher in the unstable patients throughout the period of follow-up (p equal to 0.006). Tissue-type plasminogen activator was also increased, at 14.3 plus or minus 8.4 versus 6.5 plus or minus 2.7 nanograms per millilitre in controls (p less than 0.001), whereas thrombomodulin was decreased, with values of 14.4 versus 34.6 nanograms per millilitre in controls (p for median values of less than 0.001). There was no correlation with saturations of oxygen. We conclude that measurement of von Willebrand factor, as compared with tissue-type plasminogen activator and thrombomodulin, will prove a better marker of endothelial response to hypoxaemia in patients with the Eisenmenger syndrome.

Topics: Adolescent; Adult; Biomarkers; Case-Control Studies; Child; Child, Preschool; Eisenmenger Complex; Endothelium, Vascular; Humans; Hypoxia; Male; Middle Aged; Oxygen; Thrombomodulin; Tissue Plasminogen Activator; von Willebrand Factor; Warfarin

A 57-year-old woman was hospitalized because of gait disturbance and dysuria. Close examination revealed a cauda equina tumor at the level of L2 and L3. Tumor resection was performed, with posterolateral fusion and spinal instrumentation. On the eleventh day after the surgery, she experienced dyspnea and chest pain during standing and walking exercise. Pulmonary thromboembolism was diagnosed, based on: (1) blood gas analysis findings of hypoxemia and (2) defective images in both of the upper lobes on urgent pulmonary blood flow scintigram. Her clinical status improved with urgent thrombolytic therapy (with tisokinase and urokinase) and anticoagulation therapy (with heparin and warfarin), and her life was saved. When pulmonary thromboembolism occurs, early diagnosis by pulmonary blood flow scintigram and early thrombolytic and anticoagulative therapies are necessary. Special attention should be paid to symptoms of pulmonary thromboembolism in patients after spinal surgery.

Topics: Anticoagulants; Cauda Equina; Chest Pain; Dyspnea; Female; Heparin; Humans; Hypoxia; Lumbar Vertebrae; Middle Aged; Peripheral Nervous System Neoplasms; Plasminogen Activators; Postoperative Complications; Pulmonary Embolism; Spinal Fusion; Thrombolytic Therapy; Tissue Plasminogen Activator; Urokinase-Type Plasminogen Activator; Warfarin

Chronic hypoxia produces pulmonary hypertension and pulmonary vascular remodeling. Heparin partially prevents the rise in right ventricular pressure and vascular remodeling in chronically hypoxic mice. To determine if this is due to the anticoagulant property of heparin or another property, we compared the effect of oral warfarin given at an anticoagulating dose (0.5 mg/kg/day) to heparin given by continuous infusion at a dose that does not prolong the partial thromboplastin time (PTT) (20 units/kg/h) on hypoxic pulmonary hypertension and vascular remodeling in the guinea pig. Normoxic control animals either untreated or treated with heparin or Coumadin were all alike in blood gases, pulmonary vascular resistance, right heart weights, and pulmonary histology. Hypoxia (10% 0(2) for 10 days) induced similar and significant increases in mean pulmonary artery (PA) pressure in both the hypoxic control and warfarin groups (19 +/- 1 mm Hg (mean +/- SEM) in both groups versus 11 +/- 0.1 mm Hg in the normoxic control group; p less than 0.05). Total pulmonary vascular resistance (TPR) was also increased from 0.041 +/- 0.002 in the normoxic control group to 0.087 +/- 0.007 and 0.071 +/- 0.003 mm Hg/ml/min/kg in the hypoxic control and warfarin groups, respectively (p less than 0.05). Whereas anticoagulation with warfarin did not protect the guinea pig from developing pulmonary hypertension, heparin markedly reduced PA and TPR (15 +/- 1 mm Hg and 0.052 +/- 0.002 mm Hg/ml/min/kg, respectively; p less than 0.05 versus hypoxic control or warfarin).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Animals; Blood Coagulation; Blood Vessels; Chronic Disease; Guinea Pigs; Hemodynamics; Heparin; Hypertension, Pulmonary; Hypoxia; Male; Partial Thromboplastin Time; Prothrombin Time; Pulmonary Circulation; Warfarin

A prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p less than 0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p less than 0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p less than 0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

Topics: Aspartate Aminotransferases; Blood Proteins; Extracorporeal Circulation; Heart Valve Prosthesis; Humans; Hypoxia; L-Lactate Dehydrogenase; Liver; Prothrombin Time; Warfarin; Wounds, Gunshot

Topics: Angina Pectoris; Aorta; Cardiac Surgical Procedures; Central Nervous System Diseases; Coronary Disease; Coronary Vessels; Electrocardiography; Extracorporeal Circulation; Heart Ventricles; Humans; Hypoxia; Intubation, Intratracheal; Methods; Postoperative Complications; Recurrence; Ventricular Fibrillation; Warfarin

Topics: Animals; Barbiturates; Brain Chemistry; Hexobarbital; Hyperbaric Oxygenation; Hypoxia; Isoniazid; Male; Phenylbutazone; Propiophenones; Rats; Sulfadiazine; Warfarin; Zoxazolamine