warfarin and Nausea

Exenatide, a treatment for type 2 diabetes, slows gastric emptying as part of its pharmacologic action and may alter the absorption of concomitant oral drugs. This open-label, 2-period, fixed-sequence study evaluated the influence of exenatide coadministration on the pharmacokinetics and pharmacodynamics of warfarin, a narrow therapeutic index drug, in healthy men (N = 16). A single, 25-mg oral dose of warfarin, with a standardized breakfast, was administered alone in period 1 and concomitantly with 10 microg exenatide subcutaneous twice daily in period 2. Exenatide did not produce significant changes in R- or S-warfarin pharmacokinetics. Although there were minor reductions in warfarin anticoagulant effect, the ratios of geometric means for the area under the international normalized ratio (INR)-time curve from dosing until the time of the last measurable INR value or maximum-observed INR response being 0.94 (0.93-0.96) and 0.88 (0.84-0.92), respectively, the magnitude and direction of these changes do not suggest a safety concern from this interaction.

Topics: Administration, Oral; Adult; Anticoagulants; Area Under Curve; Aryl Hydrocarbon Hydroxylases; Asian People; Chromatography, Liquid; Cytochrome P-450 CYP2C9; Dose-Response Relationship, Drug; Drug Interactions; Exenatide; Genotype; Haplotypes; Headache; Humans; Hypoglycemic Agents; Injections, Subcutaneous; International Normalized Ratio; Male; Mass Spectrometry; Middle Aged; Nausea; Peptides; Venoms; Warfarin

A 36-year-old female presented with dural sinus thrombosis manifesting as marked enlargement of the venous sinus, which could not be differentiated from epidural hematoma on computed tomography during the acute phase. Magnetic resonance imaging showed characteristic serial changes of the thrombus in the healing process. We believe this condition developed from use of oral contraceptives. Systemic anticoagulant therapy was effective without hemorrhagic complication.

Topics: Adult; Anticoagulants; Brain; Cerebral Angiography; Cerebral Veins; Cerebrovascular Circulation; Cranial Sinuses; Female; Headache; Heparin; Humans; Magnetic Resonance Imaging; Nausea; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Treatment Outcome; Warfarin

The etiology of spontaneous dissection of the carotid and vertebral arteries without antecedent trauma remains unclear. The goal of this 10-year review was to examine factors regarding presentation, diagnosis, treatment, and outcome for all patients at our institution who were diagnosed with spontaneous carotid dissections (SCD) or spontaneous vertebral dissections (SVD) with no prior trauma history. A retrospective chart analysis was performed involving all discharges from UCSD Medical Center from 1995 to 2005. Patients were selected for inclusion based on the diagnosis of carotid or vertebral dissection with no associated traumatic or iatrogenic cause for their presentation. Characteristics of these patients' medical risk factors, presenting symptoms, diagnostic method and time, treatment, and outcomes were analyzed. A total of 20 patients (10 male, age 44.8 +/- 12.9 yrs; 10 female, age 39.6 +/- 14.9 yrs) were included for study. These patients represented 12 cases of SCD and nine SVD. On presentation, a majority of patients with both SVD and SCD reported headache as their primary complaint while a significantly higher rate of nausea (25% vs. 67%, p < 0.01) was reported in SVD. SVD was associated with a significantly longer diagnostic time (11 hr vs. 16 hr, p < 0.01). The most commonly performed diagnostic exam in both SCD and SVD was magnetic resonance angiography (MRA). Anticoagulation was the primary treatment in 11 of 12 SCD and all nine SVD. One patient with persistent, symptomatic bilateral carotid dissection after anticoagulation was treated with stent placement resulting in unilateral intracranial hemorrhage (ICH). Length of stay was significantly longer in SVD (5 d vs. 7 d, p < 0.02). A significantly higher incidence of persistent neurologic deficits on discharge was seen in SCD (71% vs. 33%, p < 0.02). Radiographic evidence of cerebral infarction on discharge had a stronger correlation with clinical deficits in SCD. Although there were only two cases, those treated with endovascular therapy in the setting of SCD suffered complications related to the intervention. On discharge, there did not seem to be a correlation between persistent neurologic deficits and radiographic evidence of infarction in SVD reflecting that recovery after these episodes may not be predictable based on the appearance of the infarction.

Topics: Adult; Anticoagulants; California; Carotid Artery, Internal, Dissection; Cerebral Infarction; Cohort Studies; Female; Fibrinolytic Agents; Headache; Heparin; Humans; Length of Stay; Magnetic Resonance Angiography; Male; Medical Records; Middle Aged; Nausea; Radiography; Retrospective Studies; Stents; Time Factors; Treatment Outcome; Vascular Surgical Procedures; Vertebral Artery Dissection; Warfarin

Topics: Abdominal Pain; Angina, Unstable; Anticoagulants; Blood Coagulation Disorders; Fever of Unknown Origin; Humans; Male; Medical Errors; Middle Aged; Nausea; Partial Thromboplastin Time; Prothrombin Time; Renal Dialysis; Warfarin