warfarin and Ovarian-Diseases

Antiphospholipid syndrome (APS) is a disorder of coagulation that causes thrombosis as well as pregnancy-related complications, occurring due to the autoimmune production of antibodies against phospholipid. Full anticoagulation is the cornerstone therapy in patients with thrombosis history, and this can lead to major bleeding. During a 3-year period, 300 primary and secondary APS patients were followed up at the Rheumatology Division of the authors' University Hospital. Of them, 255 (85%) were women and 180 (60%) were of reproductive age. Three of them (1%) had severe hemorrhagic corpus luteum while receiving long-term anticoagulation treatment and are described in this report. All of them were taking warfarin, had elevated international normalized ratio (>4.0) and required prompt blood transfusion and emergency surgery. Therefore, we strongly recommend that all women with APS under anticoagulation should have ovulation suppressed with either intramuscular depot-medroxyprogesterone acetate or oral desogestrel.

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Female; Hemorrhage; Humans; Ovarian Diseases; Warfarin

To study the demographic and clinical characteristics of patients with antiphospholipid syndrome (APS) with serious haemorrhagic complications of anticoagulant treatment in an attempt to establish risk factors for bleeding.. Patients with APS who were attending our lupus unit and who presented with severe bleeding while receiving oral anticoagulation were studied retrospectively. Severe bleeding was defined by the need for admission to hospital. Demographic data, clinical features, concomitant diseases and drugs, warfarin doses, duration of anticoagulation, and International Normalised Ratios (INR) at the time of bleeding were collected.. Fifteen patients were included in the study (12 with systemic lupus erythematosus (SLE) plus APS and 3 with primary APS). The median age was 41.7 (range 27-66) and the median duration of the disease was 12.9 years (range 3-22). Duration of anticoagulation was between 10 days and 17 years. The INR at the time of bleeding was under 3 in 4 patients, between 3 and 4 in 5 patients and above 4 in 6 patients. There were 4 episodes of subdural haematoma, 4 episodes of renal haematoma (two after renal biopsy), 2 episodes of ovarian haemorrhage, 2 episodes of rectal haemorrhage, 1 episode of menorrhagia, 1 episode of haemarthrosis, and 1 episode of spinal haematoma. Concomitant drugs were aspirin in 9 patients, antibiotics in 2 patients, and azathioprine in 3 patients. In 6 patients hypertension was present as a concomitant disease. There were no deaths due to bleeding. Anticoagulant treatment was restarted in all patients and 3 of them had a new episode of bleeding.. No relation was established between age, duration of oral anticoagulant treatment, and bleeding. Concomitant drugs, mainly aspirin, and high blood pressure were present at the time of bleeding in a large number of patients.

Topics: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Antiphospholipid Syndrome; Aspirin; Female; Hemarthrosis; Hematoma; Hematoma, Subdural; Hemorrhage; Humans; Hypertension; Kidney Diseases; Male; Menorrhagia; Middle Aged; Ovarian Diseases; Recurrence; Risk Factors; Thrombosis; Warfarin

A 39-year-old woman presented with progressively severe, sharp abdominal pain of three days' duration. The pain originated in the right lower quadrant of the abdomen and radiated to the back and suprapubic area. It worsened on ambulation and was associated with nausea and loose stools.

Topics: Abdominal Pain; Adult; Anticoagulants; Diagnosis, Differential; Female; Hemorrhage; Humans; Ovarian Cysts; Ovarian Diseases; Thrombosis; Ultrasonography; Warfarin

Topics: Adult; Female; Hemorrhage; Humans; Ovarian Diseases; Warfarin

Women taking anticoagulants are at increased risk of ovarian hemorrhage when they ovulate. Management depends on the patient's clinical presentation and her medical, including obstetric, history. Bilateral oophorectomy should be considered for selected patients on chronic anticoagulation therapy and for those patients for whom reproduction is of no concern. Ovulatory suppression is warranted when conservative therapy is adopted.

Topics: Adolescent; Adult; Diagnosis, Differential; Female; Hemorrhage; Humans; Ovarian Cysts; Ovarian Diseases; Ovulation; Warfarin

Topics: Adult; Anticoagulants; Female; Hemorrhage; Humans; Ovarian Diseases; Warfarin

Six cases of ovarian hemorrhage secondary to anticoagulant therapy are described. Cardiac valvular prostheses required the use of oral anticoagulants in four patients in this series; the other two suffered a pulmonary infarction secondary to thromboembolism and required sustained anticoagulant therapy. Pertinent data from 28 other case reports are reviewed. Awareness of this syndrome during child-bearing years, early recognition, and aggressive management should prevent a fatal outcome.

Topics: Adolescent; Adult; Anticoagulants; Female; Hemorrhage; Heparin; Humans; Middle Aged; Ovarian Diseases; Warfarin

Topics: Adolescent; Adult; Anticoagulants; Female; Hematoma; Humans; Ovarian Diseases; Ovary; Warfarin

A 43-year old woman had recurrent massive intraperitoneal hemorrhage from rupture of a hemorrhagic corpus luteum in two successive menstrual cycles while receiving anticoagulant therapy. Left oophorectomy was performed on the first occasion and right salpingo-oophorectomy with left salpingectomy on the second. While the precise incidence cannot be determined, rupture from a hemorrhagic corpus luteum appears to be a rare but potentially catastrophic complication of anticoagulant therapy. Hence possible ovarian hemorrhage should be considered in women of reproductive age receiving heparin or sodium warfarin therapy.

Topics: Adult; Anticoagulants; Corpus Luteum; Female; Hemorrhage; Humans; Ovarian Diseases; Rupture, Spontaneous; Warfarin

The unpredictability of hemorrhagic complications during anticoagulant therapy is well known. An unusual case of massive intraperitoneal hemorrhage from a ruptured corpus luteum during such therapy is presented. That this complication is uncommon may be because relatively few premenopausal women are placed on anticoagulant therapy. In addition, the most likely condition for which premenopausal women are given anticoagulants is thrombophlebitis associated with pregnancy and childbirth when ovulation is inhibited.

Topics: Corpus Luteum; Female; Hematuria; Hemoperitoneum; Heparin; Humans; Middle Aged; Ovarian Diseases; Rupture, Spontaneous; Thrombophlebitis; Warfarin

Three cases of women in the reproductive age group who received warfarin sodium therapy for pulmonary embolism are presented. The therapy was complicated by rupture of ovarian cysts with intraperitoneal hemorrhage necessitating exploratory laparatomy. The possibility of intraperitoneal hemorrhage must be considered in patients who present with abdominal pain and a history of anticoagulant therapy. Lack of awareness of the complication may result in delay in making a correct diagnosis and instituting appropriate therapy.

Topics: Adult; Female; Humans; Ovarian Cysts; Ovarian Diseases; Pulmonary Embolism; Rupture, Spontaneous; Warfarin

Topics: Adult; Corpus Luteum; Female; Heart Valve Prosthesis; Hemorrhage; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Ovarian Diseases; Warfarin

Topics: Anticoagulants; Computers; Dextrans; Female; Heparin; Humans; Iodine Radioisotopes; Ovarian Diseases; Postoperative Care; Pregnancy; Pregnancy Complications, Cardiovascular; Preoperative Care; Puerperal Disorders; Thromboembolism; Thrombophlebitis; Warfarin