warfarin and Pleural-Effusion

Novel oral anticoagulants (NOAC) have been shown to have comparable risk profiles compared with warfarin. However, data on the use of NOACs in cardiac surgery patients is limited. The aim of this study is to compare postoperative effusion rates in patients who were anticoagulated with NOACs vs warfarin after coronary artery bypass grafting (CABG).. A retrospective review of 2017 patients undergoing isolated CABG from 2014 to 2017 was performed. Of those patients, 246 patients (12.2%) were placed on either a NOAC or warfarin postoperatively. The combined rates of postoperative pericardial and pleural effusions requiring invasive intervention during the index hospitalization and up to 3 months postoperatively were compared between patients who were placed on NOACs vs warfarin.. Of the 246 patients placed on oral anticoagulation after isolated CABG, 64 (26.0%) were placed on NOACs, and 182 (74.0%) received warfarin. There were no significant differences in preoperative coagulation profile and use of anticoagulation and antiplatelets preoperatively between the groups. Of the patients anticoagulated with NOACs postoperatively, 17 patients (26.6%) required invasive interventions for effusions compared with 24 patients (13.2%) in the cohort anticoagulated with warfarin (P < 0.014). Of the patients who required interventions for effusions, those on NOACs were more likely to require delayed interventions compared with those on warfarin.. Patients receiving NOACs after CABG are at increased risk of developing effusions requiring invasive interventions compared to patients receiving warfarin. This increased risk should be taken into consideration when choosing the appropriate anticoagulation strategy for postoperative patients with CABG.

Topics: Administration, Oral; Aged; Anticoagulants; Antithrombins; Coronary Artery Bypass; Factor Xa Inhibitors; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pleural Effusion; Postoperative Care; Postoperative Complications; Retrospective Studies; Risk; Warfarin

Topics: Aspirin; Child, Preschool; Drug Substitution; Drug Therapy, Combination; Fibrinolytic Agents; Fontan Procedure; Graft Occlusion, Vascular; Heart Defects, Congenital; Heart Ventricles; Hemodynamics; Humans; Male; Pleural Effusion; Thrombosis; Time Factors; Treatment Outcome; Vascular Patency; Warfarin

Thoracentesis is commonly performed to evaluate pleural effusions. Many medications (warfarin, heparin, clopidogrel) or physiological factors (elevated International Normalized Ratio [INR], thrombocytopenia, uremia) increase the risk for bleeding. Frequently these medications are withheld or transfusions are performed to normalize physiological parameters before a procedure. The safety of performing thoracentesis without correction of these bleeding risks has not been prospectively evaluated.. This prospective observational cohort study enrolled 312 patients who underwent thoracentesis. All patients were evaluated for the presence of risk factors for bleeding. Hematocrit levels were obtained pre- and postprocedure, and the occurrence of postprocedural hemothorax was evaluated.. Thoracenteses were performed in 312 patients, 42% of whom had a risk for bleeding. Elevated INR, secondary to liver disease or warfarin, and renal disease were the two most common etiologies for bleeding risk, although many patients had multiple potential bleeding risks. There was no significant difference in pre- and postprocedural hematocrit levels in patients with a bleeding risk when compared with patients with no bleeding risk. No patient developed a hemothorax as a result of the thoracentesis.. This single-center, observational study suggests that thoracentesis may be safely performed without prior correction of coagulopathy, thrombocytopenia, or medication-induced bleeding risk. This may reduce the morbidity associated with transfusions or withholding of medications.

Topics: Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation Disorders; Clopidogrel; Cohort Studies; Drainage; Female; Hepatic Insufficiency; Humans; International Normalized Ratio; Male; Middle Aged; Platelet Aggregation Inhibitors; Pleural Effusion; Postoperative Hemorrhage; Prospective Studies; Renal Insufficiency, Chronic; Risk Factors; Thrombocytopenia; Ticlopidine; Warfarin

The outcomes of 33 consecutive extracardiac Fontan operations performed between 1999 and 2008 in patients who mostly had initial Glenn shunts beyond infancy were reviewed. Preoperatively, the median oxygen saturation was 76.2% and mean pulmonary artery pressure was 10.5 mm Hg. The median age was 4.1 years at Glenn shunt procedure and 10 years at Fontan operation. The duration of chest tube drainage was longer in these patients than in series where Glenn shunts were created at a younger age. All patients received warfarin for 1 year, then warfarin and/or aspirin. At follow-up (median, 14 months), there was no significant ventricular dysfunction. Median oxygen saturation at the last follow-up was 92%. All patients in sinus rhythm preoperatively continued in this status. There was no Fontan failure or mortality. All patients were in New York Heart Association class I or II, although objective cardiopulmonary exercise evaluation in 8 patients showed impaired exercise tolerance. Despite a trend towards prolonged pleural effusion, there was no adverse outcome in the short or intermediate term. Long-term follow-up is required to see whether delayed creation of a Glenn shunt is associated with late disadvantages.

Topics: Adolescent; Anticoagulants; Aspirin; Blood Pressure; Chest Tubes; Child; Child, Preschool; Drainage; Drug Therapy, Combination; Exercise Tolerance; Female; Fontan Procedure; Heart Bypass, Right; Heart Defects, Congenital; Humans; India; Male; Oxygen; Platelet Aggregation Inhibitors; Pleural Effusion; Pulmonary Artery; Retrospective Studies; Time Factors; Treatment Outcome; Warfarin; Young Adult

Topics: Abortion, Induced; Adult; Anticoagulants; Antithrombin III; Embryo Transfer; Female; Fertilization in Vitro; Fibrinogen; Heparin; Humans; Infusions, Intravenous; Jugular Veins; Ovarian Hyperstimulation Syndrome; Pleural Effusion; Pregnancy; Pregnancy Complications, Hematologic; Subclavian Vein; Venous Thrombosis; Warfarin

Pulmonary manifestations of Behcet's disease are not very common and usually include pulmonary artery aneurysms, central venous thrombosis, pneumonia and pleurisy. Chylothorax secondary to superior vena caval obstruction is a rare complication and has been reported in only a few cases. We report a case of a 24-year-old man presenting with massive chylothorax as the initial presentation of Behcet's disease that was successfully treated conservatively.

Topics: Adult; Anti-Inflammatory Agents; Anticoagulants; Behcet Syndrome; Chylothorax; Diagnosis, Differential; Humans; Male; Pleural Effusion; Prednisolone; Superior Vena Cava Syndrome; Warfarin

Some drugs are known to induce pleural effusion. Drug-induced pleural effusion is often associated with pleural fluid eosinophilia. Anticoagulant therapy may induce pleural effusion by at least two different mechanisms: bleeding complication (haemothorax) and allergic or toxic reaction. Authors describe 76-yr-old male with warfarin-induced pleural effusion. Since INR was 15.5, and the value of pleural effusion Hct exceeded significantly 50% of Hct value in blood, spontaneous haemothorax due to warfarin overdose was diagnosed. Pleural fluid analysis revealed relatively high percentage of eosinophils (13%), but it was probably secondary to the presence of numerous red blood cells in the effusion. The authors discuss different mechanisms of drug-induced pleural effusion, with special attention to eosinophilic pleural effusion and review the literature on the spontaneous haemothorax as a complication of anticoagulant therapy.

Topics: Aged; Anticoagulants; Drug Overdose; Hemothorax; Humans; Male; Pleural Effusion; Pulmonary Eosinophilia; Time Factors; Warfarin

Material with leuckocyte migration inhibition (LMI) activity has been demonstrated in various types of nonimmunologically induced acute pleural inflammatory exudates. This activity is present in inflammatory cell-free exudate and appears to involved the deposition of fibrin around the migrating leukocyte, resulting in "cell-trapping." This is supported by the fact that removal or inhibition of fibrin formation leads to loss of exudate LMI activity. Both fibrinogen and complement as well as vitamin K-dependent clotting factors appear to be required for LMI activity. The mechanism involved in the LMI reaction and its significance in nonimmune and cell-mediated immune inflammation are discussed.

Topics: Animals; Cell Migration Inhibition; Fibrin; Heparin; Hot Temperature; Hydroxyapatites; Inflammation; Irritants; Leukocytes; Male; Pleural Effusion; Rats; Thrombin; Warfarin; Zymosan

Topics: Animals; Dog Diseases; Dogs; Female; Hemothorax; Lung Diseases; Pleural Effusion; Warfarin