warfarin and Pulmonary-Edema

The objective was to retrospectively study the initiation of anticoagulant therapy in inpatients of the two major teaching hospitals in Tasmania, Australia. The medical records of a random sample of patients with an admission diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE) during the period February 1992 to June 1994 were studied, to examine therapeutic issues including (i) the time taken after commencing heparin to achieve a therapeutic activated partial thromboplastin time (APTT), (ii) when warfarin was commenced, (iii) the time taken after commencing warfarin to achieve a therapeutic International Normalized Ratio (INR), and (iv) the degree of anticoagulant control at the time of discharge from hospital. The medical records of 99 patients (median age: 65 years and range: 16-93 years; 52 females) were studied. Heparin was generally commenced within 4 h of admission to hospital. The median duration of heparin therapy was 5 days (range: 2-26 days). The median number of APTTs performed per patient was 6 (range: 1-24), with most results (60%) being below the optimum range. Warfarin was commenced from day 1 of hospitalization in only 34% of patients. The INR was within the therapeutic range in only 29% of cases when heparin was ceased. The median time taken to achieve a therapeutic INR after starting warfarin was 3 days (range: 1-15 days).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Drug Administration Schedule; Female; Heparin; Humans; Infusions, Intravenous; Male; Middle Aged; Partial Thromboplastin Time; Pulmonary Edema; Retrospective Studies; Thrombophlebitis; Warfarin

Topics: Adrenergic beta-Antagonists; Adult; Anticoagulants; Drug Therapy, Combination; Female; Fetal Death; Heart Valve Prosthesis; Humans; Mitral Valve; Pregnancy; Pregnancy Complications, Cardiovascular; Pulmonary Edema; Rheumatic Heart Disease; Treatment Outcome; Warfarin

To identify hematoma progression in patients with warfarin-associated intracerebral hemorrhage (ICH) despite international normalized ratio (INR) normalization with fresh-frozen plasma (FFP), we reviewed 45 patients with warfarin-associated ICH given FFP. The median time for door to INR normalization was 30 hours (14 to 49.5), with 4 patients' hematomas enlarging after INR normalization. FFP is associated with substantial time delay to actual administration and pulmonary edema and may not prevent progression of ICH despite INR normalization.

Topics: Aged; Anticoagulants; Blood Transfusion; Cerebral Hemorrhage; Disease Progression; Female; Humans; International Normalized Ratio; Male; Plasma; Pulmonary Edema; Retrospective Studies; Treatment Outcome; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Drug Overdose; Erythrocyte Transfusion; Fatal Outcome; Female; Hemorrhage; Humans; Lung Diseases; Pulmonary Alveoli; Pulmonary Edema; Respiratory Distress Syndrome; Respiratory Insufficiency; Warfarin

Topics: Adult; Anticoagulants; Echocardiography, Doppler; Female; Fibrinolytic Agents; Heart Valve Prosthesis; Heparin; Humans; Mitral Valve; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Prosthesis Failure; Pulmonary Edema; Rheumatic Heart Disease; Shock, Cardiogenic; Thrombosis; Tissue Plasminogen Activator; Treatment Outcome; Warfarin

Topics: Aged; Hematoma; Humans; Laryngeal Diseases; Male; Mouth Floor; Pulmonary Edema; Warfarin

Eight patients have had thrombotic obstruction of a prosthetic valve since 1971, six mitral valves and two aortic. All eight patients had a Björk-Shiley valve. During the same period 159 Björk-Shiley valves were placed, 85 in the mitral and 74 in the aortic area. This represents a valve thrombotic occlusive incidence of 4.4 percent in our series, 5.9 percent of mitral and 2.7 percent of aortic prostheses. Among the six patients with mitral prostheses only one survived. The two patients with occluded aortic valves survived. The onset of symptoms was very abrupt in most patients and progressed very rapidly. Acute pulmonary edema was observed in five patients. Anticoagulation was considered inadequate in all patients. Aspirin or dipyridamole was being used in seven patients at the time of thrombosis. The data indicate a high frequency of thrombotic occlusion of Björk-Shiley valves in the absence of full anticoagulation with warfarin derivatives and emphasizes the urgent need for surgery once valve thrombosis is suspected.

Topics: Acute Disease; Adult; Aortic Valve; Female; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Pulmonary Edema; Thrombosis; Warfarin

Topics: Adrenal Gland Diseases; Aged; Electrocardiography; Heart Failure; Hemorrhage; Heparin; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Middle Aged; Organ Size; Pulmonary Edema; Thrombophlebitis; Warfarin