warfarin and Purpura--Thrombocytopenic--Idiopathic

Topics: Aged; Benzoates; Biopsy; Clopidogrel; Computed Tomography Angiography; Conservative Treatment; Female; Humans; Hydrazines; Hyperbaric Oxygenation; Ischemia; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Pyrazoles; Skin; Thrombosis; Tibial Arteries; Toes; Treatment Outcome; Warfarin

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Aortic Valve; Aortic Valve Stenosis; Benzoates; Bicuspid Aortic Valve Disease; Bioprosthesis; Chest Pain; Craniotomy; Echocardiography; Echocardiography, Three-Dimensional; Echocardiography, Transesophageal; Enoxaparin; Female; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hematoma, Subdural, Acute; Humans; Hydrazines; Immunologic Factors; Plasma Exchange; Purpura, Thrombocytopenic, Idiopathic; Pyrazoles; Recurrence; Rituximab; Stroke Volume; Thrombosis; Ventricular Dysfunction, Left; Warfarin

Topics: Antigens, Human Platelet; Arginine; Aspirin; Autoantibodies; Combined Modality Therapy; Coronary Thrombosis; Drug Substitution; Drug Therapy, Combination; Eptifibatide; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Pipecolic Acids; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; Platelet Transfusion; Purpura, Thrombocytopenic, Idiopathic; Shock, Cardiogenic; ST Elevation Myocardial Infarction; Stents; Sulfonamides; Thrombectomy; Thrombolytic Therapy; Thrombosis; Ticagrelor; Warfarin

Topics: Aged, 80 and over; Anticoagulants; Autoantibodies; Betacoronavirus; Combined Modality Therapy; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Enoxaparin; Fatal Outcome; Humans; International Normalized Ratio; Male; Pandemics; Platelet Count; Platelet Transfusion; Pneumonia, Viral; Purpura, Thrombocytopenic, Idiopathic; SARS-CoV-2; Thrombophlebitis; Warfarin

Intravenous immunoglobulin (IVIG) is a widely used agent as the first choice of treatment of immune thrombocytopenic purpura (ITP). IVIG has several side effects, but it is a relatively safe treatment. Life-threatening thrombosis has been reported in adults and rarely in children. We report a case of a 14-year-old boy with dural venous sinus thrombosis and pulmonary embolism after treatment with IVIG for ITP. The patient was treated with low-molecular-weight heparin followed by warfarin and the symptoms were recovered. If a patient with ITP shows mental change or respiratory difficulty, we should consider thrombosis as well as hemorrhage.

Topics: Adolescent; Anticoagulants; Biopsy; Bone Marrow; Hematologic Tests; Heparin, Low-Molecular-Weight; Humans; Immunoglobulins, Intravenous; Magnetic Resonance Angiography; Male; Pulmonary Embolism; Purpura, Thrombocytopenic, Idiopathic; Sinus Thrombosis, Intracranial; Tomography, X-Ray Computed; Treatment Outcome; Venous Thrombosis; Warfarin

Topics: Anticoagulants; Heart Diseases; Humans; Male; Purpura, Thrombocytopenic, Idiopathic; Receptors, Fc; Recombinant Fusion Proteins; Thrombocytopenia; Thrombopoietin; Warfarin

We report two patients (70- and 49-year-old Japanese men) with acute exacerbation of chronic idiopathic thrombocytopenic purpura (ITP) and deep venous thrombosis of the lower extremities. Both were successfully managed with thrombopoietin receptor agonist (TPO-RA) administration. Both had ITP refractory to steroid treatment. Their immature platelet fraction (absolute-IPF) counts were increased and paralleled the platelet recoveries after TPO-RA (eltrombopag and romiplostim, respectively) without progression of thrombosis. Although ITP has recently been evaluated as a thrombophilic disorder, reports on acute exacerbation of ITP with newly diagnosed thrombosis are limited, and the pathophysiology and association between ITP and thrombosis remain to be elucidated. Moreover, the influences of TPO-RA on thrombosis are still controversial. To our knowledge, this is the first case report describing patients with exacerbation of ITP who developed thrombosis and were treated with TPO-RA. The outcomes of our cases underscore the importance of monitoring thrombosis and not delaying the initiation of anticoagulation treatment during the use of TPO-RA.

Topics: Aged; Anticoagulants; Humans; Lower Extremity; Male; Middle Aged; Purpura, Thrombocytopenic, Idiopathic; Receptors, Thrombopoietin; Venous Thrombosis; Warfarin

Topics: Aged; Blood Platelets; Heart Diseases; Humans; Male; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Receptors, Fc; Recombinant Fusion Proteins; Thrombopoietin; Warfarin

Topics: Aged; Antibodies, Anticardiolipin; Anticoagulants; Arginine; Catheterization; Contraindications; Drug Therapy, Combination; Femoral Vein; Heparin; Humans; Iliac Vein; Infusions, Intravenous; Ischemia; Kidney; Kidney Transplantation; Male; Pipecolic Acids; Popliteal Vein; Postoperative Complications; Protein S Deficiency; Purpura, Thrombocytopenic, Idiopathic; Renal Veins; Sulfonamides; Thrombolytic Therapy; Thrombophilia; Tissue Plasminogen Activator; Vena Cava Filters; Venous Thrombosis; Warfarin

Portal vein thrombosis (PVT) is a complication of hepatic disease and a potentially lethal complication of splenectomy. The reported incidence of this complication is low (approximately 1%). However, its true incidence may have been underestimated due to difficulty in making the diagnosis. Herein we report the case of a 19 year-old woman who presented with a 2-year history of idiopathic thrombocytopenic purpura (ITP). Because she had become refractory to medical therapy, she underwent laparoscopic splenectomy. She was discharged on postoperative day 2 after an uncomplicated procedure. She did well, complaining only of mild backache, until postoperative day 21, when she presented with nausea, vomiting, and leukocytosis. CT showed PVT and superior mesenteric vein thrombosis. Despite heparin and fluid administration, her condition worsened. At laparotomy, she had diffuse small bowel edema and congestion. At a second-look procedure 24 h later, nearly all her jejunum and ileum were necrotic. After three procedures, she was left with 45 cm of proximal and 10 cm of distal small bowel. Bowel continuity was restored 8 weeks later. She continued on warfarin anticoagulation therapy for 1 year. Postsplenectomy PVT is most often seen following splenectomy for myeloproliferative disorders and almost never after trauma. The large splenic vein stump and the hypercoagulable state in patients with splenomegaly are thought to be contributory. The presentation of PVT is vague, without defining signs or symptoms. Color-flow Doppler and contrast-enhanced CT scans are the best methods for the nonoperative diagnosis of PVT. Aggressive thrombolysis offers the best hope for clot lysis and maintenance of bowel viability. Even vague symptoms must be considered seriously following splenectomy.

Topics: Adult; Anastomosis, Surgical; Anticoagulants; Back Pain; Combined Modality Therapy; Crystalloid Solutions; Diagnostic Errors; Female; Fluid Therapy; Heparin; Humans; Ileum; Immunosuppressive Agents; Ischemia; Isotonic Solutions; Jejunum; Laparoscopy; Mesenteric Veins; Muscular Diseases; Necrosis; Parenteral Nutrition; Plasma Substitutes; Plasmapheresis; Platelet Transfusion; Portal Vein; Postoperative Complications; Purpura, Thrombocytopenic, Idiopathic; Splenectomy; Splenomegaly; Venous Thrombosis; Warfarin

Danazol is a synthetic androgenic steroid used clinically for the treatment of a wide variety of disorders. Although there is no extensive evidence that androgens are thrombogenic in humans, there are case reports of cerebral, coronary, and peripheral arterial thrombosis in young male athletes abusing anabolic-androgenic steroids. There are also two reported cases of arterial and venous thrombotic events attributed to danazol therapy. We report two additional cases of limb-threatening arterial thrombosis in patients undergoing danazol therapy, and suggest the possibility that danazol may be an independent risk factor for arterial thrombosis.

Topics: Acute Disease; Adult; Aged; Angiography; Anticoagulants; Arteries; Danazol; Drug Therapy, Combination; Endometriosis; Estrogen Antagonists; Female; Heparin; Humans; Leg; Pain; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Thrombosis; Urokinase-Type Plasminogen Activator; Warfarin

To determine the clinical course and influence of antithrombotic therapy in patients with lupus anticoagulant or anticardiolipin antibodies, or both, after the first thromboembolic event.. Retrospective survey of consecutive patients treated according to their physician's best judgment.. Secondary and tertiary referral practice.. Seventy patients (48 women [69%]) with a mean age (+/- SD) of 45.5 +/- 17.3 years. The antiphospholipid syndrome was primary in 51 patients (73%) and secondary to systemic lupus erythematosus in 14 patients (20%) and to chronic idiopathic thrombocytopenic purpura in 5 patients (7%).. Site of initial and recurrent thrombotic events (venous or arterial), as well as kind (aspiring, heparin, or warfarin) and intensity of anticoagulation.. Total follow-up after the first thrombotic event was 361.0 patient-years (mean [+/- SD], 5.2 +/- 5.6 years per patient). Thirty-seven patients (53%) had 54 recurrent events, with 2 patients experiencing fatal events. Arterial events were followed by arterial events, and venous events by venous events, in 49 of 54 instances (91%). Recurrence rates during "no treatment;" aspirin therapy; or low-, intermediate-, or high-intensity warfarin therapy (international normalized ratios [INRs] less than or equal to 1.9, 2.0 to 2.9, and greater than or equal to 3.0, respectively, or rabbit brain thromboplastin prothrombin time ratios of approximately less than 1.3, 1.3 to 1.5, and greater than 1.5, respectively) were 0.19, 0.32, 0.57, 0.07 (P = 0.12), and 0.00 (P less than 0.001) per patient-year. The follow-up periods for the five types of therapy were 161.2, 37.8, 11.3, 40.9, and 110.2 patient-years, respectively. The highest INR coincident with thrombosis was 2.6. Five warfarin-treated patients had five significant bleeding events (0.031 per patient-year).. Recurrent thrombosis is a potentially serious problem for patients with lupus anticoagulant or anticardiolipin antibodies or both. The site of the first event (arterial or venous) tended to predict the site of subsequent events. Intermediate- to high-intensity warfarin therapy may confer better antithrombotic protection than low- to intermediate-intensity warfarin therapy or aspirin therapy. Further studies are needed to define more precisely the rethrombosis rate and optimal type, intensity, and duration of antithrombotic therapy.

Topics: Aged; Antiphospholipid Syndrome; Aspirin; Drug Therapy, Combination; Female; Follow-Up Studies; Heparin; Humans; Lupus Erythematosus, Systemic; Male; Middle Aged; Purpura, Thrombocytopenic, Idiopathic; Recurrence; Retrospective Studies; Thrombosis; Warfarin