warfarin and Purpura--Thrombocytopenic

Thrombotic events are rare complications during anticoagulation therapy. The thrombosis varies from localized cutaneous involvement to catastrophic thromboembolism and is usually associated with an underlying thrombophilia. We describe a patient who developed skin necrosis during warfarin treatment for a pulmonary thromboembolism. The management was complicated by the development of heparin-induced thrombocytopenia and further thrombotic events. Thrombophilia screen demonstrated the presence of protein S deficiency and Factor V Leiden as the prothrombotic factors, together with the demonstration of antiplatelet factor 4 antibodies, which confirms the diagnosis of heparin-induced thrombocytopenia (type II). Reinstitution of warfarin at a low loading dose was successful without the recurrence of skin lesions nor any further thrombosis.

Topics: Adult; Anticoagulants; Autoantibodies; Factor V; Female; Humans; Necrosis; Platelet Count; Platelet Factor 4; Protein S Deficiency; Purpura, Thrombocytopenic; Skin; Skin Diseases; Thrombophilia; Warfarin

A 33 year old woman with severe thrombocytopenic purpura complicated by typical lupus anticoagulant developed repeated spontaneous abortion, deep venous thrombosis, and cerebral thrombosis. The platelet count fluctuated from 4,000 to 400,000/mm3 during the 13 year clinical course. The physical and laboratory findings at the time of severe thrombocytopenic purpura were compatible with the criteria of idiopathic thrombocytopenic purpura except for positive lupus anticoagulant. Both immunosuppressive therapy with prednisolone and antithrombotic therapy with warfarin and aspirin were necessary for the control of bleeding and venous and arterial thrombosis.

Topics: Adult; Autoantibodies; Blood Coagulation Factors; Cardiolipins; Female; Heparin; Humans; Lupus Coagulation Inhibitor; Phosphatidylinositols; Prednisolone; Purpura, Thrombocytopenic; Warfarin

Topics: Animals; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Dog Diseases; Dogs; Female; Fibrin Fibrinogen Degradation Products; Hemophilia A; Hemorrhagic Disorders; Male; Purpura, Thrombocytopenic; von Willebrand Diseases; Warfarin

Topics: Adenosine Triphosphate; Animals; Blood Platelets; Humans; Lactates; Liver Cirrhosis; Lupus Erythematosus, Systemic; Neuraminic Acids; Neuraminidase; Platelet Adhesiveness; Purpura, Thrombocytopenic; Rabbits; Time Factors; Uremia; von Willebrand Diseases; Warfarin

Topics: Adolescent; Adult; Age Factors; Aged; Drug Interactions; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Edema; Ethnicity; Female; Glyburide; Glycyrrhiza; Hematologic Diseases; Hospitalization; Humans; Male; Middle Aged; New Zealand; Outpatient Clinics, Hospital; Phenobarbital; Plants, Medicinal; Purpura, Thrombocytopenic; Quinidine; Sex Factors; Succinates; Triterpenes; Warfarin

Topics: Adult; Chlorothiazide; Drug Hypersensitivity; Female; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis; Purpura, Thrombocytopenic; Warfarin

Topics: Adult; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Dicumarol; Factor VIII; Heparin; Humans; Infusions, Parenteral; Male; Purpura, Thrombocytopenic; Warfarin

Topics: Blood Coagulation Factors; Coumarins; Hemorrhage; Humans; Phenylbutazone; Prothrombin Time; Purpura, Thrombocytopenic; Vitamin K 1; Warfarin