warfarin and Rupture

Topics: Aortic Valve Stenosis; Coronary Artery Bypass; Coronary Artery Disease; Enoxaparin; Fibrinolytic Agents; Heart Valve Prosthesis Implantation; Hematoma; Humans; International Normalized Ratio; Male; Middle Aged; Postoperative Complications; Rupture; Sigmoid Diseases; Warfarin

This study aims to establish the prevalence of aspirin, dipyridamole, clopidogrel, and warfarin use in patients undergoing cataract surgery, and to compare local anaesthetic and intraoperative complication rates between users and non-users.. The Cataract National Dataset was remotely extracted and anonymised on 55,567 operations at 12 NHS Trusts using electronic patient records (EPRs) between 2001 and 2006.. This report analyses 48,862 of the 55,567 operations from the eight centres, which routinely recorded a drug history. In all, 28.1% of the 48,862 patients were taking aspirin, 5.1% warfarin, 1.9% clopidogrel, and 1.0% dipyridamole. The recording of any complication of a sharp needle or subtenon's cannula local anaesthetic block was increased in patients taking clopidogrel, 8.0% (P<0.0001) or warfarin, 6.2% (P=0.0026) vs non-users, 4.3%, but no increase in potentially sight-threatening complications was identified. The incidence of subconjunctival haemorrhage was increased in patients taking clopidogrel, 4.4% (P<0.0001) or warfarin, 3.7% (P<0.0001) vs non-users, 1.7%. The recording of any operative complication was increased in those taking clopidogrel, 7.3% (P=0.0002) vs non-users, 4.4%, but the haemorrhagic operative complications of choroidal/suprachoroidal haemorrhage and hyphaema were not significantly increased. The non-haemorrhagic complication of posterior capsular rupture (PCR) was increased in those taking clopidogrel, 3.23% (P=0.0057) vs non-users, 1.77%.. Clopidogrel or warfarin use was associated with a significant increase in minor complications of sharp needle and subtenon's cannula local anaesthesia but was not associated with a significant increase in potentially sight-threatening local anaesthetic or operative haemorrhagic complications.

Topics: Aged; Anesthetics, Local; Anticoagulants; Aspirin; Blood Loss, Surgical; Cataract Extraction; Choroid Hemorrhage; Clopidogrel; Dipyridamole; Eye Hemorrhage; Humans; Intraoperative Complications; Lens Capsule, Crystalline; Platelet Aggregation Inhibitors; Risk Factors; Rupture; Ticlopidine; Warfarin

We present a case of upper arm compartment syndrome following a biceps tendon rupture in a 77-year old man on warfarin sodium. Compartment syndrome is common in the forearm and leg, but rare in the upper arm with only a handful of cases reported in the literature. Our patient's anticoagulated state predisposed him to the development of compartment syndrome. To the best of our knowledge there has been only one other case reported in the literature of upper arm compartment syndrome following biceps tendon rupture in a patient on warfarin sodium. Compartment syndrome of the upper arm is a rare occurrence. Previous cases have occurred due to malposition of blood pressure cuffs, injections, venepuncture, trauma, tourniquets, shoulder dislocation, surgical complication, subatmospheric pressure induced, biceps rupture, and triceps rupture. The fascia of the upper arm is relatively thinner and more distensible than the fascia of the leg or forearm. This creates more room for the compartment to swell before pressures builds up to a significant level. Thus, a significantly increased amount of pressure needs to build up before compartment syndrome will occur in the upper arm. Once the diagnosis was formed, the patient was treated with emergent fasciotomy and evacuation of hematoma. After a prolonged hospital stay, the patient was released with minor neurological deficits. At final follow-up, the patient was neurovascularly intact with no complaints of numbness or tingling, and he had regained full motor function throughout.

Topics: Aged; Anticoagulants; Compartment Syndromes; Humans; Male; Rare Diseases; Rupture; Tendon Injuries; Treatment Outcome; Upper Extremity; Warfarin

We report three cases of severe haemorrhagic rupture of luteal ovarian cyst requiring surgical haemostasis in young women treated with long-term oral anticoagulation for antiphospholipid syndrome (APS) who used no contraception. At the time of bleeding, the international normalized ratios were 3.78, 4.24, and 7.11. Anticoagulation was resumed post-operatively, in association with antigonadotropic progestins to induce ovulatory suppression. A systematic use of these progestins should probably be discussed in young women receiving long-term warfarin for APS. Ovarian haemorrhage must be considered when such patients develop acute abdominal pain.

Topics: Administration, Oral; Adolescent; Adult; Anticoagulants; Antiphospholipid Syndrome; Female; Hemorrhage; Humans; Ovarian Cysts; Phenindione; Rupture; Warfarin

Topics: Aged; Anticoagulants; Aortic Valve; Arm; Arm Injuries; Compartment Syndromes; Heart Valve Prosthesis; Hematoma; Humans; Long-Term Care; Male; Nerve Compression Syndromes; Nerve Regeneration; Neurologic Examination; Paralysis; Rupture; Tendon Injuries; Warfarin

Stroke from surgically inaccessible intracranial atherostenosis remains a formidable clinical challenge. While antithrombotic or antiplatelet therapy may prevent distal embolism, there is no effective program for plaque stabilization preventing progression of atherosclerotic stenosis. In patients with isolated circulations (single vertebral with absent posterior communicating arteries, single carotid with contralateral internal carotid artery occlusion, or single carotid with an absent anterior communicating artery), occlusion of the stenotic vessel may produce a low flow-mediated stroke. Fifteen patients with atherosclerotic intracranial stenoses were treated by balloon angioplasty after medical therapy with warfarin failed. Treated territories included the distal internal carotid, proximal middle cerebral, distal vertebral, and basilar arteries. Dilation was successful in all vessels, with residual stenoses averaging less than 30%. Two complications included one paramedian pontine stroke and a single vessel rupture that proved fatal. There was no recurrence of transient ischemic attacks and no restenosis at the angioplasty site over a follow-up period of more than 24 months. In this small series, balloon angioplasty of intracranial vessels provided a therapeutic option for secondary stroke prevention in highly selected patients. Further studies will be necessary to establish the efficacy and safety of endovascular treatment in larger series.

Topics: Adult; Aged; Angioplasty, Balloon; Anticoagulants; Arteriosclerosis; Basilar Artery; Brain Ischemia; Carotid Artery, Internal; Carotid Stenosis; Cerebral Arteries; Cerebrovascular Disorders; Disease Progression; Embolism; Female; Fibrinolytic Agents; Follow-Up Studies; Humans; Ischemic Attack, Transient; Male; Middle Aged; Platelet Aggregation Inhibitors; Recurrence; Regional Blood Flow; Rupture; Vertebral Artery; Warfarin

Topics: Aged; Angina Pectoris; Chemical and Drug Induced Liver Injury; Erythrityl Tetranitrate; Female; Humans; Liver Diseases; Nitroglycerin; Prothrombin Time; Rupture; Warfarin

Topics: Abdomen, Acute; Aorta, Abdominal; Aortic Aneurysm; Humans; Male; Middle Aged; Pain; Phlebography; Pulse; Rupture; Vena Cava, Inferior; Warfarin

Topics: Adolescent; Adult; Anticoagulants; Cardiac Surgical Procedures; Female; Heart Septal Defects, Atrial; Hemoperitoneum; Hemorrhage; Heparin; Humans; Ovarian Cysts; Ovary; Renal Dialysis; Rupture; Warfarin

Topics: Adult; Angiography; Arterial Occlusive Diseases; Carotid Artery Diseases; Carotid Artery Injuries; Carotid Artery, Internal; Electroencephalography; Hematoma; Humans; Male; Mental Disorders; Physical Therapy Modalities; Rupture; Ultrasonography; Vasa Vasorum; Warfarin

Topics: Adult; Anticoagulants; Autopsy; Cardiac Catheterization; Digoxin; Female; Hematoma; Hemorrhage; Humans; Lung Diseases; Pulmonary Artery; Quinidine; Rupture; Warfarin

Topics: Animals; Aortic Valve; Azathioprine; Cattle; Cineangiography; Dogs; Humans; Manometry; Prognosis; Rupture; Sheep; Swine; Transplantation, Heterologous; Transplantation, Homologous; Warfarin

Topics: Cerebral Angiography; Cerebral Hemorrhage; Humans; Intracranial Aneurysm; Male; Middle Aged; Rupture; Vitamin K 1; Warfarin