warfarin and Shock--Cardiogenic

The epidemiology, diagnosis, treatment, and prophylaxis of PE are rapidly advancing. Our array of diagnostic imaging tools has expanded to include echocardiography and spiral chest CT with contrast. We have also gained a keen appreciation for the importance of risk stratification of our patients. The decision to administer thrombolysis or undertake embolectomy may now depend upon the presence of right ventricular dysfunction even if systemic arterial pressure is normal. Finally, the availability of low molecular weight heparins broadens our options for pharmacologic management.

Topics: Anticoagulants; Heparin; Humans; Pulmonary Embolism; Shock, Cardiogenic; Thrombolytic Therapy; Ventricular Dysfunction, Right; Warfarin

PE (pulmonary embolism) is a life-threatening complication rarely seen in the AIHA (autoimmune haemolytic anaemia) patients. Herein we reported a rare and serious AIHA-PE patient characterised by extensive peripheral pulmonary embolism on CTPA.. A 59-year-old woman presented to our ED (emergency department) complaining of acute chest pain and dyspnea. During her presentation in ED she experienced a sudden syncope and soon developed CA (cardiac arrest). Laboratory studies showed a increase of CK-MB,troponin T,myoglobin and D-dimer. Computed tomography pulmonary angiography (CTPA) showed no large central or segment pulmonary emboli but increased RV (right ventricle)size,enlarged main pulmonary artery and invisible peripheral pulmonary artery. She was diagnosed with acute PE and alteplase was delivered intravenously. After thrombolytic therapy she remained hypotension and developed worsening anaemia. Detailed examination for anaemia revealed AIHA. She was discharged in a stable condition after 5 weeks with methylprednisolone and warfarin. Hb, D-dimer and transthoracic echocardiography showed complete recovery at 3-months follow up.. PE attributed to AIHA is characterized by subsegment and distal pulmonary artery embolism which is easily neglected but always life-threatening. This case also highlights the PE as a secondary diagnosis should be evaluated comprehensively in order to identify the underlying pathogenesis.

Topics: Acute Disease; Anemia, Hemolytic, Autoimmune; Anticoagulants; Female; Fibrinolytic Agents; Glucocorticoids; Humans; Methylprednisolone; Middle Aged; Pulmonary Embolism; Shock, Cardiogenic; Syncope; Thrombolytic Therapy; Tissue Plasminogen Activator; Treatment Outcome; 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: Adult; Anticoagulants; Antiphospholipid Syndrome; Cardiotonic Agents; Cyclophosphamide; Dobutamine; Extracorporeal Membrane Oxygenation; Female; Heparin; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Methylprednisolone; Mitral Valve Insufficiency; Plasmapheresis; Shock, Cardiogenic; Warfarin

Dabigatran has been approved for prevention of thromboembolic complications in nonvalvular atrial fibrillation. We present a case of thrombosis of a mechanical prosthetic mitral valve during anticoagulation with dabigatran, switched from warfarin. The patient presented with cardiogenic shock, was treated with thrombolytic therapy and discharged with warfarin therapy. Dabigatran in patients with mechanical valve prosthesis should be avoided and echocardiography is indicated if dyspnoea develops in such patients.

Topics: Aged; Anticoagulants; Antithrombins; Dabigatran; Echocardiography, Transesophageal; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Shock, Cardiogenic; Thrombosis; 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

The use and scope of thrombolytic therapy in the management of pulmonary embolism (PE) continues to evolve. The results of small studies suggest that thrombolytic therapy might have an impact on survival in massive PE with cardiogenic shock; however, no large studies to further this notion exist. Furthermore, the expanded application of thrombolytic therapy to patients with PE and right ventricular dysfunction (RVD) but without overt hemodynamic collapse remains controversial. We report successful use of the thrombolytic agent tissue plasminogen activator (tPA) in the management of life-threatening PE with RVD without overt cardiovascular collapse. We present evidence for the meritorious use of thrombolytic therapy in this category of PE patients. We believe that a broadened application of thrombolytic therapy to patients with PE and RVD but without cardiogenic shock, especially in younger patients, is beneficial and worth the risk.

Topics: Adult; Age Factors; Anticoagulants; Fibrinolytic Agents; Humans; Male; Plasminogen Activators; Pulmonary Embolism; Risk Assessment; Shock, Cardiogenic; Survival Rate; Thrombolytic Therapy; Tissue Plasminogen Activator; Ventilation-Perfusion Ratio; Ventricular Dysfunction, Right; Warfarin

Topics: Acute Disease; Aged; Arrhythmias, Cardiac; Bradycardia; Cardiac Complexes, Premature; Coronary Care Units; Electrocardiography; Female; Humans; Male; Middle Aged; Morphine; Myocardial Infarction; Oxygen Inhalation Therapy; Retrospective Studies; Shock, Cardiogenic; Tachycardia; Time Factors; Warfarin

Topics: Heparin; Humans; Myocardial Infarction; Pericardial Effusion; Pericarditis; Shock, Cardiogenic; Warfarin

Topics: Angina Pectoris; Coronary Disease; Digoxin; Electrocardiography; Hydrochlorothiazide; Hypercholesterolemia; Hypertension; Metaraminol; Nitroglycerin; Shock; Shock, Cardiogenic; Vasopressins; Warfarin