warfarin and Shock

Spontaneous retroperitoneal hematoma after warfarin therapy is an extremely rare event. Here, we report a 25-year-old man who was brought in to the emergency service with confusion. On arrival, the patient had hypotension, tachycardia, tachypnea, low-grade fever, and Glasgow Coma Scale score of 12. Abdominal examination revealed distention and mild tenderness in the right upper quadrant of the abdomen. The patient had a history of aortic valve replacement surgery and was on warfarin treatment at an international normalized ratio of 2.4. Our patient progressed to cardiorespiratory arrest. The resuscitation was initiated promptly. Despite all resuscitation measures, including transfusion and administration of high doses of catecholamine, the patient died of hypovolemic shock 3 hours after admission. At autopsy, the external surface of the abdominal great vessels (descending aorta and mesenteric vessels) showed scattered petechial hemorrhages without any visible site of perforation. After comprehensive exploration of the abdomen, no evidence of traumatic event was identified and the cause of internal blood loss was noted as warfarin adverse effect.

Topics: Adult; Anticoagulants; Aorta, Thoracic; Fatal Outcome; Heart Valve Prosthesis; Hematoma; Humans; Male; Mesenteric Arteries; Mesenteric Veins; Purpura; Retroperitoneal Space; Shock; Warfarin

Topics: Age Factors; Anticoagulants; Arrhythmias, Cardiac; Coumarins; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Phenindione; Prothrombin Time; Shock; Time Factors; Warfarin

A triad of circulatory collapse, right ventricular dilatation, and large alveolar dead space is proposed for the rapid diagnosis and treatment of massive pulmonary embolism. A 17year-old female on oral contraceptives collapsed at home becoming incoherent with shallow breathing. Paramedics initiated mechanical chest compression and transported the patient to our emergency department, arriving minimally responsive with undetectable blood pressure but having positive corneal reflexes and bradycardia with wide QRS. The trachea was intubated and goal-directed echocardiography revealed marked right ventricular dilatation with septal flattening. The arterial PCO

Topics: Adolescent; Computed Tomography Angiography; Dilatation; Echocardiography; Electrocardiography; Female; Fibrinolytic Agents; Hemodynamics; Humans; Pulmonary Embolism; Respiratory Dead Space; Shock; Tissue Plasminogen Activator; Ventricular Dysfunction, Right; Warfarin

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Anticoagulants; Blood Coagulation Disorders; Cardiomyopathy, Dilated; Drug Interactions; Hematuria; Humans; International Normalized Ratio; Levofloxacin; Male; Ofloxacin; Shock; Urinary Tract Infections; Warfarin

Topics: Anticoagulants; Factor VIIa; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Mitral Valve; Recombinant Proteins; Review Literature as Topic; Safety; Shock; Warfarin

Topics: Aged; Bilirubin; Female; Hemoglobinometry; Humans; Iron; Liver; Male; Middle Aged; Myocardial Infarction; Prognosis; Shock; Time Factors; Warfarin

Topics: Anticoagulants; Arrhythmias, Cardiac; Blood Cell Count; Cerebrovascular Disorders; Coronary Disease; Diabetes Mellitus; Dicumarol; Heart Failure; Heparin; Humans; Hypertension; Kidney Diseases; Liver Diseases; Myocardial Infarction; Peptic Ulcer; Pulmonary Embolism; Shock; Thromboembolism; Thrombophlebitis; Thrombosis; Varicose Veins; Warfarin

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