warfarin and Syndrome

After acute coronary syndromes, the beneficial effect of aspirin plus clopidogrel (A+C) or aspirin plus dose-adjusted warfarin (A+W) compared with aspirin alone is well established. However, these regimens were never compared. To compare the risk-benefit profile of A+C versus A+W after acute coronary syndromes, major medical databases for randomized controlled trials comparing 1 of these combined approaches versus aspirin alone after an acute coronary syndrome (updated June 2006) were searched. Evaluated end points were major adverse events [MAEs: all-cause death, acute myocardial infarction [AMI], thromboembolic stroke, major bleeds, and overall risk of stroke [hemorrhagic or ischemic]). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for (1) A+W versus aspirin alone, (2) A+C versus aspirin alone, and (3) A+W versus A+C using adjusted indirect meta-analysis. Thirteen studies were included, totaling 69,741 patients. Ten compared A+W versus aspirin alone and 3 compared A+C versus aspirin alone. Each combined approach yielded a significantly lower risk of MAEs, albeit an increased risk of major bleeds, compared with aspirin alone. No significant difference was found for A+W versus A+C for risk of overall MAEs, death, or AMI. However, A+W versus A+C was associated with a significantly lower risk of thromboembolic stroke (OR 0.53, 95% CI 0.31 to 0.88, number needed to treat 60) and all types of stroke (OR 0.58, 95% CI 0.35 to 0.94, p=0.038), but also with increased risk of major bleeds (OR 1.9, 95% CI 1.2 to 2.8, number needed to harm 300). In conclusion, after an acute coronary syndrome, A+W and A+C are comparable in the prevention of MAEs, death, and AMI compared with aspirin alone. Allocating 100 patients to A+W (at international normalized ratio 2 to 3) with respect to A+C could prevent 17 thromboembolic strokes while causing 3 major bleeds.

Topics: Anticoagulants; Aspirin; Clopidogrel; Coronary Disease; Drug Therapy, Combination; Humans; International Normalized Ratio; Platelet Aggregation Inhibitors; Randomized Controlled Trials as Topic; Risk Assessment; Syndrome; Ticlopidine; Warfarin

After the acute coronary syndrome, adding warfarin to standard aspirin therapy decreases myocardial infarction and stroke but increases major bleeding.. To quantify the risks and benefits of warfarin therapy after the acute coronary syndrome.. MEDLINE from 1990 to October 2004. Additional data were obtained from study authors. Clinical risk factors were used to classify hypothetical patients into cardiovascular and bleeding risk groups on the basis of published data.. Randomized trials comparing intensive warfarin therapy (international normalized ratio > 2.0) plus aspirin with aspirin alone after the acute coronary syndrome.. Two reviewers independently selected studies and extracted data on study design; quality; and clinical outcomes, including myocardial infarction, stroke, revascularization, death, and major and minor bleeding. Rate ratios for outcomes were calculated and pooled by using the method of DerSimonian and Laird.. Ten trials involving a total of 5938 patients (11,334 patient-years) met the study criteria. Compared with aspirin alone, warfarin plus aspirin was associated with a decrease in the annual rate of myocardial infarction (0.022 vs. 0.041; rate ratio, 0.56 [95% CI, 0.46 to 0.69]), ischemic stroke (0.004 vs. 0.008; rate ratio, 0.46 [CI, 0.27 to 0.77]), and revascularization (0.115 vs. 0.135; rate ratio, 0.80 [CI, 0.67 to 0.95]). Warfarin was associated with an increase in major bleeding (0.015 vs. 0.006; rate ratio, 2.5 [CI, 1.7 to 3.7]). Mortality did not differ.. Two large studies provided most of the data. Studies did not include coronary stenting, and results should not be applied to patients with stents. Relative risk reductions may not be consistent across risk groups.. For patients with the acute coronary syndrome who are at low or intermediate risk for bleeding, the cardiovascular benefits of warfarin outweigh the bleeding risks.

Topics: Acute Disease; Anticoagulants; Aspirin; Coronary Disease; Female; Fibrinolytic Agents; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Risk Assessment; Secondary Prevention; Syndrome; Warfarin

Topics: Acute Disease; Anticoagulants; Aspirin; Contraindications; Coronary Disease; Fibrinolytic Agents; Humans; Platelet Aggregation Inhibitors; Prognosis; Risk Factors; Syndrome; Warfarin

Thrombosis is the most common cause of mortality in the United States, resulting in more than 2 million deaths per year. Almost an equal number of individuals are affected each year by nonfatal thrombosis, including deep vein thrombosis and nonfatal pulmonary embolism. A large proportion of thrombotic episodes can be prevented by the appropriate selection of prophylactic therapy--a clinical decision that figures greatly in numerous clinical conditions associated with an increased risk of thrombosis, including major orthopedic surgery. Orthopedic surgeons are well aware of the risks for complications inherent in total hip arthroplasty and total knee arthroplasty in particular. However, determining which protocols are optimal for thromboprophylaxis remains a matter of contention, and the choice of prophylactic therapy is a critical factor in the successful completion of any major orthopedic surgical procedure. Although there are key differences between total hip and knee arthroplasty in terms of the measures available for thromboprophylaxis and the data documenting their relative degree of effectiveness, the two procedures share many similarities in these respects as well as in their surgical protocols. By reviewing the data and practice guidelines on thromboprophylaxis in total hip and knee arthroplasty together, orthopedic surgeons can more clearly see the implications for clinical success that the choice of prophylactic therapy has on their management of these two vitally important procedures.

Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Heparin, Low-Molecular-Weight; Humans; Incidence; Postoperative Complications; Prevalence; Risk Factors; Syndrome; Venous Thrombosis; Warfarin

Anticoagulants are important in the treatment of acute coronary syndromes (ACS). When given in combination with aspirin, unfractionated heparin (UHF) improves the clinical outcome in patients who have ACS without ST-segment elevation. UHF also has potential benefits when administered in conjunction with fibrinolytic agents, especially those that are fibrin-specific. The anticoagulant effect of standard heparin is unpredictable, and excessive bleeding complications have been observed in nearly all trials.. New anticoagulants, including direct antithrombins, low-molecular-weight heparins, and more recently, agents with a pure anti-Factor Xa effect, have been tested in patients with ACS and found to have varying degrees of clinical relevance.. One new synthetic pentasaccharide, Org31540/SR90107A, an antithrombin III-binding selective inhibitor of Factor Xa, has been studied in more than 300 patients with acute myocardial infarction with ST-segment elevation (PENTALYSE trial). In an ongoing trial (PENTUA), Org31540/SR90107A is being compared with enoxaparin in patients with ACS, with and without ST-segment elevation.. Org31540/SR90107A has shown promising results in ACS with ST-segment elevation. Efficacy in ACS without ST-segment elevation is currently under evaluation.

Topics: Anticoagulants; Antithrombin III; Aspirin; Clinical Trials as Topic; Factor Xa Inhibitors; Heparin, Low-Molecular-Weight; Humans; Myocardial Infarction; Oligosaccharides; Syndrome; Warfarin

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Calcinosis; Diagnosis, Differential; Epiphyses; Female; Fetal Diseases; Humans; Infant, Newborn; Nose; Pregnancy; Prenatal Exposure Delayed Effects; Prognosis; Syndrome; Vitamin K Deficiency; Warfarin

The past decade has seen many important advances in the pathogenesis, clinical and laboratory diagnosis, and management of heparin-induced thrombocytopenia (HIT), one of the most common immune-mediated adverse drug reactions. HIT is caused by IgG antibodies that recognize complexes of heparin and platelet factor 4, leading to platelet activation via platelet Fc gamma IIa receptors. Formation of procoagulant, platelet-derived microparticles, and, possibly, activation of endothelium generate thrombin in vivo. Thrombin generation helps to explain the strong association between HIT and thrombosis, including the newly recognized syndrome of warfarin-induced venous limb gangrene. This syndrome occurs when acquired protein C deficiency during warfarin treatment of HIT and deep venous thrombosis leads to the inability to regulate thrombin generation in the microvasculature. The central role of HIT antibodies in causing HIT, as well as refinements in laboratory assays to detect these antibodies, means that HIT should be considered a clinicopathologic syndrome. The diagnosis can be made confidently when one or more typical clinical events (most frequently, thrombocytopenia with or without thrombosis) occur in a patient with detectable HIT antibodies. The central role of thrombin generation in this syndrome provides a rationale for the use of anticoagulants that reduce thrombin generation (danaparoid) or inhibit thrombin (lepirudin).

Topics: Antibodies; Anticoagulants; Antithrombin III; Chondroitin Sulfates; Dermatan Sulfate; Drug Combinations; Fibrinolytic Agents; Gangrene; Heparin; Heparinoids; Heparitin Sulfate; Hirudin Therapy; Hirudins; Humans; Immunoglobulin G; Leg; Platelet Activation; Platelet Factor 4; Protein C Deficiency; Receptors, IgG; Recombinant Proteins; Retrospective Studies; Syndrome; Thrombin; Thrombocytopenia; Venous Thrombosis; Warfarin

A 22-year-old-lady presented with multiple occlusions of the branches of the central retinal artery, accompanied by neuro-encephalic disorders and deafness. This triad is known as SICRET Syndrome (Small Infarction of Cochlear, Retinal and Encephalic Tissue). This rare syndrome, as well referred to as Susac syndrome, affects only the women and the three tissues mentioned above: eye, ear, brain. The course was characterised by a series of partially regressive evolutive steps. A remission had been obtained since two years with immuno-supressor and anti-coagulant therapy. The neuro-encephalic and cochlear disorder regressed in contrast to the severe sequel on the right eye.

Topics: Adult; Anticoagulants; Arterioles; Cerebral Infarction; Cochlea; Deafness; Diagnosis, Differential; Drug Therapy, Combination; Female; Headache; Humans; Immunosuppressive Agents; Infarction; Magnetic Resonance Imaging; Organ of Corti; Prednisolone; Retinal Artery Occlusion; Salicylic Acid; Syndrome; Vertigo; Vision Disorders; Warfarin

May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombosis. A computed tomography (CT) scan performed for abdominal pain revealed thrombosis of the entire left common and external iliac veins. A ventilation-perfusion scan diagnosed a pulmonary embolism. The patient was treated with systemic intravenous heparin and catheter-directed thrombolysis of the iliofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein patency was achieved over 5 days. A persistent stenosis in the left common iliac vein consistent with May-Thurner syndrome was alleviated with percutaneous balloon angioplasty and placement of a Wallstent. Heparin therapy was terminated at the time of stenting because of suspected heparin-induced thrombocytopenia. The patient was started on a continuous infusion of 10% dextran 40, and warfarin therapy was initiated. Heparin-induced antibodies were confirmed by a C-14 serotonin release assay. The endovascular reconstruction remains patent 4 months later. Heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with May-Thurner Syndrome is an uncommon occurrence. This case and a review of the literature are discussed.

Topics: Adult; Angioplasty, Balloon; Constriction, Pathologic; Diagnostic Imaging; Female; Femoral Vein; Heparin; Humans; Iliac Artery; Iliac Vein; Lymphedema; Pulmonary Embolism; Stents; Syndrome; Thrombocytopenia; Thrombolytic Therapy; Thrombosis; Urokinase-Type Plasminogen Activator; Warfarin

Topics: Administration, Oral; Animals; Anticoagulants; Heparin; Humans; Necrosis; Skin; Skin Diseases; Syndrome; Warfarin

The sudden development of cyanotic lesions on the feet may be a result of atheroembolic disease or a number of medical conditions. A careful history and physical examination, basic laboratory tests, and noninvasive vascular assessment usually distinguish between medical and surgical causes and direct the choice of further investigations. Specific therapy is often available for medical conditions causing this syndrome. The management of atheroembolic disease is more controversial. In particular, further research is necessary to determine which patients need surgical intervention and which patients can be managed safely by medical therapy.

Topics: Adrenal Cortex Hormones; Blood Coagulation Disorders; Calcinosis; Cyanosis; Embolism; Humans; Ischemia; Postoperative Complications; Skin Diseases; Syndrome; Toes; Vasculitis; Warfarin

Topics: Abnormalities, Drug-Induced; Craniofacial Dysostosis; Dwarfism; Fingers; Gingival Diseases; Humans; Hydantoins; Mandible; Osteolysis; Syndrome; Toes; Tooth Abnormalities; Vinyl Chloride; Warfarin

Although clopidogrel and aspirin (dual therapy, DT) are used for acute coronary syndrome (ACS), sometimes treatment with warfarin (triple therapy, TT) is required.. To determine the incidence, complications, and outcomes of TT.. We analyzed Israeli surveys of ACS from 2000 to 2004.. In these surveys, 5,706 (96%) were discharged alive from hospital. Post-ACS TT and DT were 76 patients (1.3%) and 2,661 patients (46.7%), respectively. The TT group was older with more prior cardiac disease. During hospitalization, the TT patients received more intravenous anticoagulant and antithrombotic agents, and had more heart failure, arrhythmias, ischemia, and major bleeding (2.6 vs. 0.6%, p=0.03). There were no differences in adjusted 30-day and 6-month mortality between the 2 groups.. TT is feasible among ACS patients who require concomitant warfarin treatment.

Topics: Aspirin; Clopidogrel; Coronary Disease; Drug Therapy, Combination; Female; Hematologic Agents; Humans; Male; Pyridines; Risk Factors; Syndrome; Ticlopidine; Ventricular Function; Warfarin

To analyse the occurrence of atrial fibrillation (AF) and thromboembolism in a randomised comparison of rate adaptive single chamber atrial pacing (AAIR) and dual chamber pacing (DDDR) in patients with sick sinus syndrome and normal atrioventricular (AV) conduction, in which left atrial dilatation and decreased left ventricular fractional shortening had been observed in the DDDR group.. 177 consecutive patients with sick sinus syndrome (mean (SD) age 74 (9) years, 104 women) were randomly assigned to treatment with one of three pacemakers: AAIR (n = 54), DDDR with a short rate adaptive AV delay (n = 60) (DDDR-s); or DDDR with a fixed long AV delay (n = 63) (DDDR-l). Analysis was intention to treat.. Mean follow up was 2.9 (1.1) years. AF at one or more ambulatory visits was significantly less common in the AAIR group (4 (7.4%) v 14 (23.3%) in the DDDR-s group v 11 (17.5%) in the DDDR-l group; p = 0.03, log rank test). The risk of developing AF in the AAIR group compared with the DDDR-s group was significantly decreased after adjustment for brady-tachy syndrome in a Cox regression analysis (relative risk 0.27, 95% confidence interval (CI) 0.09 to 0.83, p = 0.02). The benefit of AAIR was highest among patients with brady-tachy syndrome. Brady-tachy syndrome and a thromboembolic event before pacemaker implantation were independent predictors of thromboembolism during follow up (relative risk 7.5, 95% CI 1.6 to 36.2, p = 0.01, and relative risk 4.7, 95% CI 1.2 to 17.9, p = 0.02, respectively).. During a mean follow up of 2.9 years AAIR was associated with significantly less AF. The beneficial effect of AAIR was still significant after adjustment for brady-tachy syndrome. Brady-tachy syndrome was associated with an increased risk of thromboembolism.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Bradycardia; Cardiac Pacing, Artificial; Chronic Disease; Confidence Intervals; Female; Humans; Incidence; Male; Middle Aged; Regression Analysis; Risk Factors; Sick Sinus Syndrome; Syndrome; Tachycardia, Supraventricular; Telemetry; Thromboembolism; Warfarin

Venous limb gangrene (VLG) can occur in cancer patients, but the clinical picture and pathogenesis remain uncertain. We identified 10 patients with metastatic cancer (7 pathologically proven) who developed severe venous limb ischemia (phlegmasia/VLG) after initiating treatment of deep-vein thrombosis (DVT); in 8 patients, cancer was not known or suspected at presentation. The patients exhibited a novel, clinically distinct syndrome: warfarin-associated supratherapeutic international normalized ratio (INR; median, 6.5) at onset of limb ischemia, rising platelet count during heparin anticoagulation, and platelet fall after stopping heparin. Despite supratherapeutic INRs, patient plasma contained markedly elevated thrombin-antithrombin (TAT) complex levels (indicating uncontrolled thrombin generation) and protein C (PC) depletion; this profile resembles the greatly elevated TAT/PC activity ratios reported in patients with warfarin-associated VLG complicating heparin-induced thrombocytopenia. Analyses of vitamin K-dependent factors in 6 cancer patients with available serial plasma samples showed that variations in the INR corresponded most closely with changes in factor VII, with a highly collinear relationship between VII and PC. We conclude that venous limb ischemia/gangrene is explained in some cancer patients by profoundly disturbed procoagulant-anticoagulant balance, whereby warfarin fails to block cancer-associated hypercoagulability while nonetheless contributing to severe PC depletion, manifest as a characteristic supratherapeutic INR caused by parallel severe factor VII depletion.

Topics: Aged; Anticoagulants; Antithrombin III; Blood Coagulation Factors; Blood Platelets; Female; Follow-Up Studies; Gangrene; Heparin; Humans; International Normalized Ratio; Ischemia; Leg; Male; Middle Aged; Neoplasms; Peptide Hydrolases; Prognosis; Protein C Deficiency; Syndrome; Venous Thrombosis; Vitamin K; Warfarin

In the setting of acute heparin-induced thrombocytopenia (HIT), argatroban is one of the initial anticoagulants of choice, which is eventually bridged to warfarin over a period of 5 or more days. Argatroban prolongs prothrombin time (PT) and increases international normalized ratio (INR). However, the effects of prolonged argatroban exposure on the PT and INR are not known. We describe an unusual case of prolonged argatroban treatment in a patient with heparin-induced thrombocytopenia with thrombosis syndrome (HITTS) resulting in a minimal elevation of the INR. The patient received a total of 58 days of argatroban and was resistant to warfarin therapy, requiring a 13-day bridge to achieve a therapeutic INR of 2.0 to 3.0. Ultimately, argatroban was successfully transitioned to warfarin therapy when the INR was 2.7 on both agents, producing the confirmatory true INR of 2.4. Argatroban and warfarin cotherapy did not increase the INR beyond 4.0 after prolonged argatroban exposure. Clinicians should consider this unusual response in other cases of prolonged argatroban use, and monitor INR carefully during warfarin and argatroban cotherapy. The use of other methods to monitor anticoagulant therapy, such as chromogenic factor X assay (CFX), may be helpful in this setting.

Topics: Anticoagulants; Antithrombins; Arginine; Carcinoma, Squamous Cell; Drug Substitution; Female; Heparin; Humans; International Normalized Ratio; Mandibular Neoplasms; Middle Aged; Mouth Mucosa; Pipecolic Acids; Prothrombin Time; Sulfonamides; Syndrome; Thrombocytopenia; Thrombosis; Treatment Failure; Warfarin

In this study we report our experience with the diagnosis and surgical treatment of popliteal entrapment syndrome (PAES) over a 10-year period.. Between 2002 and 2011, PAES was diagnosed in 27 limbs of 24 patients (19 males and 5 females), based on clinical symptoms and imaging examinations. The mean age of the patients was 30.4 years (range 8-69 years). All patients underwent surgical decompression of the entrapment mechanism and selective vascular reconstruction. Oral aspirin and warfarin therapy was administered after discharge.. All patients underwent successful surgical treatment. No perioperative complications occurred. Clinical symptoms either disappeared or exhibited obvious improvement in all patients after surgery. No patient presented with recurrent symptoms after discharge. Doppler ultrasound during follow-up revealed the patency of the popliteal artery and saphenous vein grafts.. PAES is an unusual but major cause of peripheral arterial insufficiency, particularly in patients lacking risk factors for atherosclerosis. A combination of imaging examinations is required for an early and accurate diagnosis. Surgical decompression and selective vascular reconstruction is recommended for both anatomic and symptomatic functional entrapment.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anticoagulants; Arterial Occlusive Diseases; Aspirin; Child; Constriction, Pathologic; Decompression, Surgical; Diagnostic Imaging; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Plastic Surgery Procedures; Platelet Aggregation Inhibitors; Popliteal Artery; Predictive Value of Tests; Syndrome; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler; Vascular Patency; Vascular Surgical Procedures; Warfarin; Young Adult

Topics: Acute Kidney Injury; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Embolism, Cholesterol; Enoxaparin; Fatal Outcome; Female; Fibrinolytic Agents; Humans; Infarction, Middle Cerebral Artery; Recombinant Proteins; Syndrome; Thrombolytic Therapy; Tissue Plasminogen Activator; Toes; Warfarin

Topics: Anticoagulants; Humans; Intraoperative Complications; Iris Diseases; Male; Middle Aged; Phacoemulsification; Syndrome; Vitrectomy; Warfarin

Di Sala syndrome or fetal warfarin syndrome/fetal warfarin embryopathy is a rare condition as result of fetal exposure due to maternal ingestion of warfarin during pregnancy. The authors report here a male infant with this condition whose mother was suffering from rheumatic mitral valvular heart disease for which she underwent prosthetic mitral valvular replacement surgery and put on injectable long acting penicillin and oral low-molecular weight anticoagulant drug (warfarin) for life long. The patient presented with facial dysmorphism, pectus excavatum, stippled epiphyses dolichocephaly, brachydactyly, polydactyly short neck and growth retardation. Shortened fourth metacarpal bones were also noted in this case which was not yet reported in literatures, to the best of our knowledge.

Topics: Abnormalities, Drug-Induced; Abnormalities, Multiple; Anticoagulants; Diagnosis, Differential; Female; Humans; Infant; Male; Pregnancy; Prenatal Exposure Delayed Effects; Syndrome; Warfarin

Herein we report the clinical presentation and radiographic findings of a patient with a known history of multiple nonossifying fibromas, also known as the Jaffe-Campanacci syndrome, who presented with persistent pleuritic chest pain after a fall and was found to have a small pulmonary embolus. The presentation, pathophysiology and management of the syndrome are briefly discussed.

Topics: Angiography; Bone Neoplasms; Cafe-au-Lait Spots; Chest Pain; Female; Fibroma; Heparin; Humans; Pleurisy; Pulmonary Embolism; Syndrome; Treatment Outcome; Warfarin; Young Adult

Shrinking lung syndrome is characterized by pulmonary compromise secondary to unilateral or bilateral paralysis of the diaphragm.. Shrinking lung syndrome was diagnosed in a patient with antiphospholipid syndrome after a cesarean delivery at 28 4/7 weeks of gestation. Signs and symptoms included unexplained right-side chest pain, dyspnea, tachypnea, and absent breath sounds at the right base of the lungs. After initiation of corticosteroids, her symptoms resolved.. Although seen in association with systemic lupus erythematosus, shrinking lung syndrome has not been described with antiphospholipid syndrome or during pregnancy. Diagnosis and awareness are important because treatment with moderate- to high-dose corticosteroids appears to improve the clinical outcome.

Topics: Adult; Antiphospholipid Syndrome; Aspirin; Cesarean Section; Chest Pain; Dyspnea; Female; Heparin; Humans; Hyperventilation; Lung Diseases; Oxygen; Prednisolone; Pregnancy; Pregnancy Complications; Radiography; Respiratory Paralysis; Respiratory Sounds; Syndrome; Treatment Outcome; Warfarin

We report a case of Hughes-Stovin syndrome (HSS) associated with hyperhomocysteinemia. A 24-year-old man who has no clinical features suggestive of Behcet's disease was admitted for hemoptysis and dyspnea. Radiological and laboratory evaluation revealed multifocal pulmonary artery aneurysms involving bilateral segmental pulmonary artery, thrombi in right atrium and ventricle, and hyperhomocysteinemia. Accordingly, HSS associated with hyperhomocysteinemia was diagnosed, and the clinical and radiological improvement was achieved after treatment with prednisolone, warfarin, and folic acid.

Topics: Anti-Inflammatory Agents; Anticoagulants; Dyspnea; Folic Acid; Hematinics; Hemoptysis; Humans; Hyperhomocysteinemia; Male; Prednisolone; Syndrome; Treatment Outcome; Warfarin; Young Adult

Topics: Aged; Anticoagulants; Cholesterol; Embolism; Humans; Male; Syndrome; Toes; Warfarin

Iliac vein compression syndrome (CS) is a rare cause of deep venous thrombosis. It is caused by an anatomic anomaly in which the right common iliac artery overlies the left common iliac vein causing mechanical compression. Subsequent endothelial changes within the vessels have the potential to spur thrombus formation. Aggressive diagnostic and therapeutic interventions must be implemented upon suspicion to avoid long-term complications. We report on a 19 year old male who presented with ICS. We discuss the clinical presentation, diagnosis, and current treatment options.

Topics: Anticoagulants; Clopidogrel; Constriction, Pathologic; Heparin; Humans; Iliac Vein; Lower Extremity; Male; Platelet Aggregation Inhibitors; Syndrome; Thrombectomy; Thrombolytic Therapy; Ticlopidine; Venous Thrombosis; Warfarin; Young Adult

Topics: Aged; Anticoagulants; Atherosclerosis; Cystitis; Diagnosis, Differential; Embolism, Cholesterol; Female; Foreign-Body Reaction; Gastrointestinal Hemorrhage; Granuloma; Hematuria; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Ischemic Attack, Transient; Risk Factors; Syndrome; Tuberculosis, Urogenital; Urinary Bladder Neoplasms; Warfarin

May-Thurner syndrome is characterized by left common iliac obstruction secondary to compression of the left iliac vein by the right common iliac artery against the fifth-lumbar vertebra. This anatomic variant results in an increased incidence of left-sided deep venous thrombosis (DVT). Furthermore, while a preponderance of left-sided DVT has been demonstrated in women during pregnancy and oral contraceptive use, patients are not typically screened for this condition after developing a left-sided DVT. As anticoagulation alone is ineffective for DVT treatment in the setting of May-Thurner anatomy, more aggressive treatment is warranted. Failure to diagnosis this condition predisposes these women to the unnecessary risks of recurrent DVT and post-thrombotic syndrome.. We present the occurrence of 7 adolescent patients with previously undiagnosed May-Thurner syndrome who presented with DVT after the initiation of oral contraceptive steroids (OCP) use. All 7 patients elected to proceed with mechanical thrombolysis/catheter based thrombolysis followed by endovascular stenting and were postoperatively treated with 6 months of warfarin.. Mean patient age was 18.3 +/- 3.3 years (range, 16-24 years). Mean time to presentation after initiation of OCP was 5 weeks (range, 2-10 weeks). Mean time to intervention was 16.8 days (range, 10-24 days). All patients were treated with mechanical thrombectomy. Our rate of intraoperative clot resolution was 100%. All 7 patients were treated with self expanding nitinol stents after angioplasty of the iliac vein stenosis with resolution of the stenotic segment. Primary stent patency is 100% (7/7). Mean follow-up time is 13 +/- 13.84 months (range, 6-42 months). There have been no long-term complications related to surgical treatment or anticoagulation. All 7 patients have experienced resolution of left leg swelling and pain and have no evidence of post-thrombotic syndrome or DVT recurrence to date.. Women on OCPs presenting with left-sided iliofemoral DVT should be screened for hypercoagulable disorders and underlying May-Thurner anatomy. Treatment of May-Thurner syndrome should include thrombolysis/thrombectomy and anticoagulation for current DVT in addition to angioplasty and stenting of the underlying obstruction.

Topics: Adolescent; Angioplasty; Anticoagulants; Combined Modality Therapy; Constriction, Pathologic; Contraceptives, Oral, Hormonal; Female; Femoral Vein; Humans; Iliac Artery; Iliac Vein; Peripheral Vascular Diseases; Phlebography; Retrospective Studies; Stents; Syndrome; Thrombectomy; Thrombolytic Therapy; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Color; Venous Thrombosis; Warfarin; Young Adult

Topics: Aged; Anticoagulants; Cardiovascular Diseases; Female; Foot Diseases; Humans; Pigmentation Disorders; Syndrome; Toes; Warfarin

A 34-year old woman with dizziness, headache and both upper and lower extremities weakness was admitted to hospital. She had a history of photosensitivity but no asthma or allergy. On physical examination, malar rash and livedo reticularis were noted. White blood cell count was 18500/microL with 7585 eosinophils (41%). She also had positive antinuclear antibody (ANA), anti-double stranded DNA antibody (anti-ds-DNA antibody) and anticardiolipin antibody (aCL antibody). Echocardiography revealed left and right ventricular obliteration with fibromatous biventricular endothelial thickening. Brain MRI showed changes in favour of white matter ischaemia and lacunar infarction. Hypereosinophilic syndrome (HES) and systemic lupus erythematosus may be considered to have occurred concurrently in this patient.

Topics: Adrenal Cortex Hormones; Adult; Anticoagulants; Antirheumatic Agents; Azathioprine; Diagnosis, Differential; Drug Therapy, Combination; Echocardiography; Eosinophilia; Female; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Methylprednisolone; Syndrome; Warfarin

Air travel is implicated as a predisposing factor for thromboembolism, which at times can have catastrophic consequences. We present three cases who developed deep vein thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE) after transatlantic air travel.

Topics: Adult; Aircraft; Anticoagulants; Enoxaparin; Humans; Male; Middle Aged; Pulmonary Embolism; Risk Factors; Syndrome; Thromboembolism; Travel; Venous Thrombosis; Warfarin

Topics: Aged, 80 and over; Angiodysplasia; Anticoagulants; Aortic Valve Stenosis; Atrial Fibrillation; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis Implantation; Humans; Syndrome; Warfarin

Topics: Adenosine Diphosphate; Adult; Anticoagulants; Blood Platelet Disorders; Diagnosis, Differential; Dizziness; Epinephrine; Female; Humans; Platelet Aggregation; Syndrome; Thromboembolism; Vertigo; Vomiting; Warfarin

A case of inferior vena cava syndrome following percutaneous vertebroplasty is described herein.. To alert clinicians to the potential occurrence of inferior vena cava syndrome following percutaneous vertebroplasty.. Vertebroplasty is a less invasive treatment solution for the osteoporotic compression fracture. There complications of the cement leakage would appear to have been rather infrequent. We report a case of inferior vena cava syndrome related to the cement leakage.. A 59-year-old woman underwent percutaneous vertebroplasty for painful T11, L1, L2, and L3 compression fractures, under general anesthesia at a community hospital. A contralateral transpedicular approach was made in order to inject polymethylmethacrylate resin into the fractured vertebra.. Just subsequent to surgery, this patient developed dyspnea, arthralgia, myalgia, and progressive right lower-limb pain, redness, and swelling., conservative treatment being then undertaken, albeit in vain. One week after the attempted remediation of this patient's condition, she was transferred to our hospital for further management. After admission, radiography of the patient's lumbar spine (lateral view) revealed multiple cement leakage in the area of the posterior longitudinal ligament and also in the anterior paravertebral area. The abdominal and pelvic CT scan and venography revealed vertebroplasty cement leakage into the lumbar vein, the left renal vein, and the inferior vena cava. Thrombosis at the left common iliac vein and left femoral vein were noted with extension into the inferior part of the inferior vena cava. Intravenous heparin was then administered to our patient for the ensuing 20 days, at which time heparin was replaced by warfarin, in order to attempt to prevent progressive venous thrombosis. The patient's leg edema appeared to improve 10 weeks subsequent to her surgery, she then being able to perambulate using a rigid walker.. This case illustrates the need for clinicians to be critically aware of the potential occurrence of inferior vena cava syndrome among patients who have undergone percutaneous vertebroplasty, especially when multiple levels of vertebra are injected as part of the vertebroplasty procedure.

Topics: Anticoagulants; Bone Cements; Female; Fractures, Compression; Heparin; Humans; Lumbar Vertebrae; Middle Aged; Phlebography; Polymethyl Methacrylate; Spinal Fractures; Syndrome; Thoracic Vertebrae; Tomography, X-Ray Computed; Treatment Outcome; Vena Cava, Inferior; Venous Thrombosis; Vertebroplasty; Warfarin

Paget-Schroetter syndrome, or 'effort' thrombosis of the axillary-subclavian vein, is an uncommon deep vein thrombosis usually caused by excessive upper limb activity. It may cause post-thrombotic syndrome, leading to significant disability if not treated appropriately. The optimal management for this syndrome is still controversial because the outcomes of different treatment strategies are based on case studies and series in small numbers. We report a case of Paget-Schroetter syndrome in a young male weight-lifter and discuss treatment strategies suggested by the current literature.

Topics: Adolescent; Anticoagulants; Heparin; Humans; Male; Subclavian Vein; Syndrome; Treatment Outcome; Ultrasonography; Urokinase-Type Plasminogen Activator; Venous Thrombosis; Warfarin; Weight Lifting

Orbital infarction syndrome is defined as ischemia of global intraorbital structures such as extraocular muscles, optic nerves, and retina. The most common cause of this syndrome is carotid arterial occlusion. Other causes include vasculitis, vasospasm, and compression of intraorbital circulation. There has never been reported a case of orbital infarction syndrome in nephrotic syndrome patient. We present a case of 42-year-old Thai man with underlying disease nephrotic syndrome presented with abrupt onset of headache at left temporal area, horizontal diplopia, limitation of eye movement in all directions, ptosis, and blurred vision on the left eye. He was treated with pulse methylprednisolone intravenously for 3 days. Leg edema was improved however, the eye symptoms persisted. There was no evidence of hypercoagulable state. Magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) revealed loss of signal intensity at left internal carotid artery from base of skull to intracavernous part. Cerebral angiography demonstrated complete occlusion of left common carotid artery. After the anticoagulant treatment, his symptoms were gradually improved. The cause of extensive carotid arterial occlusion in this patient is most likely from hypercoagulable state. Although it was negative for hypercoagulable state evidence, the authors assume that the high dose steroid treatment could lead to remission of nephrotic syndrome and resulting in the resolution of hypercoagulable state.

Topics: Adult; Anticoagulants; Carotid Artery Diseases; Carotid Stenosis; Cerebral Infarction; Humans; Male; Orbital Diseases; Syndrome; Warfarin

Topics: Adult; Anticoagulants; Carotid Artery, Internal; Carotid Stenosis; Coronary Angiography; Drug Therapy, Combination; Eye; Female; Fluorescein Angiography; Heparin, Low-Molecular-Weight; Humans; Ischemia; Retinal Artery Occlusion; Scleroderma, Diffuse; Syndrome; Ultrasonography, Doppler; Warfarin

Popliteal vascular entrapment syndrome can result in calf claudication, aneurysm formation, distal arterial emboli, or popliteal vessel thrombosis. The most commonly reported causes of this syndrome have been anomalies of the medial head of the gastrocnemius muscle as it relates to the course of the popliteal artery. We report two cases of rare anomalous slips of the lateral head of the gastrocnemius muscle causing popliteal vascular entrapment syndrome.

Topics: Angiography, Digital Subtraction; Anticoagulants; Arterial Occlusive Diseases; Constriction, Pathologic; Female; Fibrinolytic Agents; Humans; Leg; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Popliteal Artery; Popliteal Vein; Rare Diseases; Syndrome; Tissue Plasminogen Activator; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Venous Thrombosis; Warfarin

Susac's syndrome is a rare disease of unknown aetiology affecting the small vessels of the retina, brain, and cochlea. We present the case of a 55-year-old female, the oldest patient yet described with the condition, and highlight the syndrome's clinical features.

Topics: Anti-Inflammatory Agents; Anticoagulants; Cerebral Angiography; Cerebrovascular Disorders; Cochlear Diseases; Cognition Disorders; Female; Hearing Disorders; Humans; Methylprednisolone; Middle Aged; Retinal Diseases; Syndrome; Warfarin

Topics: Acute Disease; Anticoagulants; Aspirin; Coronary Disease; Female; Fibrinolytic Agents; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Risk Assessment; Secondary Prevention; Syndrome; Warfarin

Topics: Angioplasty, Balloon, Coronary; Anticoagulants; Aorta, Thoracic; Arteriosclerosis; Cardiac Catheterization; Embolism, Cholesterol; Humans; Hypertension; Lower Extremity; Male; Middle Aged; Myocardial Infarction; Peripheral Vascular Diseases; Stents; Syndrome; Ultrasonography; Warfarin

To elicit the most sensitive and reliable method of control over administration of indirect anticoagulants.. Sixty patients with acute coronary syndrome were studied. They received varfarin under the control of international normalized ratio (INR) calculated by the tables in cases of prothrombin time (PT) estimation on a stationary turbidynamic hemocoagulometer from venous and capillary blood by thromboplastins. In parallel, PT was estimated from whole capillary blood on individual portable coagulometer "Coagu Check C" by means of standard test-strip (prothrombin test--PT) on the study day 1, 3, 5, 7, 14 and 21. The results were assessed on the study day 21. All the patients were treated in hospital then outpatiently.. The assessment of PT results implied calculation of variation coefficient (VC) and error (m) by each index obtained with thromboplastins. VS and m were the lowest when INR was made from whole capillary blood on coagulometer "Coagu Check C".. An optimal method of control over efficacy of varfarin treatment is calculation of INR from capillary blood on coagulometer "Coagu Check C" as calculation of INR from capillary and venous blood on stationary coagulometer is complicated and reliability depends on thromboplastin used.

Topics: Acute Disease; Adult; Aged; Anticoagulants; Blood Coagulation Tests; Coronary Disease; Female; Humans; International Normalized Ratio; Laboratories, Hospital; Male; Middle Aged; Partial Thromboplastin Time; Point-of-Care Systems; Prothrombin Time; Quality Assurance, Health Care; Quality Control; Reference Standards; Syndrome; Time Factors; Warfarin

Fetuses exposed to Warfarin in the first trimester of pregnancy have an increased risk of embryopathy which consists of nasal hypoplasia and stippled epiphyses, known as fetal warfarin syndrome or warfarin embryopathy. We herein report a first case of an infant with fetal warfarin syndrome in Thailand. The patient was an offspring of a 34-year-old mother with history of SLE and arterial embolism for several years. She had an unplanned pregnancy while taking warfarin. The patient developed difficulty breathing in the first few hours after birth from severe nasal hypoplasia. He also had short limbs, brachydactyly, nail hypoplasia, and calcifications in the epiphyseal regions of humeri, femora and vertebrae radiographically. The patient eventually died from respiratory failure at 6 months of age.

Topics: Abnormalities, Drug-Induced; Fetal Diseases; Humans; Infant, Newborn; Male; Syndrome; Warfarin

Heparin-induced thrombocytopenia and thrombosis (HIT/T) syndrome is usually triggered by an immune response after repeated administration of heparin. The syndrome is strongly associated with limb deep vein thrombosis and is potentially life-threatening if unrecognized. We describe the case of a patient with compartment syndrome of the left forearm complicated by HIT/T that developed after Port-A-Cath implantation through the left subclavian vein. Prompt recognition of HIT/T, immediate withdrawal of heparin, and timely institution of thrombolytic therapy successfully prevented limb loss.

Topics: Aged; Anticoagulants; Carcinoma, Ductal, Breast; Catheterization, Central Venous; Female; Heparin; Humans; Syndrome; Thrombocytopenia; Thrombosis; Time Factors; Treatment Outcome; Warfarin

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Aspirin; Biomarkers; Cardiomyopathies; Chest Pain; Echocardiography; Electrocardiography; Heart Diseases; Heart Ventricles; Heparin; Humans; Male; Platelet Aggregation Inhibitors; Syndrome; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Troponin; Warfarin

Purple toes syndrome is an extremely uncommon, nonhemorrhagic, cutaneous complication associated with warfarin therapy. It is characterized by the sudden appearance of bilateral, painful, purple lesions on the toes and sides of the feet that blanch with pressure. The syndrome usually develops 3-8 weeks after the start of warfarin therapy. A 47-year-old man with a history of purple toes syndrome that resolved after discontinuing warfarin--prescribed for a deep vein thrombosis (DVT) in his right lower leg--experienced an acute, proximal DVT in his other leg. Warfarin again was prescribed; 1 week later, purple toes syndrome developed in that extremity. Warfarin therapy again was discontinued, and intravenous unfractionated heparin was started; the patient's clinical picture indicated a possible pulmonary embolism, and laboratory analysis suggested antiphospholipid syndrome. The patient's toe pain resolved, but the purple discoloration persisted. Follow-up laboratory analysis confirmed antiphospholipid syndrome, and warfarin was restarted with close monitoring. No further complications occurred with long-term therapy. Although a rare complication of therapy, clinicians should monitor for the development of purple toes syndrome in patients taking warfarin.

Topics: Anticoagulants; Antiphospholipid Syndrome; Color; Drug Eruptions; Drug Monitoring; Foot Diseases; Humans; Male; Middle Aged; Syndrome; Toes; Warfarin

A 74-year-old woman with hypertension and bronchial asthma had chest discomfort at rest and 4 days later was admitted to her nearby hospital because of the sudden onset of right hemiparesis. The hemiparesis had almost disappeared within 24 h of onset, but because an electrocardiogram showed sinus tachycardia and diffuse symmetrical T-wave inversion, she was referred for cardiac examination. Coronary angiography did not reveal any significant coronary artery stenosis, but left ventriculography revealed severe hypokinesis of the left ventricular apical region, which contained a 4 x 4-mm solid thrombus moving freely with a wavy motion. Moreover, the activity of both protein C and protein S had decreased. The thrombus disappeared after 2 weeks of anticoagulant treatment with warfarin. Her clinical course suggested that the transient cerebral ischemic attack was caused by embolism of the left ventricular thrombus associated with 'tako-tsubo-like left ventricular dysfunction'.

Topics: Aged; Anticoagulants; Female; Heart Diseases; Heart Ventricles; Humans; Ischemic Attack, Transient; Radiography; Syndrome; Thrombosis; Ventricular Dysfunction, Left; Warfarin

Topics: Aged; Aircraft; Anticoagulants; Aspirin; Diabetes Complications; Female; Graves Disease; Humans; Pulmonary Embolism; Risk Factors; Syndrome; Travel; Venous Thrombosis; Warfarin

Pregnancy associated with primary pulmonary hypertension is an uncommon observation, with maternal mortality > 50%. Experience treating this condition is limited. Past reports have emphasized the need for pregnancy termination. In the last few years there has been considerable interest in long-term intravenous use of epoprostenol (prostacyclin) in patients with primary pulmonary hypertension.. A woman with severe primary pulmonary hypertension who was on long-term epoprostenol therapy became pregnant with twins and was treated with high doses of epoprostenol and nitric oxide during delivery and the postpartum period. She was well six months later on continuous epoprostenol therapy. The one viable infant was alive and still hospitalized at this writing.. Epoprostenol therapy may be continued during pregnancy in patients with severe primary pulmonary hypertension for long-term pulmonary vasodilatation.

Topics: Abnormalities, Drug-Induced; Adult; Anticoagulants; Antihypertensive Agents; Bronchodilator Agents; Epoprostenol; Face; Female; Humans; Hydrocephalus; Hypertension, Pulmonary; Nitric Oxide; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnancy, Multiple; Syndrome; Twins; Warfarin

Topics: Abnormalities, Drug-Induced; Adult; Anticoagulants; Chondrodysplasia Punctata; Female; Femur; Fetal Death; Fetal Growth Retardation; Gestational Age; Humans; Male; Nose; Pregnancy; Syndrome; Ultrasonography, Prenatal; Warfarin

Effort thrombosis of the axillary-subclavian vein (Paget-Schroetter syndrome) develops usually secondary to heavy arm exertion. An underlying chronic venous compressive anomaly at the thoracic outlet or intimal damage of the axillary vein following forceful hyperabduction, external rotation of the shoulder joint has been proposed to explain the pathophysiology of this thrombosis. This condition is usually not attributed to an underlying hypercoagulability such as deficiency of natural coagulation inhibitors. Here, the authors present a case with thrombosis of the axillary-subclavian vein following an effort, with factor V Leiden and prothrombin 20210A mutations. Both factor V Leiden and the genetic variant in the prothrombin gene have been shown to confer an increased risk for venous thrombosis. Although rare, effort thrombosis may develop in a patient with hereditary thrombophilia, so laboratory evaluation should include the common causes of thrombosis.

Topics: Adult; Alleles; Anticoagulants; Axillary Vein; Factor V; Humans; Male; Phlebography; Point Mutation; Polymerase Chain Reaction; Prothrombin; Recurrence; Subclavian Vein; Syndrome; Thrombectomy; Venous Thrombosis; Warfarin

We describe a patient with May-Thurner syndrome who underwent operative transection and transposition of the right common iliac artery without direct venous repair, because preoperative and intraoperative intravascular ultrasound scans were negative for "spurs" in the left common iliac vein. When symptoms and signs persisted, a postoperative magnetic resonance venogram (MRV) showed severe stenosis in the left common iliac vein. Progressive, but incomplete, clinical improvement occurred with conservative management.

Topics: Adolescent; Anticoagulants; Bandages; Constriction, Pathologic; Female; Humans; Iliac Artery; Iliac Vein; Peripheral Vascular Diseases; Syndrome; Treatment Failure; Warfarin

A case is reported here of effort-related thrombosis of the axillary and subclavian veins (Paget-Schrotter syndrome) treated primarily with a combination of thrombolysis, percutaneous balloon angioplasty (PTA) and stent insertion, but without immediate rib resection. The subsequent course was complicated by fracture of the stent, managed by first rib resection.

Topics: Adult; Angioplasty, Balloon; Anticoagulants; Axillary Vein; Equipment Failure; Female; Humans; Phlebography; Plasminogen Activators; Ribs; Stents; Subclavian Vein; Syndrome; Urokinase-Type Plasminogen Activator; Venous Thrombosis; Warfarin

We reported a 61% morbidity rate and a 23% mortality rate for the heparin-induced thrombocytopenia (HIT) syndrome in 1983. We subsequently reported in 1987 that with early recognition, immediate cessation of the administration of heparin, and platelet function inhibition, the morbidity rate could be reduced to 23% and the mortality rate to 12%. One hundred recent cases of patients with heparin-associated antiplatelet antibodies (HAAb) have been reviewed to determine whether aggressive screening, early diagnosis, and alternate management could further reduce morbidity and mortality rates.. The consecutive records of 100 patients with positive platelet aggregation tests were reviewed. Sixty-six patients were male. The patients' ages ranged from 23 days to 92 years. The patients were from vascular (28), cardiothoracic (42), and other (30) services. HIT was suspected in patients who received heparin and had falling platelet counts, platelet counts less than 100,000/mm3, or new thromboembolic or hemorrhagic events.. Heparin was not offered to six patients with known HAAb. Twelve patients were successfully treated with antiplatelet therapy and limited reexposure to heparin, and 75 patients were successfully treated with early diagnosis and prompt cessation of heparin. Alternate forms of anticoagulation therapy were used selectively. Seven patients had 11 complications. Three of the seven patients were treated successfully with warfarin anticoagulation and aspirin (2) or with aspirin alone (1). A fourth patient was treated with thrombectomy, hematoma evacuation, and aspirin. A fifth patient underwent thrombolysis and coronary angioplasty in addition to receiving warfarin and aspirin. The sixth patient required two thrombectomies and warfarin. A seventh patient required two thrombectomies and aspirin. HIT was responsible for one of 17 deaths.. A 7.4% morbidity rate and a 1.1% mortality rate have been achieved in patients with HAAb by aggressive screening, early recognition of HIT, and prompt cessation of the administration of heparin. Platelet function inhibitors and other anticoagulants, including nonreacting low molecular weight heparin, are important adjuncts in the management of the thromboembolic disorders associated with HIT.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Aspirin; Autoimmune Diseases; Blood Platelets; Child; Child, Preschool; Female; Heparin; Humans; Infant; Infant, Newborn; Male; Middle Aged; Morbidity; Platelet Aggregation; Platelet Aggregation Inhibitors; Retrospective Studies; Syndrome; Thrombocytopenia; Warfarin

The occurrence of thromboembolic phenomena during long-duration airplane flights is called "economy-class syndrome". Recently it has become more popular for Japanese to go abroad by airplane, and an increase in the prevalence of pulmonary thromboembolism should be expected. However, there are few reports of the economy-class syndrome in Japan. A 52-year-old woman was admitted to our hospital because of chest discomfort and dyspnea that developed during an airplane flight. We suspected pulmonary thromboembolism, on the basis of a chest X-ray film and on electrocardiogram. A ventilation-perfusion lung scan disclosed mismatching between ventilation and perfusion in the right upper lung field. Pulmonary thromboembolism was confirmed by pulmonary arteriography. The patient was treated with heparin and urokinase. A phlebogram of the legs showed no significant findings. There was no history of thromboembolic disease or of consumption of oral contraceptives. We conclude that the pulmonary thromboembolism might have been caused by stasis of blood in the lower limb veins during the airplane flight. We emphasize the importance of including pulmonary thromboembolism in the differential diagnosis of patients with chest discomfort and dyspnea that develop during airplane flights. No noninvasive test can lead to a definitive diagnosis of pulmonary thromboembolism. Early pulmonary angiography should be recommended when pulmonary thromboembolism is suspected.

Topics: Dehydration; Dyspnea; Female; Heparin; Humans; Middle Aged; Pulmonary Embolism; Syndrome; Thrombolytic Therapy; Travel; Urokinase-Type Plasminogen Activator; Warfarin

In patients who have symptomatic deep venous thrombosis, the long-term risk for recurrent venous thromboembolism and the incidence and severity of post-thrombotic sequelae have not been well documented.. To determine the clinical course of patients during the 8 years after their first episode of symptomatic deep venous thrombosis.. Prospective cohort study.. University outpatient thrombosis clinic.. 355 consecutive patients with a first episode of symptomatic deep venous thrombosis.. Recurrent venous thromboembolism, the post-thrombotic syndrome, and death. Potential risk factors for these outcomes were also evaluated.. The cumulative incidence of recurrent venous thromboembolism was 17.5% after 2 years of follow-up (95% CI, 13.6% to 22.2%), 24.6% after 5 years (CI, 19.6% to 29.7%), and 30.3% after 8 years (CI, 23.6% to 37.0%). The presence of cancer and of impaired coagulation inhibition increased the risk for recurrent venous thromboembolism (hazard ratios, 1.72 [CI, 1.31 to 2.25] and 1.44 [CI, 1.02 to 2.01], respectively). In contrast, surgery and recent trauma or fracture were associated with a decreased risk for recurrent venous thromboembolism (hazard ratios, 0.36 [CI, 0.21 to 0.62] and 0.51 [CI, 0.32 to 0.87], respectively). The cumulative incidence of the post-thrombotic syndrome was 22.8% after 2 years (CI, 18.0% to 27.5%), 28.0% after 5 years (CI, 22.7% to 33.3%), and 29.1% after 8 years (CI, 23.4% to 34.7%). The development of ipsilateral recurrent deep venous thrombosis was strongly associated with the risk for the post-thrombotic syndrome (hazard ratio, 6.4; CI, 3.1 to 13.3). Survival after 8 years was 70.2% (CI, 64.7% to 75.6%). The presence of cancer increased the risk for death (hazard ratio, 8.1; CI, 3.6 to 18.1).. Patients with symptomatic deep venous thrombosis, especially those without transient risk factors for deep venous thrombosis, have a high risk for recurrent venous thromboembolism that persists for many years. The post-thrombotic syndrome occurs in almost one third of these patients and is strongly related to ipsilateral recurrent deep venous thrombosis. These findings challenge the widely adopted use of short-course anticoagulation therapy in patients with symptomatic deep venous thrombosis.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Confidence Intervals; Female; Follow-Up Studies; Heparin; Humans; Male; Middle Aged; Proportional Hazards Models; Prospective Studies; Recurrence; Syndrome; Thrombophlebitis; Warfarin

Extracorporeal membrane oxygenation (ECMO) may serve as extracorporeal lung assist (ECLA) in patients with acute respiratory failure (ARF) or as extracorporeal heart assist (ECHA) in patients with low output syndrome (LOS) after open heart surgery. From 1988 to 1992 seven patients underwent ECMO in our hospital; four suffered from ARF and three from LOS. Various bypass techniques were employed. Two ARF patients, aged 58 and 18 years, had veno-venous bypass; in the latter, ECMO was reinstituted as a veno-arterial bypass one week after weaning. In a three-year-old boy, the ECMO outflow tubing was primarily connected to the pulmonary artery, and shortly afterwards relocated to the common carotid artery. In a 31-year-old man with ARF, and three LOS patients, a 56-year-old woman, and two men aged 68 and 70 years, ECMO was veno-arterial with direct access to the ascending aorta. A heparin-coated system was used, and all but one patient, who was treated with warfarin, received a daily low dose of heparin, which was withdrawn after from one to nine days. Six patients were weaned off ECMO after 4.5 to 21 days. Three ARF patients recovered completely; the child died. In one LOS patient, ECMO was withdrawn due to a poor general condition. Two others were weaned off ECMO and the intra-aortic balloon pump, and the inotropic support was significantly reduced, but both died of multiple system organ failure. Although no firm conclusions can be drawn from these few case reports, the heparin-coated system used as ECLA appears promising, whereas ECHA seems to imply a poor prognosis in patients who are not candidates for cardiac transplantation.

Topics: Acute Disease; Adolescent; Adult; Aged; Anticoagulants; Aorta; Cardiac Output, Low; Cardiac Surgical Procedures; Carotid Artery, Common; Child; Child, Preschool; Extracorporeal Membrane Oxygenation; Female; Heart; Heparin; Humans; Intra-Aortic Balloon Pumping; Lung; Male; Middle Aged; Multiple Organ Failure; Pulmonary Artery; Respiratory Insufficiency; Survival Rate; Syndrome; Warfarin

A 44-year-old Japanese man having aplastic anemia (AA)-paroxyamal nocturnal hemoglobinuria (PNH) syndrome was referred to our hospital because of purpuras due to thrombocytopenia in July 1994. He suffered from pneumonia after admission, complicated with cerebral, splenic, and left renal infarction. Pulmonary infaction was also confirmed by perfusion lung scan. He had a plasma plasminogen (PLG) functional activity of 54.4% with a normal level of PLG antigen. The gel isoelectrofocusing pattern of the plasminogen derived from the patient showed 10 normal bands and 10 additional doublet bands with slightly higher isoelectric points than the normal components. Abnormal PLG is converted by urokinase to an inactive two-chain plasmin molecule. These findings were similar to those of a case with dysplasminogenemia (PLG Tochigi) reported by Aoki et al. He was given warfarin for the prevention of thrombosis in December 1994. As of October 1995, these was no recurrence of thrombosis. The cause of thrombosis in the present case have been the association with PNH, predisposition to PLG Tochigi, or the complication of pneumonia. This is the first report of AA/PNH syndrome associated with dysplasminogenemia.

Topics: Adult; Anemia, Aplastic; Anticoagulants; Hemoglobinuria, Paroxysmal; Humans; Male; Plasminogen; Pneumonia; Syndrome; Thrombosis; Warfarin

A 20 year-old female patient with Kasabach-Merrit syndrome, suffered from chronic consumption coagulopathy due to localized intravascular coagulation in the tumors. She had been diagnosed as Kasabach-Merrit syndrome immediately after birth and below knee amputation of her right lower leg was performed at the age of 2 years because of her giant hemangioma on the right foot and lower leg. After the operation, she had often complained of severe pain and enlargement of the residual tumors due to continuous thrombus formation within the tumors. She was admitted to the third Department of Tohoku University Hospital in order to initiate oral anticoagulant therapy with Warfarin at the age of 12 years. After the administration of 2.5 mg/day Warfarin, she has maintained good clinical condition until now, despite the occasional occurrence of coagulation abnormalities. We believe that the results of this case indicate the efficacy of oral anticoagulant therapy in the treatment of chronic consumption coagulopathies complicated with other diseases.

Topics: Administration, Oral; Adult; Disseminated Intravascular Coagulation; Female; Hemangioma, Cavernous; Humans; Syndrome; Warfarin

A recent case of the "Economy Class Syndrome" is presented, emphasizing the syndrome's aeromedical implications and prevention. The clinical presentation, current modes of prophylaxis and therapy, plus a brief but pertinent historical background, are described. The syndrome is potentially fatal, and the authors stress that the condition needs to be recognized as a preventable hazard of air travel. Adoption of the preventive measures described herein can assist in promoting healthy air travel.

Topics: Aerospace Medicine; Aircraft; Bandages; Heparin; Humans; Male; Middle Aged; Syndrome; Thrombophlebitis; Travel; Warfarin

We report 4 cases of Trousseau's syndrome, in which spontaneous recurrent or migratory venous thromboses, arterial emboli caused by nonbacterial thrombotic endocarditis, or both, develop in a patient with a recognized or occult malignant tumor. The clinical course of 3 of the patients emphasizes a key point: The occurrence for no known reason of thromboses preventable by anticoagulation therapy with heparin but not with warfarin sodium should alert a physician to focus diagnostic efforts on uncovering an underlying malignant lesion. Thromboses may occur months to years before the tumor is discovered, and a thorough negative initial examination does not obviate the need for a continuing search. Patients with Trousseau's syndrome have persistent low-grade intravascular coagulation, and therapy with heparin should be continued indefinitely. Stopping heparin therapy for even a day may permit a new thrombosis to develop. Immunostaining a biopsy specimen from 1 patient provided evidence that 2 properties of a neoplastic lesion are required for the syndrome to develop: The malignant cells express surface membrane tissue factor, and structural features of the tumor permit the malignant cells or vesicles it sheds to be exposed to circulating blood.

Topics: Adult; Embolism; Female; Heparin; Humans; Male; Middle Aged; Neoplasms; Recurrence; Syndrome; Thrombosis; Warfarin

Topics: Aged; Angiodysplasia; Aortic Valve Stenosis; Calcinosis; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Humans; Male; Recurrence; Syndrome; Warfarin

This study describes our experience with 12 patients with white clot syndrome encountered during a recent 36-month period. The diagnosis was based on the following criteria: (1) development of thrombocytopenia of less than 100,000/mm3 during administration of heparin therapy, (2) normalization of the platelet count after an interruption in heparin therapy, (3) exclusion of other causes of thrombocytopenia, (4) a positive heparin-induced platelet aggregation test, (5) detection of white clots on pathologic examination, and (6) the presence of thrombotic complications. Of 2,500 patients who received heparin therapy, 12 (0.48%) developed white clot syndrome. Various indications, routes of administration, and types of heparin were implicated. The mean platelet nadir was 26,900/mm3, and the mean time to onset of heparin-induced thrombocytopenia was 5 days. Thrombotic complications included arterial occlusions of the legs in 11 patients, deep vein thrombosis of the legs in 9 patients (4 had pulmonary embolism), and combined arterial and venous thrombosis in 8 patients. Treatment strategies included discontinuation of heparin in all patients and intravenous infusion of dextran, followed by arterial thrombectomy in four patients, urokinase therapy in two patients for arterial complications, and insertion of Greenfield filters in six patients. All patients were given warfarin. The mortality rate was 25% and the morbidity rate was 50%. An initial platelet count should be obtained on all patients prior to receiving heparin, followed by repeat platelet counts every 2 to 3 days. Once thrombocytopenia or thrombosis is diagnosed, heparin should be discontinued and other methods of therapy considered.

Topics: Dextrans; Heparin; Humans; Infusions, Intravenous; Platelet Aggregation; Platelet Count; Syndrome; Thrombocytopenia; Thrombosis; Urokinase-Type Plasminogen Activator; Warfarin

Topics: Abnormalities, Drug-Induced; Chondrodysplasia Punctata; Female; Humans; Maxilla; Nasal Bone; Phenotype; Pregnancy; Syndrome; Terminology as Topic; Warfarin

Embolic occlusion of lower extremity arteries caused by hyperthyroidism-induced atrial fibrillation occurs rarely. Severe end organ damage may be prevented by aggressive medical and surgical intervention. Subtle signs of hyperthyroidism should be sought when arterial occlusion and atrial dysrhythmia are discovered. About 25% of thyrotoxic patients have atrial fibrillation, and up to 40% of this subgroup have systemic emboli; thus, 3% to 10% of all thyrotoxic patients may have systemic emboli. This estimation supports the recommendation for anticoagulation in all hyperthyroid individuals with atrial fibrillation.

Topics: Adult; Atrial Fibrillation; Embolism; Female; Femoral Artery; Humans; Quinidine; Syndrome; Thyrotoxicosis; Warfarin

A case of axillary-subclavian vein thrombosis associated with effort is described (Paget-Schrötter syndrome). This patient was treated successfully with thrombolytic and anticoagulant therapy. Diagnosis and management of this rare clinical entity are discussed.

Topics: Axillary Vein; Drug Therapy, Combination; Emergency Medical Services; Fibrinolytic Agents; Humans; Male; Middle Aged; Physical Exertion; Streptokinase; Subclavian Vein; Syndrome; Thrombosis; Urokinase-Type Plasminogen Activator; Warfarin

The "purple toes syndrome" is a rare complication of oral anticoagulant therapy. Four patients who presented with "purple toes syndrome" several weeks after warfarin therapy was initiated are described. The diagnosis of cholesterol microembolization was made by biopsy in three cases. Malignant hypertension and renal failure developed in two patients who died within three to six months of onset of purple toes. Postmortem examination in one of these patients showed widespread cholesterol microembolization. Renal failure has not developed in the other two patients, who are doing well. These biopsy and autopsy results suggest that the warfarin-related "purple toes syndrome" is due to cholesterol microembolization.

Topics: Aged; Arteriosclerosis; Cholesterol; Color; Embolism; Female; Humans; Male; Middle Aged; Regional Blood Flow; Syndrome; Toes; Warfarin

A rare congenital nasal deformity due to warfarin embryopathy is reported. The commonest anomalies described in this syndrome are: hypoplasia of the nose, stippling of bone, optic atrophy and mental retardation. The various abnormalities and the mechanism of warfarin teratogenesis are discussed.

Topics: Abnormalities, Drug-Induced; Humans; Infant, Newborn; Male; Nasal Bone; Syndrome; Warfarin

Two patients with Trousseau's syndrome experienced frequently recurring concomitant arterial and venous thrombotic events that resulted in sequential amputation and loss of the lower extremities. Serial examination of the blood in the patients demonstrated that these devastating thrombotic events were preceded by severe disseminated intravascular coagulopathy that occurred within an interval of a few hours. Warfarin therapy was without effect in preventing the occurrence of these events. Both patients demonstrated the absolute need for intravenous heparin, which effectively prevented the thrombotic events; when it was discontinued, the immediate consequences were disastrous and resulted in death. Techniques for long-term outpatient heparin therapy are discussed.

Topics: Blood Coagulation Tests; Carcinoma, Bronchogenic; Disseminated Intravascular Coagulation; Heparin; Humans; Lung Neoplasms; Male; Middle Aged; Platelet Count; Recurrence; Syndrome; Thrombosis; Time Factors; Warfarin

The efficacy of heparin, sodium warfarin, and elastic stockings in preventing the late leg sequelae of deep venous thrombosis was evaluated by reexamining 15 patients with previous acute deep venous thrombosis so treated. All 5 patients with iliocommon femoral disease and only 5 of 10 patients with distal disease had evidence of postphlebitic syndrome. Venous Doppler and strain gauge plethysmography confirmed these clinical findings. The most striking and consistent laboratory abnormalities were in the patients with proximal disease. Treatment of acute deep venous thrombosis by traditional means does not prevent the clinical and laboratory late leg sequelae. In light of these findings, serious investigation of new therapeutic modalities is strongly suggested.

Topics: Clothing; Femoral Vein; Follow-Up Studies; Heparin; Humans; Iliac Vein; Plethysmography; Popliteal Vein; Regional Blood Flow; Syndrome; Thrombosis; Ultrasonography; Warfarin

In August, 1981, paediatric hospitals in Ho Chi Minh City (formerly Saigon), Vietnam, began to report cases of a haemorrhagic syndrome in infants. The cause of this haemorrhagic phenomenon was identified as talcum powder contaminated with the anticoagulant warfarin. Analysis of talcum powders revealed warfarin in concentrations between 1.7% and 6.5%. 741 cases were detected and 177 patients died. The possibility of accidental contamination or substitution of a perfuming agent by warfarin can be rejected. In an experiment with two baboons, the animal exposed to the contaminated talc died five days later from haemorrhage. The accident and the animal study demonstrate the significant transcutaneous uptake of the anticoagulant.

Topics: Animals; Disease Outbreaks; Drug Contamination; Female; Hemorrhagic Disorders; Humans; Infant; Infant, Newborn; Male; Maternal-Fetal Exchange; Pan troglodytes; Pregnancy; Skin; Skin Absorption; Syndrome; Talc; Vietnam; Warfarin

"Purple toes" syndrome and a generalized skin eruption developed in a 73-year-old woman who was taking warfarin sodium (Coumadin) as well as antiarrhythmic agents after a stroke. Both the rash and the discoloration of her feet were apparently related to use of warfarin and gradually resolved after discontinuation of the drug.

Topics: Aged; Cerebrovascular Disorders; Female; Foot Dermatoses; Humans; Syndrome; Toes; Warfarin

A case is reported of a baby born with congenital abnormalities due to maternal ingestion of warfarin during pregnancy. Warfarin is known to be teratogenic, producing characteristic abnormalities, namely a hypoplastic nose, stippled epiphyses, and skeletal abnormalities. A variety of ocular abnormalities have been reported. Ophthalmologists should seek a history of maternal warfarin ingestion when seeing a baby with congenital ocular abnormalities. They should also be aware of the possible teratogenic effects when considering warfarin therapy for a woman of childbearing age.

Topics: Abnormalities, Drug-Induced; Female; Humans; Infant, Newborn; Male; Nose; Pregnancy; Syndrome; Warfarin

Topics: Abnormalities, Drug-Induced; Humans; Infant, Newborn; Male; Nose; Syndrome; Warfarin

Topics: Chondrodysplasia Punctata; Female; Humans; Infant; Nasal Septum; Syndrome; Warfarin

Topics: Capillaries; Color; Female; Humans; Middle Aged; Syndrome; Toes; Warfarin

Topics: Acute Disease; Adolescent; Adult; Aged; Aneurysm; Child; Chronic Disease; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Female; Fetal Death; Fibrinolysis; Hemangioma; Heparin; Humans; Iliac Artery; Infusions, Parenteral; Lung Neoplasms; Lymphatic Metastasis; Male; Melanoma; Middle Aged; Pregnancy; Sepsis; Streptococcal Infections; Syndrome; Thrombophlebitis; Thumb; Warfarin

Topics: Angiography; Blood Protein Disorders; Blood Proteins; Cholesterol; Headache; Humans; Immunoelectrophoresis; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Skin Diseases; Syndrome; Warfarin

Topics: Autoimmune Diseases; Betamethasone; Dexamethasone; Digoxin; Humans; Myocardial Infarction; Radiography, Thoracic; Syndrome; Warfarin