warfarin and Urinary-Retention

Intracerebral hemorrhage is a well-known complication resulting from warfarin use; however, warfarin-associated intraspinal hematoma is very rare. Warfarin-associated intraspinal hematoma may exhibit delayed progression, and patients may present with atypical symptoms, occasionally resulting in delayed diagnosis. We report the case of a 65-year-old man who visited our emergency department (ED) with acute urinary retention. He had been previously diagnosed with non-valvular atrial fibrillation, arterial hypertension, and benign prostatic hyperplasia, and he used warfarin for the prevention of systemic embolism. The patient was initially diagnosed with worsening of the prostatic hyperplasia. After 2 days, he revisited the ED with painless paraparesis. Magnetic resonance imaging of the thoracic spine revealed an intraspinal hematoma at Th7-8, and blood coagulation tests indicated a prothrombin time-international normalized ratio of 3.33. Despite attempts to reverse the effects of warfarin with vitamin K administration, the paraparesis progressed to paraplegia, necessitating urgent surgical removal of the hematoma. Partial recovery of motor function was evident after surgery. From the present case, we learned that intraspinal hematoma should be included in the differential diagnosis of patients using warfarin who present with acute urinary retention. Although there are no evidence-based treatment guidelines for warfarin-associated intraspinal hematoma, surgical treatment may be warranted for those who exhibit neurological deterioration.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Delayed Diagnosis; Diagnosis, Differential; Disease Progression; Hematoma, Epidural, Spinal; Humans; Hypertension; International Normalized Ratio; Male; Paraparesis; Prostatic Hyperplasia; Prothrombin Time; Recovery of Function; Urinary Retention; Warfarin

We are presenting a case of non-traumatic spontaneous spinal subdural hematoma in a patient on warfarin and fluoxetine. This diagnosis should be considered early in patients who are on warfarin or fluoxetine or both presenting with acute neurological abnormalities of the limbs, and early decompression could result in good neurological outcome.

Topics: Aged; Antifibrinolytic Agents; Back Pain; Blood Coagulation Factors; Combined Modality Therapy; Decompression, Surgical; Dexamethasone; Early Diagnosis; Early Medical Intervention; Fluoxetine; Glucocorticoids; Hematoma, Subdural, Spinal; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Paraplegia; Spinal Cord Compression; Treatment Outcome; Urinary Retention; Vitamin K; Warfarin

Spontaneous spinal epidural hematoma is an uncommon cause of spinal cord compression. It may be associated with various causative factors, but in many patients, anticoagulation can be implicated. It is noteworthy that many of the reported cases were anticoagulated in the therapeutic range. Spontaneous spinal epidural hematoma should be suspected in any patient receiving anticoagulant agents who complains of local or referred spinal pain associated with limb weakness, sensory deficits, or urinary retention. Early diagnosis and treatment are very important for the functional recovery of the patient. Spinal magnetic resonance imaging is the most suitable neuroradiological method for early diagnosis. Although primary management is the surgical evacuation of the spinal epidural hematoma via laminectomy, rare cases in which the patient is improving rapidly and progressively could be treated conservatively. A 22-yr-old man with a spontaneous spinal epidural hematoma who was receiving warfarin treatment for a mechanical aortic valve is presented in this article.

Topics: Adult; Anticoagulants; Decompression, Surgical; Hematoma, Epidural, Cranial; Humans; Laminectomy; Magnetic Resonance Imaging; Male; Urinary Retention; Warfarin

Two women on warfarin anticoagulation experienced urinary retention following urethral collagen bulk injections. Both women developed implant site hematomas, with urinary retention and intravesical hemorrhage. One woman was supratherapeutic and the other was therapeutic on warfarin therapy. Both women required transfusion and prolonged catheterization.

Topics: Aged; Aged, 80 and over; Anticoagulants; Collagen; Female; Hematoma; Humans; Injections; Prostheses and Implants; Urinary Bladder Diseases; Urinary Incontinence, Stress; Urinary Retention; Warfarin

To assess the safety of transurethral prostatectomy (TURP) in patients on long-term full anticoagulation.. Twelve TURPs were performed on 11 patients with urinary retention or severe symptoms from prostatic obstruction who also required anticoagulation for a history of life-threatening thromboembolic disease (seven) or prosthetic heart valves (four). Patients stopped taking warfarin 3 days before surgery; on admission a day later, full intravenous heparinization was commenced. Heparin was stopped 4 h before TURP and re-commenced with an initial bolus in the recovery room, and warfarin re-started that evening.. The mean weight of prostate resected was 23 g and the mean peri-operative decrease in haemoglobin was 1.6 g/dL. Only one patient required a transfusion of 3 units, but the activated partial thromboplastin time (APTT) had risen to >4. The mean pre- and post-operative APTT were 1.7 and 2.64, respectively, and the mean total length of hospital stay 6.7 days. Three patients were re-admitted for secondary haemorrhage at 8, 9 and 28 days after TURP, but all resolved with catheterization for 24 h only. There were no other major complications or thrombo-embolic phenomena.. TURP can be conducted safely in this high-risk group of patients with a regimen that allows a brief but controlled interruption to their full anticoagulation. This protects from the risks of thromboembolic incidents with no major increase in haemorrhage or hospital stay.

Topics: Aged; Anticoagulants; Humans; Length of Stay; Male; Neoplasm Recurrence, Local; Postoperative Hemorrhage; Prostatectomy; Prostatic Neoplasms; Reoperation; Retrospective Studies; Thromboembolism; Urinary Retention; Warfarin

Topics: Anticoagulants; Back Pain; Cranial Nerve Diseases; Female; Heart Valve Prosthesis; Hematoma, Subdural; Heparin; Humans; Magnetic Resonance Imaging; Middle Aged; Risk; Spinal Cord Compression; Spinal Puncture; Thromboembolism; Urinary Catheterization; Urinary Retention; Warfarin