warfarin and Vasculitis

Severe peripheral artery disease (PAD) is the predominant cause of ischemic ulcerations involving the lower extremities. PAD-associated ulcerations are typically distally located involving the feet, toes, and sometimes the calves. In contradistinction, atypical ischemic ulcerations of the lower extremity are often non-atherosclerotic in etiology, involve the proximal leg (thigh/buttocks), can evolve despite palpable distal pulses, and may coexist with other cutaneous aberrations (e.g. macules, purpura, nodules, and livedo reticularis). A differential diagnosis of atypical ischemic ulcerations involving the legs is presented.

Topics: Anticoagulants; Antiphospholipid Syndrome; Calciphylaxis; Diagnosis, Differential; Drug Eruptions; Embolism, Cholesterol; Heparin; Humans; Ischemia; Leg Ulcer; Lower Extremity; Peripheral Vascular Diseases; Spider Bites; Vasculitis; 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

Anticoagulation-related nephropathy (ARN) is a rare form of acute kidney injury where the use of anticoagulation causes hemorrhage in various compartments of nephron including glomerulus, renal tubules, and interstitial compartment. Also, warfarin-induced vasculitis is an extremely rare condition characterized by the appearance of purpuric lesions on the skin which on biopsy are suggestive of leukocytoclastic vasculitis (LV). We hereby report a case presenting with coexistent warfarin-induced nephropathy and cutaneous vasculitis. A 64-year-old male, on warfarin for 10 years, presented with complaints of palpable purpuric rashes over lower limbs, hematuria, and decrease urine output. INR was in the supratherapeutic range (INR-6.3). Skin biopsy of the lesion was suggestive of LV and kidney biopsy showed RBCs in Bowman's capsule, RBCs and RBC casts in tubules suggestive of ARN. All vasculitic markers were negative. Thus, a diagnosis of warfarin-induced nephropathy and cutaneous vasculitis was made. Warfarin was discontinued and oral steroids were started. Gradually, his skin lesions improved, and he became dialysis independent. He was then discharged on apixaban. On follow-up after 3 months, his skin lesions had disappeared with partial recovery of kidney function (cr-5.49).

Topics: Anticoagulants; Female; Humans; Male; Middle Aged; Renal Dialysis; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous; Warfarin

Cutaneous small vessel vasculitis (CSVV) was identified as a safety signal among patients treated with direct oral anticoagulants (DOAC). This study aimed to determine if CSVV risk differed among patients with atrial fibrillation (Afib) who newly initiated warfarin or a DOAC.. We identified enrollees aged ≥21 years diagnosed with Afib who newly initiated rivaroxaban, dabigatran, apixaban, and warfarin in the Sentinel Distributed Database from October 19, 2010 to February 29, 2020. We selected and followed patients who did not have evidence of the following in the 183 days prior to initiating treatment: CSVV diagnosis, dispensing of other study drugs, select autoimmune diseases or autoimmune medications, cancer diagnoses or chemotherapeutic treatment, kidney dialysis or transplant, alternative anticoagulation indications, or an institutional (nursing home, hospice, hospital) stay on the treatment initiation date (index date) until CSVV outcome or pre-specified censoring. We conducted 1:1 propensity score matching in six comparisons.. CSVV incidence rates for DOACs and warfarin ranged from 3.3 to 5.6 per 10 000-person years in our matched Afib population. The adjusted CSVV hazard ratio (HR) and 95% confidence interval (CI) was 0.94 (0.64, 1.39) for rivaroxaban versus warfarin; 1.17 (0.67, 2.06) for dabigatran vs. warfarin; 0.85 (0.62, 1.16) for apixaban vs. warfarin; 0.86 (0.49, 1.50) for rivaroxaban vs. dabigatran; 0.99 (0.68, 1.45) for rivaroxaban versus apixaban; and 1.70 (0.90, 3.21) for dabigatran versus apixaban.. We did not find significant evidence of differential CSVV risk in pair-wise comparisons of DOACs and warfarin.

Topics: Anticoagulants; Atrial Fibrillation; Cohort Studies; Dabigatran; Humans; Pyridones; Retrospective Studies; Rivaroxaban; Stroke; Vasculitis; Warfarin

Topics: Behcet Syndrome; Humans; Thrombosis; Vasculitis; Venous Thrombosis; Warfarin

Antithrombotic therapy could trigger diffuse alveolar hemorrhage (DAH), and there are several case reports of DAH that occurred during antithrombotic therapy (DAH-AT). However, little is known about the clinical features and outcomes of DAH-AT. The purpose of this study was to clarify the features and mortality of DAH-AT.. 76 consecutive patients with DAH who were admitted to our hospital between January 2003 and April 2014 were retrospectively reviewed to identify the clinical features and outcomes of DAH-AT. The primary outcome was 90-day mortality.. Of the 76 patients with DAH, 39 patients (51 %) had DAH-AT, and 37 patients (49 %) had DAH that occurred with no antithrombotic therapy (DAH-NAT). Of the patients with DAH-AT, 25 (64 %) were taking aspirin, 14 (36 %) were taking warfarin, 5 (13 %) were taking clopidogrel sulfate, and 4 (10 %) were taking cilostazol. Pre-existing cardiac disease was present in 23 (59 %) DAH-AT cases and 5 (14 %) DAH-NAT cases. Logistic regression analysis was used to assess the effect of antithrombotic therapy on the mortality of DAH patients, and no significant difference in survival was seen with antithrombotic therapy (OR 1.18, 95 % CI 0.38-3.78).. Antithrombotic therapies had no effect on the 90-day mortality of DAH patients.

Topics: Adult; Aged; Aged, 80 and over; Aspirin; Cilostazol; Clopidogrel; Connective Tissue Diseases; Female; Fibrinolytic Agents; Heart Failure; Hemorrhage; Humans; Infections; Lung Diseases; Male; Middle Aged; Neoplasms; Pneumonia; Pulmonary Alveoli; Retrospective Studies; Survival Rate; Tetrazoles; Ticlopidine; Vasculitis; Warfarin

Topics: Adolescent; Antiphospholipid Syndrome; Comorbidity; Drug Therapy, Combination; Female; Humans; Hydroxychloroquine; Infarction; Intestines; Kidney; Lupus Erythematosus, Systemic; Prednisolone; Tomography, X-Ray Computed; Treatment Outcome; Vasculitis; Warfarin

Topics: Abdominal Pain; Anticoagulants; Antiphospholipid Syndrome; Fatal Outcome; Female; Fever; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mesenteric Arteries; Mesenteric Veins; Postprandial Period; Vasculitis; Warfarin; Young Adult

We report herein a case of a 28-year-old woman with persistent livedo racemosa and recurrent ulcerations on the lower extremities. The clinical presentation, together with histopathological findings of vascular occlusion without overt vasculitis in the dermis, led to the diagnosis of livedoid vasculopathy. The patient experienced recurrence of ulcerations and developed peripheral neuropathy affecting the distal extremities during the course of treatment with sarpogrelate hydrochloride. The skin lesions and neurological symptoms improved dramatically after adding low-dose warfarin potassium to the treatment regimen. This case suggests that administration of low-dose warfarin is an effective therapy of choice for patients with livedoid vasculopathy.

Topics: Adult; Anticoagulants; Female; Humans; Leg; Leg Ulcer; Livedo Reticularis; Mononeuropathies; Succinates; Vasculitis; Warfarin

Topics: Acetates; Amines; Anticoagulants; Anticonvulsants; Brain; Carbamazepine; Central Nervous System Diseases; Clotrimazole; Cyclohexanecarboxylic Acids; Cyclophosphamide; Drug Hypersensitivity; Drug Therapy, Combination; Gabapentin; gamma-Aminobutyric Acid; Humans; Immunosuppressive Agents; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Vasculitis; Vasculitis, Leukocytoclastic, Cutaneous; Warfarin

Two cases demonstrating unusual side effects of warfarin are described. The first case illustrates the 'purple toes' syndrome, which occurred as a complication following the use of warfarin for the treatment of atrial fibrillation and stroke. The second case is an example of warfarin-induced vasculitis in a patient with a mechanical valve prosthesis. He was unable to tolerate warfarin but was successfully managed with nicoumalone, a related compound. These complications are rare but potentially dangerous effects of a commonly used agent, warfarin.

Topics: Adult; Aged; Anticoagulants; Humans; Male; Toes; Vasculitis; Warfarin

To illustrate a case of peripheral retinal neovascularization (Eales disease) in a patient who tested positive for the factor V Leiden mutation.. A 42-year-old woman had a 1-week history of blurred vision in her right eye. Her medical history was remarkable for a cerebrovascular accident. Ophthalmoscopy of the right eye disclosed a mild vitreous hemorrhage and a ridge of retinal neovascularization in the temporal periphery. The left fundus showed evidence of temporal retinal ischemia. A laboratory evaluation for hypercoagulability was positive for factor V Leiden mutation.. Peripheral scatter laser photocoagulation was applied to the ischemic retina, and the neovascularization regressed. The patient began taking warfarin sodium to prevent further thrombotic events.. A laboratory evaluation for coagulopathy, including the factor V Leiden mutation, should be added to the examination of patients with Eales disease, especially individuals with a history of a previous thrombotic event.

Topics: Adult; Anticoagulants; Factor V; Female; Fluorescein Angiography; Fundus Oculi; Humans; Ischemia; Laser Coagulation; Mutation; Retinal Neovascularization; Retinal Vessels; Vasculitis; Vitreous Hemorrhage; Warfarin

Topics: Dose-Response Relationship, Drug; Drug Eruptions; Female; Humans; Middle Aged; Vasculitis; Warfarin