warfarin and von-Willebrand-Diseases

Topics: Anticoagulants; Blood Coagulation Disorders; Dental Care for Chronically Ill; Genetic Therapy; Hemophilia A; Humans; International Normalized Ratio; Male; Self Administration; von Willebrand Diseases; Warfarin

To evaluate the competing pro-haemorrhagic contribution of acquired von Willebrand (vW) disease and antithrombotic therapy in patients implanted with continuous-flow left ventricular assist devices (LVADs).. We compared the extent of vW factor (vWf) degradation [vWf antigen (vWf:Ag)] and a decrease of functional activity of large vWf multimers [vWf collagen binding (vWf:CB)] in LVAD patients who did and did not suffer from bleeding. Data were measured pre-implant, at short-term (t1: <3 months) and long-term (t2: >12 months) follow-up. The occurrence of primary bleeding events, as well as bleeding recurrence, was correlated with patient-specific vWf profile and antithrombotic regimen. Indeed, patients were discharged on warfarin (international normalized ratio: 2-2.5) and aspirin, with the latter withhold after a first bleeding episode.. Fifty-three patients were enrolled. The median follow-up was 324 (226-468) days. We recorded 25 primary bleeding events (47% of patients). All primary events occurred in patients on warfarin and aspirin. Both vWf:Ag and vWf:CB decreased significantly post-implant (P = 0.0003 and P < 0.0001), and patients showing pathological vWf:CB/vWf:Ag ratio (<0.7) increased progressively over the time of support (pre-implant = 26%, t1 = 58%, t2 = 74%; P < 0.0001). Of note, activity of large vWf multimers of bleeders was significantly lower at t2 with respect to non-bleeders (vWf:CB: 61 (36-115) vs 100 (68-121), P = 0.04; vWf:CB/vWf:Ag ratio: 0.36 (0.26-0.61) vs 0.58 (0.33-0.96), P = 0.04). Despite these marked differences in the vWf profile, following aspirin discontinuation only 3 patients had bleeding recurrence.. Aspirin contributes significantly to haemorrhagic events in the background of acquired vW disease; its discontinuation significantly reduces bleeding recurrence.. https://clinicaltrials.gov/ct2/show/NCT03255928; ClinicalTrials.gov Identifier: NCT03255928.

Topics: Aspirin; Fibrinolytic Agents; Heart-Assist Devices; Hemorrhage; Humans; von Willebrand Diseases; von Willebrand Factor; Warfarin

Patients treated with continuous flow assist devices may have increased bleeding tendencies due to an induced high molecular weight von Willebrand factor (VWF) multimer deficiency. We report a patient supported with a HeartMate II (Thoratec, Pleasanton, CA) who developed severe gastrointestinal bleeding refractory to conventional therapy and needing a total of 60 transfusions. After documenting the lack of large VWF multimers, suggestive of a defective platelet function, the patient was switched from aspirin to warfarin therapy (target international normalized ratio between 1.5 and 2.0). Three days after changing the anticoagulant regimen, the patient stopped bleeding and required no further transfusion.

Topics: Anticoagulants; Gastrointestinal Hemorrhage; Heart-Assist Devices; Humans; Male; Middle Aged; Severity of Illness Index; von Willebrand Diseases; Warfarin

To determine the efficacy of the topical application of Ankaferd Blood Stopper (ABS) on hemorrhagic diathesis following dental procedures under different conditions.. Some patients have a tendency to bleed excessively after dental surgery for a variety of reasons, making oral surgical procedures more risky for these patients. Since hemorrhage can cause major morbidity and mortality, the identification of a novel, effective hemostatic agent could improve the management of excessive bleeding that occurs during dental procedures.. Four patients (3 females, 1 male) aged 28-45 with bleeding tendencies due to different presurgical conditions such as von Willebrand Disease, chronic liver failure, and mitral valve replacement presented for tooth extraction. Hematological consultations were obtained prior to surgical intervention and their international normalized (INR) ratio values were adjusted to less than 1.5; none received clotting factor replacement. All the extractions were performed under local anesthesia with and without epinephrine. In the presence of postsurgical bleeding, the efficacy of the ampule form of topical ABS was observed. Sex, age, anamnesis, von Willebrand Factor, activated partial thromboplastin time, factor VIII, and platelet counts of patients were recorded prior to the extractions.. ABS was found to be effective within 10 to 20 minutes in controlling bleeding in most of the patients after dental surgery. These observations suggest the use of ABS may be a beneficial hemostatic agent for use in patients with hemorrhagic diathesis following tooth extraction. Additional research is needed to clarify the role of this unique medicinal product in the surgical treatment of dental patients with bleeding tendency.. ABS has demonstrated potential for being an effective hemostatic agent for the treatment of excessive bleeding following dental surgery in four patients with hemorrhagic diathesis.

Topics: Adult; Alpinia; Dental Care for Chronically Ill; Female; Glycyrrhiza; Heart Valve Prosthesis; Hemostatics; Humans; Male; Middle Aged; Oral Hemorrhage; Phytotherapy; Plant Extracts; Postoperative Hemorrhage; Thymus Plant; Tooth Extraction; Urtica dioica; Vitis; von Willebrand Diseases; Warfarin

This report deals with clinical experience of urologic surgery of patients with hemostatic disorder or hemolytic disease. In the past 5 years from May 1986, 14 operations were conducted in our clinic on 13 patients, consisting of 4 with von Willebrand disease (vWd), 1 with hemophilia B, 4 who had warfarin administration, 3 with essential thrombocythemia and 2 with spherocytosis. Almost all patients were treated hematologically before the urological operations. Except in 1 case, the post-operative course was favorable and under hematologic control. Massive bleeding in 1 case was obviously attributable to over-dosage of warfarin. It is difficult to determine the optimal dose of warfarin under an unstable hemostatic condition during the operation and recovery periods. However, it is possible to carry out urologic surgery for these patients under appropriate hematologic control, and ESWL was safely performed without medical treatment on 3 patients; 1 with vWd, 1 treated with warfarin and 1 with spherocytosis.

Topics: Adult; Aged; Blood Coagulation Factors; Blood Transfusion, Autologous; Child; Child, Preschool; Factor VIII; Female; Fibrinogen; Hemophilia B; Humans; Hydroxyurea; Lithotripsy; Male; Middle Aged; Spherocytosis, Hereditary; Thrombocythemia, Essential; Urologic Diseases; von Willebrand Diseases; Warfarin

Topics: Animals; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Dog Diseases; Dogs; Female; Fibrin Fibrinogen Degradation Products; Hemophilia A; Hemorrhagic Disorders; Male; Purpura, Thrombocytopenic; von Willebrand Diseases; Warfarin

Topics: Adenosine Triphosphate; Animals; Blood Platelets; Humans; Lactates; Liver Cirrhosis; Lupus Erythematosus, Systemic; Neuraminic Acids; Neuraminidase; Platelet Adhesiveness; Purpura, Thrombocytopenic; Rabbits; Time Factors; Uremia; von Willebrand Diseases; Warfarin

Topics: Blood Coagulation Tests; Heparin; Humans; In Vitro Techniques; Male; Thrombin; Thromboplastin; Time Factors; von Willebrand Diseases; Warfarin