Presentation
The most common presentation of long-acting anticoagulant rodenticide poisoning is mucocutaneous bleeding, with other common presentations including haematuria, gingival bleeding, epistaxis and gastrointestinal bleeding. [ncbi.nlm.nih.gov]
Entire Body System
- Asymptomatic
Literature review revealed that successful conservative management of a patient with asymptomatic DIC and subsequent fever without infection is extremely rare. [ncbi.nlm.nih.gov]
[…] in patients younger than 50 years of age, thrombosis at unusual sites, late pregnancy loss, any thrombosis or pregnancy morbidity in patients with autoimmune disease No contraindications are noted; however, the ISTH discourages nonspecific testing in asymptomatic [emedicine.medscape.com]
As detailed in the prescribing information, Bevyxxa efficacy was measured in the modified Intent-to-Treat (mITT) analysis, which includes 7,441 patients assessed by a composite outcome score comprising either the occurrence of asymptomatic proximal DVT [globenewswire.com]
- Fatigue
Signs and symptoms of atrial flutter include near fainting, palpitations, mild shortness of breath, and fatigue. [medicinenet.com]
Hematological
- Easy Bruising
These side effects, as well as easy bruising, dark stools, itching or hives, vomiting of blood, or back pain, should be reported to a healthcare professional immediately. [uspharmacist.com]
Gastrointestinal
- Dyspepsia
Direct thrombin inhibitors haemorrhage nausea dyspepsia diarrhoea abdominal pain anaemia Use with caution in the elderly and in patients with low body weight Use with caution in patients with bleeding disorders, thrombocytopenia, recent biopsy or major [drugoffice.gov.hk]
Risk of bleeding 7,8 HAS-BLED score (≥ 3 points = high risk) 8 A mechanical heart valve or hemodynamically significant valve disease 6 Renal function 6,7 Advanced liver disease 6 Body weight 7 Risk of coronary events 7 Propensity to dyspepsia 7 Patient [coaguchek.com]
The lower pH has previously been associated with dyspepsia; some hypothesize that this plays a role in the increased risk of gastrointestinal bleeding.[12] A small but significantly increased risk of myocardial infarctions (heart attacks) has been noted [en.wikipedia.org]
The only adverse effect that was significantly more common with dabigatran than with warfarin was dyspepsia ( Table 4 ). [doi.org]
- Nausea
The patient was admitted with intense abdominal pain, nausea, vomiting, and a total obstruction of duodenum. After a diagnosis of intramural hematoma, a good prognosis was achieved with conservative care. [ncbi.nlm.nih.gov]
Direct factor Xa inhibitors Apixaban haemorrhage nausea bruising anaemia Rivaroxaban haemorrhage nausea and vomiting diarrhoea constipation dyspepsia abdominal pain dizziness headache Use with caution in patients at risk of bleeding, or taking concomitant [drugoffice.gov.hk]
The more common side effects that have been associated with anticoagulants include: Bleeding Gastrointestinal effects such as diarrhea, heartburn, nausea, and loss of appetite Irritation and pain around the site of injection (injectable anticoagulants [drugs.com]
Increased bruising or bleeding Blood in the urine Bloody or black, tarry stools Severe menstrual bleeding Feeling very tired or weak Nausea and vomiting for more than 24 hours Bleeding from the gums after brushing teeth Also call if you fall or have [nationaljewish.org]
- Abdominal Pain
The patient was admitted with intense abdominal pain, nausea, vomiting, and a total obstruction of duodenum. After a diagnosis of intramural hematoma, a good prognosis was achieved with conservative care. [ncbi.nlm.nih.gov]
Direct thrombin inhibitors haemorrhage nausea dyspepsia diarrhoea abdominal pain anaemia Use with caution in the elderly and in patients with low body weight Use with caution in patients with bleeding disorders, thrombocytopenia, recent biopsy or major [drugoffice.gov.hk]
- Melena
The patient was admitted in hospital as she presented with gastrointestinal bleeding (melena), asthenia and progressive anemia. [ncbi.nlm.nih.gov]
We classified as belonging to the group “upper gastrointestinal bleedings” any hemorrhagic event that occurs between the oropharynx and the ligament of Treitz, or any event that could be highly associated with upper gastrointestinal bleedings (e.g., melena [frontiersin.org]
Jaw & Teeth
- Bleeding Gums
Excessive bleeding Signs of excessive bleeding can include: passing blood in your pee passing blood when you poo or having black poo severe bruising prolonged nosebleeds (lasting longer than 10 minutes) bleeding gums vomiting blood or coughing up blood [nhs.uk]
gums Purple coloring to your fingers or toes Again, tell your doctor right away if you have any of these side effects. [texasheart.org]
- Oral Bleeding
A: If at any time you have a concern regarding bleeding after surgery, you should feel free to contact your dentist or oral surgeon. [aaom.com]
Skin
- Alopecia
Vitamin K antagonist haemorrhage nausea and vomiting diarrhea jaundice hepatic dysfunction pancreatitis pyrexia alopecia rash Use with caution in mild to moderate renal impairment. [drugoffice.gov.hk]
Face, Head & Neck
- Epistaxis
The most common presentation of long-acting anticoagulant rodenticide poisoning is mucocutaneous bleeding, with other common presentations including haematuria, gingival bleeding, epistaxis and gastrointestinal bleeding. [ncbi.nlm.nih.gov]
In fact, in our preventable case, the co-treatment with apixaban and acetylsalicylic acid has only caused a minor bleeding (epistaxis) in an elderly patient. [frontiersin.org]
INR range 2.0 to 3.0, 29% below 2.0, 11% within 3.1 to Major Hemorrhage During the first year, 26 patients sustained a major hemorrhage (9 intracranial, 11 gastrointestinal, 1 retroperitoneal, 1 hemothorax after a fall, 1 ocular, 1 hemarthrosis, and 2 epistaxis [doi.org]
Neurologic
- Vertigo
Symptoms of a stroke may include: weakness, numbness, double vision or vision loss, confusion, vertigo, difficulty speaking or understanding speech. A physical exam, imaging tests, neurological exam, and blood tests may be used to diagnose a stroke. [medicinenet.com]
- Irritability
The more common side effects that have been associated with anticoagulants include: Bleeding Gastrointestinal effects such as diarrhea, heartburn, nausea, and loss of appetite Irritation and pain around the site of injection (injectable anticoagulants [drugs.com]
‘Aspirin has a direct irritant effect on stomach lining and can cause stomach bleeding, and it increases the risk of bleeding due to enhancement of the anticoagulant effect of warfarin.’ [en.oxforddictionaries.com]
Alcohol can interfere with the effectiveness of anticoagulant medications, can be harmful to your liver, and can irritate your stomach (gastritis), causing bleeding. [hopkinslupus.org]
Take antiplatelet drugs with or after food to help reduce irritation to the stomach. When you are taking warfarin, Avoid binge drinking or getting drunk as doing this can increase the effect of warfarin and so increase the risk of bleeding. [drugoffice.gov.hk]
Urogenital
- Hematuria
No patients in any of the groups experienced cardiovascular events during their hospital stay or required rehospitalization for hematuria after discharge. [ncbi.nlm.nih.gov]
Workup
Hereditary and Acquired Hypercoagulability Workup. Medscape Hematology. Available online at https://emedicine.medscape.com/article/211039-workup. Accessed on 8/05/18. Krautscheid, P. et. al. (2018 August, Updated). [labtestsonline.org]
X-Ray
- Pericardial Effusion
A key result of the PREVAIL trial was that pericardial effusions requiring intervention occurred at a rate comparable to other left atrial procedures. [dicardiology.com]
Hemophilia or another bleeding disorder Are pregnant High risk of bleeding in the brain (hemorrhagic stroke) Cerebral aneurysm Dissecting aorta Pericarditis Pericardial effusion Bacterial endocarditis Active ulceration An active bleed Are undergoing surgery [medicinenet.com]
Treatment
Elevated INR values due to VKA treatment could be reversed (INR≤1.5) in 63.1% (95% CI: 61.0-65.2) of study subjects after treatment with 4F-PCC, as compared with 12.2% (95% CI: 8.2-16.2) after treatment with fresh frozen plasma (FFP), (p CONCLUSIONS: [ncbi.nlm.nih.gov]
Prognosis
After a diagnosis of intramural hematoma, a good prognosis was achieved with conservative care. [ncbi.nlm.nih.gov]
‘Patients with a poor short-term prognosis, those with contraindications to aspirin and those taking anticoagulants or anti-inflammatory agents were excluded from the study.’ [en.oxforddictionaries.com]
Adverse prognosis of incidentally detected ambulatory atrial fibrillation: a cohort study. Thromb Haemost. 2014;112(2):276-286. PubMed Google Scholar Crossref 4. Fine JP, Gray RJ. [jamanetwork.com]
Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. [ Links ] 7. Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. [scielo.org.mx]
Etiology
Unstable angina: an etiologic approach to management. Circulation 1998;98(21):2219-22. PMID: 9826306. DeWood MA, Stifter WF, Simpson CS, et al. Coronary arteriographic findings soon after non-Q-wave myocardial infarction. [effectivehealthcare.ahrq.gov]
ELEVATED INR IN THE ABSENCE OF BLEEDING The 2012 ACCP Chest Guideline and 2015 Anticoagulation (AC) Forum recommendations for managing elevated INRs in the absence of bleeding are described in Table 1. 24,25 Patients should be interviewed to identify etiologies [powerpak.com]
Epidemiology
An in-depth analysis of the ACS therapeutic area and an epidemiology driven sales forecast models are presented in Decision Resources’ ACS Pharmacor. [web.archive.org]
Epidemiology of thromboembolic diseases: atrialfibrillation, venous thromboembolic disease and acute coronary syndrome. Med Clin (Barc) 2012;139:4-9. [PubMed] [Google Scholar] 5. Wang C. [ncbi.nlm.nih.gov]
Venous thrombosis epidemiology, pathophysiology, andanticoagulant therapies and trials in severe acute respiratory syndrome coronavirus 2 infection. J Vasc Surg Venous Lymphat Disord. 2021;9(1):23-35. [ Links ] 23. [scielo.org.mx]
Epidemiological profile of atrial fibrillation: a contemporary perspective.. Prog Cardiovasc Dis., 48 (2005), pp. 1-8 [3] Marinigh R, Lip GY, Fiotti N, Giansante C, Lane DA.. [revespcardiol.org]
Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA 3 Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington [bmj.com]
Pathophysiology
Patients can develop independent indications for antiplatelet and oral anticoagulant therapy, but in most cases the pathophysiology will intersect. [bmj.com]
Both disease states have thrombosis as a core pathophysiologic process which requires treatment - low sheer stress thrombi in AF and intracoronary high sheer stress thrombi in PCI. [ncbi.nlm.nih.gov]
This pharmacology lecture covers topics such as pathophysiology of blood clot formation and platelet function; activation, aggregation, cross-linking; ADP receptors, glycoprotein IIb/IIIa receptors, cyclooxygenase-1 (COX-1) enzyme, fibrinogen, fibrin [youtube.com]
[…] this antibody was first demonstrated in 1952 by Conley and Hartmann when they observed prolongation of lipid dependent coagulation tests in patients with systemic lupus erythematosus (SLE). [11] For a lack of a better understanding of the underlying pathophysiology [emedicine.medscape.com]
Prevention
CONCLUSION: Findings from this overview support the superiority of NOACs and patient's self-management for preventing stroke in AF patients. [ncbi.nlm.nih.gov]
[…] in non-valvular AF Primary prevention of VTE in patients undergoing elective total hip replacement surgery Primary prevention of VTE in patients undergoing elective total knee replacement surgery Treatment of acute DVT or PE Prevention of recurrent DVT [boehringer-ingelheim.com]
The NOACs directly inhibit one specific coagulation factor in the cascade, whereas warfarin prevents the coagulation process by suppressing the synthesis of several vitamin K-dependent coagulation factors. [pharmaceutical-journal.com]
Preventability of Cases of Bleeding In total, 58 cases out of 253 (22.9%) were preventable. [frontiersin.org]