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
- Pain
They also had an improvement of pain and functionality. [ncbi.nlm.nih.gov]
Deep vein thrombosis can cause pain and swelling, but can occur without any symptoms. [newhamccg.nhs.uk]
They are usually applied topically and are easily absorbed into the skin where they can reduce small blood clots, reduce inflammation and associated pain and discomfort. Chitin and chondroitin sulfate are also heparinoids. [drugs.com]
Reg Anesth Pain Med 2003 ; 28 : 172 – 97. 12 The risks of continuing or discontinuing anticoagulants for patients undergoing common interventional pain procedures. Pain Med 2016 ; 18 : 403 – 9. 13, et al. [academic.oup.com]
- Weakness
For low-risk endoscopic procedures we suggest that warfarin therapy should be continued (low quality evidence, weak recommendation). [esge.com]
In patients on dual antiplatelet therapy, we suggest continuing aspirin (low quality evidence, weak recommendation). [bsg.org.uk]
Weak recommendations, therefore, are sensitive to differences in patient values and preferences. [bloodjournal.org]
ACD‐A was underestimated for higher density of the units (p < 0.0005); a weak association was also observed with triglycerides (underestimated for higher levels, p = 0.015) and sex (overestimated in females, p = 0.008), but our model explained only 35% [onlinelibrary.wiley.com]
It is a weak anticoagulant but is often added as preservative for blood glucose together with potassium oxalate as anticoagulant. It is effective at a concentration of 2mg/ml blood. [edusanjalbiochemist.blogspot.com]
- 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]
- Pallor
The method was fully validated and applied to a case of intentional poisoning perpetrated by administration of difenacoum and α-chloralose to a 97-year-old woman, who was hospitalized because of severe symptoms, including drowsiness, convulsions, pallor [ncbi.nlm.nih.gov]
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
- 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]
Cardiovascular
- Heart Disease
See a picture of the Heart and learn more... Heart Disease: Symptoms, Signs, and Causes What is heart disease (coronary artery disease)? Learn about the causes of heart disease. Symptoms of heart disease include chest... [medicinenet.com]
We describe a case of an 84-year-old man with arterial hypertension, coronary heart disease and atrial fibrillation treated with acenocoumarol, who presented with haematoproteinuria and acute kidney injury during a phase of excessive anticoagulation. [ncbi.nlm.nih.gov]
- Palpitations
Signs and symptoms of atrial flutter include near fainting, palpitations, mild shortness of breath, and fatigue. [medicinenet.com]
Atrial fibrillation can produce palpitations, shortness of breath, lightheadedness, weakness, and chest pain, or may occur without symptoms. [fda.gov]
- Tachycardia
The patient was evaluated and received appropriate antitachycardia pacing for atrial tachyarrhythmias for an episode of ventricular tachycardia (VT), and antiarrhythmic therapy with sotalol was initiated to reduce both his AF and VT burden. [ncbi.nlm.nih.gov]
[…] such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-Parkinson-White syndrome, brachycardia, or heart blocks. [medicinenet.com]
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
- Dizziness
Possible other side effects include: diarrhoea or constipation feeling and being sick indigestion dizziness headaches rashes itchy skin hair loss jaundice (yellowing of the skin and whites of the eyes) Speak to your GP or anticoagulant clinic if you have [nhs.uk]
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]
[…] a sharp, stabbing pain that may be worse when you breathe in Shortness of breath, this can – come on suddenly or have developed gradually Coughing this is - usually dry and may include coughing up blood or mucus that contains blood Feeling faint or dizzy [newhamccg.nhs.uk]
Less common side effects: Coughing up or throwing up blood Dark stools A skin rash, hives, or itching Sore throat Hair loss Bruising more often Back pain Fever, chills, or weakness Yellowing of the skin or eyes (jaundice) Rare side effects: Headache Dizziness [texasheart.org]
- 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]
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]
Serum
- Dyslipidemia
In the case of positive answers to any of the sections regarding diagnosed cardiovascular disease (ischemic heart disease, angina or HF, or IS) or the presence of risk factors (dyslipidemia, AHT, DM, or tobacco use), a second page was also filled out. [revespcardiol.org]
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]