Presentation
Remnant liver volume present in the donor was expressed as Remnant % or RmDWR. [jpgmonline.com]
Clinical Scenario A 72-year-old woman presents with a minor head injury (MHI). [bestbets.org]
In the present study, incidence of post-operative coagulopathy was 45.34% in patients who underwent major liver resection. [ijaweb.org]
All patients were haemodynamically stable at presentation to OR. After induction, baseline temperature using oropharyngeal temperature probe was recorded. [jnaccjournal.org]
Defects in primary and secondary hemostasis typically have different presentations. [intechopen.com]
Entire Body System
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Falling
Warfarin should be restarted, if necessary, when the INR falls below 5.0. [pharmaceutical-journal.com]
We recommend removal of the epidural catheter after the fifth postoperative day when INR falls below 1.5. [jpgmonline.com]
The patient was discharged to a skilled nursing facility (SNF) for physical therapy on low-molecular-weight heparin, with a plan to initiate warfarin once it became clear that that she was not at high risk for falls. [psnet.ahrq.gov]
Mean age 75 with almost equal sex distribution. 83.6% were ground level falls and 89.5% were GCS 15 Cohort study Immediate TICH 60 patients (6.1%; 95% CI 4.7% to 7.8%). [bestbets.org]
[…] with a PT ratio of 1.3 to 1.5, and an INR of 3.0 to 4.5 with a PT ratio of 1.5 to 1.9, depending on the sensitivity index of the prothrombin reagent. 45 The therapeutic INR range varies according to the medical indication for its use, but generally falls [nature.com]
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Hypothermia
None of the patients had hypothermia defined as temperature The incidence of pre-operative thrombocytopenia in our study was 3.5% on the 1 st day which increased to 14.7% on the 3 rd day post-injury. [jnaccjournal.org]
Patient's hypothermia is prevented by warm fluid infusion, forced-air warming and the use of warm water on the surgical field. [clinmedjournals.org]
Quantitative evaluation of hypothermia, hyperthermia, and hemodilution on coagulation. J Extra Corpor Technol 2001 ; 33 : 100 –5 57 Koh SC, Pua HL, Tay DH, et al. [academic.oup.com]
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Weakness
Blood clot symptoms Sudden weakness in any limb New numbness or tingling anywhere Visual changes Sudden onset of slurred speech or inability to speak Dizziness, faintness, loss of balance (lack of coordination) New pain, swelling, redness, or heat in [inrtracker.com]
Relevant Paper(s) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Menditto et al 2012 Italy 97 prospectively enrolled consecutive warfarinised (for at least 1/52) patients 14 years old in Level [bestbets.org]
Aspirin, an ingredient of many prescription and over-the-counter drugs ( Table 1 ), has weak antiplatelet activity through acetylating and irreversibly inactivating the enzyme cyclo-oxygenase, which prevents the conversion of arachidonic acid to thromboxane [nature.com]
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Fever
Disease - any recent illness, fever, N/V/D, significant pain or stress? Track all these things that affect your INR by signing up for a FREE account here on INR Tracker. Learn More or sign up now. [inrtracker.com]
Finally, conditions such as old age, liver disease, biliary disease, malabsorption, congestive heart failure, fever, hypo- and hyperthyroidism, malnutrition, cancer, and vitamin K excess or deficiency can all interfere with warfarin activity. [nature.com]
According to these guidelines, prophylactic platelet transfusions are indicated in leukaemia patients at platelet counts 1 in the absence of fever, heparin treatment or active minor bleeding (although lower, safe thresholds have been described by Gmür [academic.oup.com]
Cardiovascular
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Heart Disease
Antithrombotic therapy in valvular heart disease. Chest. 1995;108(4 Suppl):360S–70S. 7. Schulman S, Granqvist S, Holmstrom M, Carlsson A, Lindmarker P, Nicol P, et al. [aafp.org]
Optimal frequency of patient monitoring and intensity of oral anticoagulation therapy in valvular heart disease. J Thromb Thrombolysis. 1998;5(Suppl 1):19-24. Ansell J, Hirsh J, Dalen J, et al. Managing oral anticoagulant therapy. [myvmc.com]
disease Atrial fibrillation When You Are in Your Target INR Range It is safer when you are in your target INR range, because the risks of an INR lower than your target range could indicate potential clots and an INR higher than your target range could [inrtracker.com]
disease, and Mechanical heart valves ( Table 3 ). [nature.com]
Patients at high risk for a cardiovascular event include those patients with congestive heart failure, diabetes mellitus, renal insufficiency, ischemic heart disease, and cerebrovascular disease [ 108 ]. 3.3.2. [intechopen.com]
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Heart Failure
failure Nephrotic syndrome Stroke Myeloproliferative syndrome Behçet's disease Pregnancy, puerperium Clinical risk factors Drugs Inherited thrombophilia Acquired thrombophilia History of thromboembolism Oral contraceptives Activated protein C resistance [academic.oup.com]
Finally, conditions such as old age, liver disease, biliary disease, malabsorption, congestive heart failure, fever, hypo- and hyperthyroidism, malnutrition, cancer, and vitamin K excess or deficiency can all interfere with warfarin activity. [nature.com]
Patients at high risk for a cardiovascular event include those patients with congestive heart failure, diabetes mellitus, renal insufficiency, ischemic heart disease, and cerebrovascular disease [ 108 ]. 3.3.2. [intechopen.com]
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Vascular Disease
Since platelets have an important role in coagulation and, in particular, arterial thrombosis, antiplatelet drugs are in widespread use for the prevention of morbidity and mortality from vascular disease. [nature.com]
Musculoskeletal
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Contusion
Patients underwent craniotomy, for evacuation of either extradural haematoma (EDH), subdural haematoma (SDH) or contusion or for the elevation of depressed fracture. Patients on antiplatelet agents or anticoagulants were excluded from the study. [jnaccjournal.org]
Urogenital
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Renal Insufficiency
In patients with moderate renal insufficiency, creatinine clearance 30–50 ml/min, the half‐life of fondaparinux is 29 h, and in patients with severe renal insufficiency, creatinine clearance 119 ]. [intechopen.com]
20 Comorbid disease states 26 Hypertension 20, 27 Cerebrovascular disease 20 Serious heart disease 4, 20 Renal insufficiency 20 If bleeding occurs during warfarin therapy, the physician should immediately consider the severity of bleeding, the intensity [aafp.org]
Workup
Patients with TBI are first triaged in emergency department where basic resuscitation (including intubation) and diagnostic workup including computed tomography (CT) scan is done. [jnaccjournal.org]
Patients with unexplained thrombocytopenia have a complex differential diagnosis and should be referred to a hematologist for consultation and complete workup. [intechopen.com]
Treatment
Treatment Efficacy As primary endpoint, INR was calculated during 24 h before and 1 h after the administration of PCCs. Secondary endpoints were bleeding control and bleeding event after treatment. [karger.com]
For bleeding patients, the severity of haemorrhage governs whether or not warfarin reversal treatment is used and the type of treatment — not the INR level. [pharmaceutical-journal.com]
Wound treatment in bleeding disorders Single tooth extraction: INR 2,03,5 Extended restoration: INR 1,6-1,9 Prophylaxis: Only small incisions Only one tooth per sitting Always provide qualified medical aid Treatment: Tight wound closure!!! [med-college.de]
Treatment of warfarin-associated coagulopathy with oral vitamin K: a randomized clinical trial. Lancet. 2000;356:1551-1553.[ go to PubMed ] 11. Glover JJ, Morrill GB. Conservative treatment of overanticoagulated patients. [psnet.ahrq.gov]
Patients: Adult patients admitted with hepatic dysfunction who received CFC for treatment of an active bleed or to normalize coagulopathy prior to an invasive procedure. Interventions: None. [scitechnol.com]
Prognosis
These tools are highly associated with the patient’s prognosis, but there is no recommendation on how to relate these scoring systems in assessing bleeding risk. [karger.com]
Recently, results from the IMPACT (International Mission for Prognosis and Clinical Trial) study showed that the PT is a powerful independent prognostic factor after TBI. [9] We also found that coagulopathy was associated with increased blood loss leading [jnaccjournal.org]
Etiology
5:2. doi:10.4172/2324-903X.1000141 Abstract Objective: To evaluate the efficacy and safety of three different normalization strategies utilizing coagulation factor concentrates (CFCs) in patients with hepatic coagulopathy of either acute or chronic etiology [scitechnol.com]
When factor deficiencies are suspected, the etiology can usually be determined by checking a limited number of factors, keeping the following facts in mind: Factors II (prothrombin), VII, IX, and X are vitamin K-dependent. [cancertherapyadvisor.com]
Figure 1 shows the proportion of patients who developed postoperative coagulopathy divided for type of resection and etiology of coagulopathy (INR 1.5, PLT 100,000/ml or both). [clinmedjournals.org]
Epidemiology
References Bosch FX, Ribes J, Borras J (1999) Epidemiology of primary liver cancer. Semin Liver Dis 19: 271-285. [clinmedjournals.org]
Anticoagulant-related bleeding: clinical epidemiology, prediction, and prevention. Am J Med. 1993;95:315–28. 23. Landefeld CS, Rosenblatt MW, Goldman L. [aafp.org]
[…] spinal injury * 30 mg s.c. every 12 h * * * * An increasing body of literature, generally examining hip replacement patients as a risk model, shows a significant incidence of DVT developing only weeks after hospital discharge. 77 In particular, a recent epidemiological [academic.oup.com]
Prevention
Warfarin is the oral anticoagulant most frequently used to control and prevent thromboembolic disorders. [aafp.org]
This study was designed to evaluate whether PCC treatment could prevent bleeding in patients with liver coagulopathy who underwent urgent medical procedures. [karger.com]
Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb. 141(2 Suppl):e44S-88S. [Medline]. [Full Text]. [emedicine.medscape.com]
Rivaroxaban is approved for prevention of stroke in patients with atrial fibrillation, prevention of venous thromboembolism following surgery, and in the treatment and prevention of venous thromboembolism [ 108 ]. [intechopen.com]
Early detection of any disturbance in coagulation will lead to prevention of life threatening complications. [medcraveonline.com]