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Warfarin

Warfarin Sodium


Presentation

  • From the present case, we learned that intraspinal hematoma should be included in the differential diagnosis of patients using warfarin who present with acute urinary retention.[ncbi.nlm.nih.gov]
  • Pectoral haematomas are an unusual presentation of bleeding diathesis, and are also seldom reported in the literature.[ncbi.nlm.nih.gov]
  • DISCUSSION In the present case, it is necessary to consider the possibility of coincidence, but the patient had presented cluster headache crises for more than six years, with no effective control, spite of being in use of suitable medications.[doi.org]
  • Rarely do such patients present with hemoperitoneum producing symptoms. Hemoperitoneum can produce shock, cause compression symptoms or may even be fatal.[ncbi.nlm.nih.gov]
  • A woman aged 76 years presented with signs of an acute stroke and despite not meeting the eligibility criteria, given her background use of warfarin, she received intravenous thrombolysis with an excellent outcome.[ncbi.nlm.nih.gov]
Congestive Heart Failure
  • A study of the beneficial effects of anticoagulant therapy in congestive heart failure. Ann Intern Med 1952 ;37: 867 - 887 9. Harvey WP, Finch CA. Dicumarol prophylaxis of thromboembolic disease in congestive heart failure.[nejm.org]
  • Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly.[medicinenet.com]
  • Related Disease Conditions 12 Congestive Heart Failure Symptoms, Stages, Causes, and Life Expectancy Congestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease,...[medicinenet.com]
  • To make sure warfarin is safe for you, tell your doctor if you have ever had: diabetes; congestive heart failure; liver disease, kidney disease (or if you are on dialysis); a hereditary clotting deficiency; or low blood platelets after receiving heparin[drugs.com]
  • The arrhythmia is associated with a five-fold risk of stroke and a three-fold incidence of congestive heart failure, and higher mortality. Hospitalization of patients with AF is also very common.[web.archive.org]
Chinese Herbal Drugs
  • Database searches combined the keyword warfarin with drug interactions, herbal medicines, Chinese herbal drugs, and food-drug interactions. Eligible articles contained original reports of warfarin drug or food interactions in human subjects.[ncbi.nlm.nih.gov]
  • Database searches combined the keyword warfarin with drug interactions, herbal medicines, Chinese herbal drugs, and food-drug interactions.[doi.org]
Cushingoid
  • He returned to our office in March, 2003, in a deplorable psychological status, still having frequent crises of headache and with several side effects of corticotherapy: cushingoid aspect; systemic blood hypertension and diabetes mellitus.[doi.org]
Easy Bruising
  • bruising — so you can report them to your doctor seeing your doctor if you become unwell – stomach upsets or being sick can sometimes affect your INR, especially if you don’t eat normally wearing a MedicAlert ID stating that you are taking warfarin.[nps.org.au]
  • These signs and symptoms include: bleeding from the gums or nose red or black bowel movements coughing up blood ( hemoptysis ) heavy bleeding from cuts or wounds that will not stop unusually heavy menstrual bleeding blood in the urine easy bruising or[encyclopedia.com]
Hemophilia A
  • Before using this medication , tell your doctor or pharmacist your medical history, especially of: blood disorders (such as anemia , hemophilia ), bleeding problems (such as bleeding of the stomach / intestines , bleeding in the brain ), blood vessel[webmd.com]
  • Warfarin should be used with caution in the following cases: Hemophilia and other bleeding problems Liver problems Kidney problems. Older people and those who have recently had surgery need to use warfarin with care.[medicalnewstoday.com]
  • ., hemophilia, polycythemia vera, purpura, leukemia) or a history of hemorrhagic diathesis or tendencies. 211 Recent or contemplated eye, brain, or spinal cord surgery or prostatectomy. 211 Open ulcerative, traumatic, or surgical wounds. 211 Active ulceration[web.archive.org]
Nausea
  • Side Effects The side effects of warfarin may include: Abdominal pain Bloating Chills Fever Gastrointestinal bleeding Headache Long nosebleeds Nausea and vomiting Taste changes Drug Interactions Warfarin is well known for the vast number of medications[news-medical.net]
  • Common ones include nausea, vomiting, diarrhea and abdominal pain. The most common side effect — bleeding — can be life-threatening. Rare side effects include stroke, gangrene and death.[drugwatch.com]
  • […] infrequently with chronic warfarin therapy include the following: Agranulocytosis Alopecia Anaphylactoid reactions Anorexia Cold intolerance Diarrhea Dizziness Elevated hepatic enzyme levels Exfoliative dermatitis Headache Hepatitis Jaundice Leukopenia Nausea[emedicine.medscape.com]
  • Common side effects include nausea (feeling sick) and diarrhoea (runny poos). These may go away with time. Tell your doctor if troublesome. Increased risk of bleeding Warfarin increases your risk of bleeding.[healthnavigator.org.nz]
Hematemesis
  • ., intracranial hemorrhage, gastrointestinal (GI) bleed, hematemesis, intraocular bleeding, hemarthrosis) can occur at virtually any site on the body.[ncbi.nlm.nih.gov]
Bleeding Gums
  • The patients on anticoagulation therapy especially warfarin can develop gastrointestinal bleed, gum bleeding, hematuria or ecchymosis. Rarely do such patients present with hemoperitoneum producing symptoms.[ncbi.nlm.nih.gov]
  • You may occasionally notice bleeding, such as bruises on your body or bleeding gums when you brush your teeth.[nps.org.au]
  • Call your doctor at once if you have other signs of bleeding such as: swelling, pain, feeling very weak or dizzy, unusual bruising, bleeding gums, nosebleeds, heavy menstrual periods or abnormal vaginal bleeding, blood in your urine, bloody or tarry stools[drugs.com]
Purpura
  • Piette, Purpura and Microvascular Occlusion, Rook's Textbook of Dermatology, (2351-2394), (2008).[dx.doi.org]
  • The differential diagnosis included hematoma, disseminated intravascular coagulation, purpura fulminans, necrotizing fasciitis, cellulitis, venous gangrene and calciphylaxis 1, 6, 7.[ncbi.nlm.nih.gov]
  • Incidence of allergic reactions with fresh frozen plasma or cryo-supernatant plasma in the treatment of thrombotic thrombocytopenic purpura. J Clin Apher 2001; 16: 134-138. 8 Toy P, Popovsky MA, Abraham E. et al.[doi.org]
  • […] epistaxis Gastrointestinal disorders Gastroinestinal haemorrhage, rectal haemorrhage, haematemesis; pancreatitis; diarrhoea; nausea; vomiting; melaena Hepatobiliary disorders Jaundice; hepatic dysfunction Skin and subcutaneous disorders Rash; alopecia; purpura[medicines.org.uk]
Alopecia
  • Additional complications Other adverse reactions that occur infrequently with chronic warfarin therapy include the following: Agranulocytosis Alopecia Anaphylactoid reactions Anorexia Cold intolerance Diarrhea Dizziness Elevated hepatic enzyme levels[emedicine.medscape.com]
  • Other side effects that may occur with warfarin treatment include: mild stomach cramps upset stomach hair loss ( alopecia ) poor appetite ( anorexia ) cough or hoarseness fever or chills skin rash, hive, or itching painful or difficult urination The occurrence[encyclopedia.com]
  • Side effects of warfarin As with any medication these are rare and unpredictable, but may include: Hypersensitivity Rash Alopecia (hair loss) Diarrhoea Nausea (feeling sick) Vomiting (being sick) Changes to skin circulation which may cause a purple or[gosh.nhs.uk]
Epistaxis
  • The following day his INR rebounded to 8.5 and he suffered a spontaneous epistaxis requiring readmission; he was treated with low titrated doses of vitamin K1.[ncbi.nlm.nih.gov]
  • The most frequently reported events were: increased international normalised ratio (INR, 111 reports); contusion (21); haematuria (17); and epistaxis (8).[gov.uk]
  • Minor bleeding from mucous membranes, subconjunctival hemorrhage, hematuria, epistaxis, and ecchymoses may occur. Major bleeding complications include GI hemorrhage, intracranial bleeding, and retroperitoneal bleeding.[emedicine.medscape.com]
  • Label, 19 Epistaxis, ecchymoses, as well as renal and hepatic bleeding are also associated. These symptoms become apparent within 2-4 days of overdose although increases in prothrombin time can be observed within 24 hours.[drugbank.ca]
Intracranial Hemorrhage
  • hemorrhage; and (4) weighted sum of differences between rates of death, ischemic stroke or systemic embolism, intracranial hemorrhage, and major bleeding.[ncbi.nlm.nih.gov]
  • Whereas the medication itself is more expensive than traditional warfarin, the total cost of a hospital admission has not been compared between patients on DOACs and warfarin who have sustained a blunt traumatic intracranial hemorrhage (ICH).[ncbi.nlm.nih.gov]
  • Introduction: Advancements in the treatment of warfarin-associated intracranial hemorrhage (ICH) include the use of four-factor prothrombin complex concentrate (4F-PCC), which has demonstrated more rapid reversal of the international normalized ratio[ncbi.nlm.nih.gov]
  • *The term ‘stroke’ refers to ischemic strokes, those caused by blockage of a blood vessel, while we use the term ‘intracranial hemorrhage’ to indicate bleeding in the brain.[thennt.com]
  • The most catastrophic form of bleeding that can occur is intracranial hemorrhage, “which is fatal in almost all cases,” Sheikh says.[todaysgeriatricmedicine.com]
Hematuria
  • The patients on anticoagulation therapy especially warfarin can develop gastrointestinal bleed, gum bleeding, hematuria or ecchymosis. Rarely do such patients present with hemoperitoneum producing symptoms.[ncbi.nlm.nih.gov]
  • The authors hereby report a 56-year-old man who developed gross hematuria and severe acute kidney injury (AKI) necessitating hemodialysis, following supra-therapeutic INR level.[ncbi.nlm.nih.gov]
  • We herein present the case of a patient with frank hemoptysis and hematuria, dyspnea, and cough. The patient was known to be affected by Chronic Obstructive Pulmonary Disease (COPD) and dilated cardiomyopathy with atrial fibrillation.[ncbi.nlm.nih.gov]
  • Four weeks later, the patient came to the emergency department with hematuria. He denied dysuria, taking more than the prescribed amount of warfarin, any changes in his diet, taking any over-the-counter or herbal products, and any other bleeding.[ncbi.nlm.nih.gov]
  • […] foods; high vitamin K consumption may decrease warfarin effect In patients with altered glomerular integrity or with history of kidney disease, acute kidney injury may occur with therapy, possibly in relation to episodes of excessive anticoagulation and hematuria[reference.medscape.com]
Macroscopic Hematuria
  • On November 11th, 2010, the patient noticed significant macroscopic hematuria that lasted for three days and a supratherapeutic INR (7.22) was measured on the same day.[bmcpharmacoltoxicol.biomedcentral.com]

Workup

  • A laboratory workup indicated a normal clotting profile ( Table 1 ). A histopathologic examination of incisional cutaneous biopsy was suggestive of warfarin-induced skin necrosis ( Fig. 1B ).[ncbi.nlm.nih.gov]
  • CMS did not hold a MEDCAC meeting to specifically address the evidentiary base for the use of pharmacogenetic testing as part of the workup of patients needing anticoagulation.[web.archive.org]

Treatment

  • Two patients required dose reductions after HCV treatment completion, whereas the other two did not.[ncbi.nlm.nih.gov]
  • A case of increased warfarin requirements during treatment with sofosbuvir and ribavirin for chronic hepatitis C virus (HCV) infection is reported.[ncbi.nlm.nih.gov]
  • During 2years of warfarin treatment, there were only two minor episodes of purpuric access and no bleeding was reported.[ncbi.nlm.nih.gov]
  • Diagnosis and effective treatment can be delayed if patients are on warfarin treatment, as the bleeding symptoms may be erroneously attributed to this agent.[ncbi.nlm.nih.gov]
  • We suggested again the surgical treatment and he agreed.[doi.org]

Prognosis

  • Prompt diagnosis and discontinuation of warfarin are crucial for the prognosis.[ncbi.nlm.nih.gov]
  • The case report presents an incomplete picture of the patient’s prognosis, but it is clear that a combination of factors may have contributed to his elevated INR.[doi.org]
  • Improvement of prognosis by home prothrombin estimation in patients with life-long anticoagulant therapy. Eur Heart J . 1996; 17 (suppl): 230.Abstract.[ahajournals.org]
  • Improvement of prognosis by home prothrombin estimation in patients with life-long anticoagulant therapy. Eur Heart J. 1996; 17 (suppl): 230.Abstract.[circ.ahajournals.org]

Etiology

  • An extensive review of the pharmacokinetic and pharmacodynamic literature did not uncover a definitive etiology for this interaction. However, several undefined aspects in each drug's disposition pathway need further elucidation.[ncbi.nlm.nih.gov]
  • […] which may lead to necrosis or death Use caution in patients with prolonged vitamin K insufficiencies Thyroid disease may increase warfarin responsiveness May impair synthesis of coagulation factors in patients with reduced liver function, regardless of etiology[reference.medscape.com]
  • General recommendations The requisite features of causality exist for a warfarin/acetaminophen interaction: temporal relationship, measurable effect with dechallenge and rechallenge, dose-response, exclusion or accounting of other possible etiologic factors[bloodjournal.org]
  • ., Determining Etiology: Biopsy and Laboratory Investigation, Wound Healing and Ulcers of the Skin, 10.1007/3-540-26761-1_6, (71-88), (2005). W. C.[dx.doi.org]

Epidemiology

  • Thromb Haemost 2016; 116(05): 879-890 DOI: 10.1160/TH16-04-0266 Coagulation and Fibrinolysis Schattauer GmbH Chatree Chai-Adisaksopha 1 Department of Medicine, McMaster University, Canada 2 Department of Clinical Epidemiology and Biostatistics, McMaster[doi.org]
  • As John Concato, MD, Director, VA Clinical Epidemiology Research Center at Yale University says "Putting what we know into practice would prevent more disease than worshiping at the altar of randomized trials."[genelex.com]
  • Open Access Review 1 Animal Health and Veterinary Laboratories Agency, Woodham Lane, Surrey, KT15 3NB, UK 2 Rabies Laboratory, Virology Department, Institute of Epidemiology Diagnostic and Reference (InDRE), Francisco de P. Miranda #177Bis.[doi.org]
  • In: Statistical Models in Epidemiology . Oxford, England: Oxford Science Publications; 1998:298-306. 29. Khoury MJ, Beaty TH, Cohen BH. The Hardy-Weinberg principle. In: Fundamentals of Genetic Epidemiology .[dx.doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Our review indicates that warfarin-associated calciphylaxis is clinically and pathophysiologically distinct from classic calciphylaxis. To review warfarin-associated calciphylaxis and determine its relationship to classic calciphylaxis.[ncbi.nlm.nih.gov]
  • Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Warfarin (Coumadin) is an anticoagulant that acts by antagonizing the action of vitamin K resulting in the same coagulation abnormalities[mayomedicallaboratories.com]
  • Such exercises have allowed us to better understand the pathophysiology of those diseases as well as to better characterize the pre‐thrombotic state.[doi.org]
  • Yunyoung Chang, Ganary Dabiri, Elizabeth Damstetter, Emily Baiyee Ebot, Jennifer Gloeckner Powers and Tania Phillips, Coagulation disorders and their cutaneous presentations: Pathophysiology, Journal of the American Academy of Dermatology, 10.1016/j.jaad[dx.doi.org]

Prevention

  • Stroke Prevention in Atrial Fibrillation Study Group Investigators. Preliminary report of the Stroke Prevention in Atrial Fibrillation Study. N Engl J Med. 1990; 322:863-8. 223.[drugs.com]
  • World Heart Federation and the Preventive Cardiovascular Nurses Association.[web.archive.org]
  • The drug is currently being tested for the prevention and treatment of VTE, for the prevention of stroke or systemic embolism in patients with AF, and for the management of ACS.[web.archive.org]
  • Though no specific guidelines are currently available to prevent or treat this less-recognized side effect, discontinuing warfarin and using an alternative anticoagulant seems to be a reasonable option.[ncbi.nlm.nih.gov]
  • Cranberry juice is increasingly used for the prevention and adjunctive treatment of urinary tract infections.[web.archive.org]

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