An unusual case of warfarin-induced pinna skin necrosis

2008 ◽  
Vol 123 (6) ◽  
pp. 685-688 ◽  
Author(s):  
M Martinez Del Pero ◽  
S Verma ◽  
A Espeso ◽  
M Griffiths ◽  
P Jani
Keyword(s):  
Skin Necrosis ◽  
Protein S ◽  
Unusual Site ◽  
Vein Thrombosis ◽  
Low Protein ◽  
Menopausal Women ◽  
Diagnostic Confusion ◽  
History Of ◽  
Recurrent Deep Vein Thrombosis ◽  
Deep Vein

AbstractIntroduction:Warfarin-induced skin necrosis is a rare but recognised complication of this drug. The condition predominantly affects the breasts, buttocks and thighs of obese, peri-menopausal women. We present the case of a patient with the condition in an unusual site, and we discuss the management challenges involved.Case report:An 82-year-old man presented to the ENT department with a diagnosis of pinna haematoma. There was no history of trauma or infection. The patient was taking warfarin long-term for recurrent deep vein thrombosis. Two weeks prior to admission, the patient had had a loading course of warfarin following surgery. Multiple clinical teams were involved in treatment. The only abnormal laboratory investigation was a low protein S level; biopsy showed skin necrosis.Conclusion:In this case, the unusual presentation created diagnostic confusion, and may have precipitated aggressive surgical debridement. However, a more conservative management strategy was used, which we would recommend in future.

scholarly journals Favorable Evolution of a Patient with Thromboembolic Pulmonary Hypertension

2017 ◽  
Vol 23 (2) ◽  
pp. 94-98
Author(s):  
Cristina Nedelcu ◽  
Irinel Raluca Parepa ◽  
Laura Mazilu ◽  
Andra-Iulia Suceveanu ◽  
Luminita Matei ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Young Adulthood ◽  
Primary Pulmonary Hypertension ◽  
Endothelin Receptor ◽  
Vein Thrombosis ◽  
Thromboembolic Pulmonary Hypertension ◽  
History Of ◽  
Recurrent Deep Vein Thrombosis ◽  
Deep Vein ◽  
Phosphodiesterase 5

AbstractWe present a case of severe thromboembolic pulmonary hypertension in a patient with history of recurrent deep vein thrombosis and pulmonary restrictive disease due to pulmonary and vertebral tuberculosis in young adulthood. He was considered not eligible in the National Program for Primary Pulmonary Hypertension, being referred for thoracic surgery, but he was considered unfit for thrombendarterectomy. Despite guidelines, we administered him specific medical therapy (phosphodiesterase-5 inhibitors and endothelin receptor antagonists). His clinical evolution was satisfactory, with increasing effort tolerance and decreasing need for ambulatory oxigenotherapy.

Recurrent deep vein thrombosis with a protein S Tokushima mutation

2017 ◽  
Vol 178 (1) ◽  
Author(s):  
R. Torai ◽  
T. Makino ◽  
M. Mizawa ◽  
M. Hayashi ◽  
F. Furukawa ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Protein S ◽  
Vein Thrombosis ◽  
Recurrent Deep Vein Thrombosis ◽  
Deep Vein

Homozygosity for the Protein S Heerlen Allele Is Associated with Type I PS Deficiency in a Thrombophilic Pedigree with Multiple Risk Factors

2000 ◽  
Vol 83 (01) ◽  
pp. 102-106 ◽  
Author(s):  
Yolanda Espinosa-Parrilla ◽  
Gemma Navarro ◽  
Marta Morell ◽  
Eugènia Abella ◽  
Xavier Estivill ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protein S ◽  
Type I ◽  
Factor V ◽  
Type Iii ◽  
Vein Thrombosis ◽  
Multiple Risk Factors ◽  
S Deficiency ◽  
Recurrent Deep Vein Thrombosis ◽  
Deep Vein

SummaryThe multifactorial character of thrombotic disease is shown in a Spanish pedigree in which the propositus, with recurrent deep vein thrombosis, inherited the factor V R/Q506 mutation, the prothrombin 20210G/A variant and type III Protein S deficiency. Among 14 relatives carrying one or two of these three risk factors, thrombosis is present in a heterozygote for R/Q506 and in another for 20210G/A, who also had slightly positive antiphospholipid antibodies. Type I PS deficiency was also found in a young asymptomatic woman. PROS1 analysis showed coexistence of type III and type I PS deficiency to be associated with heterozygosity and homozygosity, respectively, for the P460 or PS Heerlen allele of the S/P460 variant. Analysis of PS values in this and other pedigrees segregating this variant revealed that not only free but also mean total PS levels are slightly but significantly lower in the SP460 heterozygotes than in the SS460 homozygotes. These findings strongly suggest a role of the P460 variant in the expression of the PS deficient phenotype.

Factor XII gene (F12) −4C/C polymorphism in combination with low protein S activity is associated with deep vein thrombosis

2006 ◽  
Vol 96 (12) ◽  
pp. 854-855 ◽  
Author(s):  
Kumiko Watanabe ◽  
Sachiko Hattori ◽  
Michiyo Urata ◽  
Hiroko Iida ◽  
Sachiko Kinoshita ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Protein S ◽  
Factor Xii ◽  
Vein Thrombosis ◽  
Low Protein ◽  
Deep Vein ◽  
Protein S Activity

Spontaneous retroperitoneal haemorrhage secondary to anticoagulation polypharmacy

2021 ◽  
Vol 14 (8) ◽  
pp. e242934
Author(s):  
Mohammed M Uddin ◽  
Tanveer Mir ◽  
Amir Khalil ◽  
Zeenat Bhat ◽  
Anita Maria Noronha
Keyword(s):  
Management Strategies ◽  
Vein Thrombosis ◽  
Anticoagulation Agents ◽  
Concurrent Use ◽  
Life Threatening ◽  
History Of ◽  
Recurrent Deep Vein Thrombosis ◽  
Retroperitoneal Haemorrhage ◽  
Deep Vein

Retroperitoneal haemorrhage (RH) is not uncommon in patients with provoking events like trauma. However, spontaneous RH (SRH) is a rare and life-threatening complication described as the development of bleeding into the retroperitoneal cavity, appearing spontaneously and without a preceding history of trauma or other predisposing illness. We are reporting a case of an elderly patient with recurrent deep vein thrombosis who had developed SRH secondary to concurrent use of multiple anticoagulation agents, resulting from poor healthcare follow-up and lack of sufficient medication reconciliation. This article highlights the significance of recognising risk factors for SRH, as well as management strategies through literature review.

Natural history of deep vein thrombosis in children

2014 ◽  
Vol 30 (6) ◽  
pp. 412-417 ◽  
Author(s):  
G Spentzouris ◽  
A Gasparis ◽  
RJ Scriven ◽  
TK Lee ◽  
N Labropoulos
Keyword(s):  
Deep Vein Thrombosis ◽  
Signs And Symptoms ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Vein Thrombosis ◽  
History Of ◽  
Recurrent Deep Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Objective To determine the natural history of deep vein thrombosis in children presented with a first episode in the lower extremity veins. Methods Children with objective diagnosis of acute deep vein thrombosis were followed up with ultrasound and clinical examination. Risk factors and clinical presentation were prospectively collected. The prevalence of recurrent deep vein thrombosis and the development of signs and symptoms of chronic venous disease were recorded. Results There were 27 children, 15 males and 12 females, with acute deep vein thrombosis, with a mean age of 4 years, range 0.1–16 years. The median follow-up was 23 months, range 8–62 months. The location of thrombosis involved the iliac and common femoral vein in 18 patients and the femoral and popliteal veins in 9. Only one vein was affected in 7 children, two veins in 14 and more than two veins in 6. Recurrent deep vein thrombosis occurred in two patients, while no patient had a clinically significant pulmonary embolism. Signs and symptoms of chronic venous disease were present at last follow-up in 11 patients. There were nine patients with vein collaterals, but no patient developed varicose veins. Reflux was found in 18 veins of 11 patients. Failure of recanalization was seen in 7 patients and partial recanalization in 11. Iliofemoral thrombosis ( p = 0.012) and failure to recanalize ( p = 0.036) increased significantly the risk for developing signs and symptoms. Conclusions Children with acute proximal deep vein thrombosis develop mild chronic venous disease signs and symptoms at mid-term follow-up and are closely related with iliofemoral thrombosis and failure to recanalization.

Autoimmune Protein S Deficiency and Deep Vein Thrombosis after Chickenpox

1996 ◽  
Vol 75 (01) ◽  
pp. 212-213 ◽  
Author(s):  
Flora Peyvandi ◽  
Elena Faioni ◽  
Gian Alessandro Moroni ◽  
Alberto Rosti ◽  
Luigi Leo ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Protein S ◽  
Protein S Deficiency ◽  
Vein Thrombosis ◽  
S Deficiency ◽  
Deep Vein

Does Low Protein Concentration of Tissue-type Plasminogen Activator Predict a Low Risk of Spontaneous Deep Vein Thrombosis?

1995 ◽  
Vol 74 (02) ◽  
pp. 718-721 ◽  
Author(s):  
Jørgen Gram ◽  
Johannes Sidelmann ◽  
Jørgen Jespersen
Keyword(s):  
Deep Vein Thrombosis ◽  
Confidence Interval ◽  
Plasminogen Activator ◽  
Fibrinolytic Activity ◽  
Protein Concentration ◽  
Tissue Type ◽  
Vein Thrombosis ◽  
Low Protein ◽  
Deep Vein ◽  
Pai 1

SummaryMany reports have demonstrated an abnormal fibrinolysis in a subset of patients with deep vein thrombosis. We have studied systemic global fibrinolytic activity and protein concentrations of tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) in plasma of 25 young patients with a previous instance of spontaneous deep vein thrombosis documented by phlebography and in 50 healthy controls. The two populations were comparable with respect to a number of base-line variables (age, height, weight, etc.), while the patients had significantly lower fibrinolytic activity (p <0.02), and significantly higher protein concentrations of t-PA (p <0.0001) and PAI-1 (p <0.0006).We used probit scale plots to identify the consequence of different cut-off points to separate patients from controls. Reasonable separation could be obtained for t-PA with a cut-off point of 5.2 ng/ml and for PAI-1 18 ng/ml. The sensitivity and specificity for these cut-off points were for t-PA 73% (95% confidence interval 63%-84%) and for PAI-1 67% (confidence interval 55%-77%). The negative predictive value with a cut-off point t-PA concentration of 5.2 ng/ml was 85% (95% confidence interval 70%-94%). We observed a significantly negative association between concentration of t-PA and fibrinolytic activity (rs = -0.47; p <0.005) and also between PAI-1 and fibrinolytic activity (rs = -0.78; p <0.005).We conclude that a young healthy population is characterized by low protein concentration of t-PA (and PAI-1) compared with young patients with a previous instance of spontaneous vein thrombosis, and we tentatively state that a low protein concentration of t-PA predicts a low risk of spontaneous deep vein thrombosis.

Role of Platelets in Recurrent Deep Vein Thrombosis

1975 ◽  
Author(s):  
K. K. Wu ◽  
R. W. Barnes ◽  
J. C. Hoak
Keyword(s):  
Deep Vein Thrombosis ◽  
Oral Anticoagulant Therapy ◽  
Additional Patient ◽  
Ratio Method ◽  
Vein Thrombosis ◽  
Platelet Survival ◽  
Platelet Aggregate ◽  
Recurrent Deep Vein Thrombosis ◽  
Platelet Aggregates ◽  
Deep Vein

To evaluate the role that platelets play in the pathogenesis of recurrent deep vein thrombosis (DVT), a platelet count ratio method was used for the detection of platelet aggregates and an aggregometric technique was used to measure spontaneous aggregation (SPA) in 27 patients with idiopathic recurrent DVT. Seventeen patients were found to have decreased platelet aggregate ratios (mean 0.63±SEM 0.02) which were significantly lower than those of normals (0.90 ±0.02, p < 0.01). Twelve of the 17 patients had SPA. The mean platelet survival half-time of 5 patients with increased platelet aggregates was 2.9 days±0.49, significantly decreased from that of normals (4.2 ±0.10, p < 0.05). Platelet survival values were normal in patients with normal platelet aggregate ratios. Five patients who failed to improve on oral anticoagulant therapy responded to aspirin and dipyridamole with normalization of platelet aggregates and disappearance of SPA. An additional patient responded to sulfinpyrazone. When the drug was discontinued, pulmonary embolus recurred. These findings suggest that recurrent DVT may involve heterogeneous groups of patients and platelets may play an important pathogenetic role in some of them. The approach to the problem with this panel of 3 tests appears useful in the selection of patients for treatment with antiplatelet agents.

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