scholarly journals Management of Anticoagulants before and after Endoscopy

2003 ◽  
Vol 17 (5) ◽  
pp. 329-332 ◽  
Author(s):  
Axel Hittelet ◽  
Jacques Devière
Keyword(s):  
High Risk ◽  
Warfarin Therapy ◽  
Fresh Frozen Plasma ◽  
Stent Insertion ◽  
Normal Range ◽  
Endoscopic Retrograde ◽  
Before And After ◽  
Fresh Frozen ◽  
Inflammatory Drugs ◽  
Frozen Plasma

The risk of procedure-related bleeding while taking anticoagulants needs to be weighed against the risk of thromboembolism from discontinuing these drugs. It is not necessary to adjust anticoagulation for low-risk procedures, such as upper endoscopy with biopsy, colonoscopy with biopsy or endoscopic retrograde cholangiopancreatography with stent insertion (but without sphincterotomy). Procedures that incur a high risk of bleeding include polypectomy, endoscopic sphincterotomy, laser therapy, mucosal ablation and treatment of varices. For these procedures, warfarin should be discontinued four to five days beforehand. Depending on the risk of thromboembolism, that is based on the nature of the underlying condition, the patient may require vitamin K and/or fresh frozen plasma (to ensure that coagulation parameters are within the normal range) or heparin infusions (to ensure that some degree of anticoagulation is maintained). Low molecular weight heparin is an alternative to unfractionated heparin for select cases with a high risk of thromboembolism. Warfarin therapy may generally be resumed on the night of the procedure and may be supplemented by heparin in patients with a high risk of thromboembolism. It is not necessary to discontinue acetylsalicylic acid or nonsteroidal anti-inflammatory drugs, when used in standard doses, for endoscopic procedures. There are insufficient data to make recommendations regarding newer antiplatelet drugs, such as ticlopidine or clopidogrel, but it is prudent to discontinue these medications seven to 10 days before a high-risk procedure.

scholarly journals Concurrent Spontaneous Sublingual and Intramural Small Bowel Hematoma due to Warfarin Use

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Gül Pamukçu Günaydın ◽  
Hatice Duygu Çiftçi Sivri ◽  
Serkan Sivri ◽  
Yavuz Otal ◽  
Ayhan Özhasenekler ◽  
...  
Keyword(s):  
Emergency Department ◽  
Small Bowel ◽  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Close Monitoring ◽  
Observation Unit ◽  
Fresh Frozen ◽  
Tomography Scan ◽  
Frozen Plasma

Introduction. We present a case of concurrent spontaneous sublingual and intramural small bowel hematoma due to warfarin anticoagulation.Case. A 71-year-old man presented to the emergency department complaining of a swollen, painful tongue. He was on warfarin therapy. Physical examination revealed sublingual hematoma. His international normalized ratio was 11.9. The computed tomography scan of the neck demonstrated sublingual hematoma. He was admitted to emergency department observation unit, monitored closely; anticoagulation was reversed with fresh frozen plasma and vitamin K. 26 hours after his arrival to the emergency department, his abdominal pain and melena started. His abdomen tomography demonstrated intestinal submucosal hemorrhage in the ileum. He was admitted to surgical floor, monitored closely, and discharged on day 4.Conclusion. Since the patient did not have airway compromise holding anticoagulant, reversing anticoagulation, close monitoring and observation were enough for management of both sublingual and spontaneous intramural small bowel hematoma.

Predisposing factors for enlargement of intracerebral hemorrhage in patients treated with warfarin

2003 ◽  
Vol 89 (02) ◽  
pp. 278-283 ◽  
Author(s):  
Kazuo Minematsu ◽  
Hiroaki Naritomi ◽  
Toshiyuki Sakata ◽  
Takenori Yamaguchi ◽  
Masahiro Yasaka
Keyword(s):  
Logistic Regression Model ◽  
Prothrombin Complex Concentrate ◽  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Predisposing Factors ◽  
Predisposing Factor ◽  
Fresh Frozen ◽  
Cerebral Hematoma ◽  
Frozen Plasma

SummaryTo elucidate predisposing factors for enlargement of intra-cerebral hematoma (ICH) during warfarin therapy, we reviewed 47 patients on warfarin who developed acute ICH and determined relationships among ICH enlargement, INR reversal and clinical data. Among 36 patients treated to counteract the effects of warfarin within 24 h of onset, ICH increased in 10 patients (enlarged group), but remained unchanged in the remaining 26 (unchanged group), while ICH remained unchanged in another 11 patients in whom the effect of warfarin was reversed after 24 h. The international normalized ratio (INR) was counteracted immediately in 11 patients treated with prothrombin complex concentrate (PCC) but gradually in the other 36 treated by reducing the dose of warfarin, or by administering vitamin K or fresh frozen plasma. Multivariate analysis with a logistic regression model showed an INR value <2.0 at admission or for 24 h after immediate INR correction with PCC prevented ICH enlargement (OR 0.069, 95%CI 0.006-0.789, p = 0.031). An INR value of >2.0 within 24 h of ICH seems an important predisposing factor for ICH enlargement.

Retrospective evaluation of the indications, safety and effects of fresh frozen plasma transfusions in 36 cats (2014–2018)

2019 ◽  
Vol 22 (8) ◽  
pp. 696-704
Author(s):  
Elizabeth T Mansi ◽  
Jennifer E Waldrop ◽  
Elizabeth B Davidow
Keyword(s):  
Retrospective Study ◽  
Fresh Frozen Plasma ◽  
Packed Red Blood Cells ◽  
Tolerable Risk ◽  
Coagulation Testing ◽  
Before And After ◽  
Referral Hospitals ◽  
Fresh Frozen ◽  
Frozen Plasma ◽  
Transfusion Reactions

Objectives The goals of this study were to classify the indications, risks, effects on coagulation times and outcomes of cats receiving fresh frozen plasma (FFP) transfusions in clinical practice. Methods This was a retrospective study of FFP transfusions administered in two referral hospitals from 2014 to 2018. Transfusion administration forms and medical records were reviewed. Information was collected on indication, underlying condition, coagulation times and signs of transfusion reactions. Seven-day outcomes after FFP administration were also evaluated when available. Results Thirty-six cats received 54 FFP transfusions. Ninety-four percent of cats were administered FFP for treatment of a coagulopathy. Twenty cats had paired coagulation testing before and after FFP administration. Eighteen of these cats had improved coagulation times after receiving 1–3 units of FFP. Eight of the 36 cats had probable transfusion reactions (14.8% of 54 FFP transfusions). These reactions included respiratory signs (n = 4), fever (n = 2) and gastrointestinal signs (n = 2). Five of the eight cats with probable reactions had received packed red blood cells contemporaneously. Overall mortality rate during hospitalization was 29.7%, with 52.8% (n = 19/36) of cats confirmed to be alive 7 days after discharge. Conclusions and relevance This retrospective study shows that FFP transfusions improve coagulation times in cats. Transfusion reactions are a risk, and risk–benefit ratios must be measured prior to administration and possible reactions monitored. In the study cats, the FFP transfusions appeared to be a tolerable risk given the benefit to prolonged coagulation times.

Management of upper airway obstruction secondary to warfarin therapy: the conservative approach

2006 ◽  
Vol 120 (2) ◽  
pp. 1-2 ◽  
Author(s):  
Mingyann Lim ◽  
Meena Chaudhari ◽  
Pablo M Devesa ◽  
Angus Waddell ◽  
Deepak Gupta
Keyword(s):  
Airway Obstruction ◽  
Endotracheal Intubation ◽  
Warfarin Therapy ◽  
Upper Airway ◽  
Emergency Situation ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
The Right ◽  
Frozen Plasma

Airway obstruction secondary to bleeding from warfarin therapy is difficult to manage and uncommon but has been previously described. Previous reports have emphasized the need for reversal of therapy using vitamin K and fresh frozen plasma (FFP). Where a definitive airway has been required, cricothyroidotomy or tracheostomy seem to have been favoured. Several authors have reported failed attempts at endotracheal intubation due to the obstructive effects of a sublingual haematoma. We report here a case which illustrates how endotracheal intubation can be used successfully under the right conditions. It also highlights the superiority of prothrombin complex concentrate over FFP in achieving rapid reversal of abnormal international normalized ratio in the emergency situation.

Homozygous Protein C Deficiency: Observations on the Nature of the Molecular Abnormality and the Effectiveness of Warfarin Therapy

PEDIATRICS ◽  
1988 ◽  
Vol 81 (2) ◽  
pp. 272-276
Author(s):  
Charles Peters ◽  
James F. Casella ◽  
Richard A. Marlar ◽  
Robert R. Montgomery ◽  
William H. Zinkham
Keyword(s):  
Protein C ◽  
Warfarin Therapy ◽  
Purpura Fulminans ◽  
Fresh Frozen Plasma ◽  
Dietary Vitamin ◽  
Medical Attention ◽  
Protein C Deficiency ◽  
Plasma Therapy ◽  
Fresh Frozen ◽  
Frozen Plasma

An infant with severe homozygous protein C deficiency was brought to medical attention because of purpura fulminans and severe bilateral vitreous hemorrhages in the neonatal period. Infusions of fresh frozen plasma were given for 8 months. On two occasions, attempts to decrease the frequency of fresh frozen plasma infusions to less than twice a day led to episodes of microangiopathic hemolysis, fibrinolysis, and acute renal failure. Infarction of skin and subcutaneous tissues did not recur. Both episodes were controlled after reinstitution of fresh frozen plasma. Complications of therapy with fresh frozen plasma included hyperproteinemia and hypertension. Warfarin therapy was instituted when the baby was 8 months of age, followed by a gradual withdrawal of fresh frozen plasma therapy. The dose of warfarin required to maintain the prothrombin time in a range of 1.8 to 2.2 times normal varied considerably during short periods, a phenomenon that may have been due to several factors: hypercatabolism of the drug with prolonged administration, abnormality of liver function, variation in levels of serum albumin, fluctuations in drug dosage secondary to oral administration, and variations in dietary vitamin K. Protein C determinations by immunologic and functional assays consistently showed detectable but reduced protein C antigen levels with undetectable activity levels, suggesting that a dysproteinemia rather than a deficiency of synthesis is responsible for the child's coagulopathy.

Use of Prothrombin Complex Concentrate as an Adjunct to Fresh Frozen Plasma Shortens Time to Craniotomy in Traumatic Brain Injury Patients

Neurosurgery ◽  
2015 ◽  
Vol 76 (5) ◽  
pp. 601-607 ◽  
Author(s):  
Bellal Joseph ◽  
Viraj Pandit ◽  
Mazhar Khalil ◽  
Narong Kulvatunyou ◽  
Hassan Aziz ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Scale Score ◽  
Prothrombin Complex Concentrate ◽  
Warfarin Therapy ◽  
International Normalized Ratio ◽  
Fresh Frozen Plasma ◽  
Fresh Frozen ◽  
The Mean ◽  
Frozen Plasma

AbstractBACKGROUND:The use of prothrombin complex concentrate (PCC) to reverse acquired (coagulopathy of trauma) and induced coagulopathy (preinjury warfarin use) is well defined.OBJECTIVE:To compare outcomes in patients with traumatic brain injury without warfarin therapy receiving PCC as an adjunct to fresh frozen plasma (FFP) therapy compared with patients receiving FFP therapy alone.METHODS:All patients with traumatic brain injury coagulopathy without warfarin therapy who received PCC (25 IU/kg) in conjunction with FFP or FFP alone at our Level I trauma center were reviewed. Coagulopathy was defined as an international normalized ratio &gt;1.5. The groups (PCC + FFP vs FFP alone) were matched using propensity score matching on a 1:2 ratio for age, sex, Glasgow Coma Scale score, Injury Severity Score, head Abbreviated Injury Scale score, and international normalized ratio (INR) on presentation. The primary outcome measure was time to craniotomy. Secondary outcome measures were blood product requirements, cost of therapy, and mortality.RESULTS:A total of 1641 patients were reviewed, 222 of whom were included (PCC + FFP, 74; FFP, 148). The mean ± standard deviation age was 46.4 ± 21.7 years, the median (range) Glasgow Coma Scale score was 8 (3-12), and the mean ± standard deviation INR on presentation was 1.92 ± 0.6. PCC + FFP therapy was associated with an accelerated correction of INR (P = .001) and decrease in overall pack red blood cell (P = .035) and FFP (P = .041) administration requirement. Craniotomy was performed in 26.1% of patients (n = 58). Patients who received PCC + FFP therapy had faster time to craniotomy (P = .028) compared with patients who received FFP therapy alone.CONCLUSION:PCC as an adjunct to FFP decreases the time to craniotomy with faster correction of INR and concomitant decrease in the need for blood product requirement in patients with traumatic brain injury exclusive of prehospital warfarin therapy.

scholarly journals Effect of Plasma Exchange in Thyroid Storm With Consideration of Its Distribution Into the Extravascular Space

2020 ◽  
Vol 4 (4) ◽  
Author(s):  
Mai Shinohara ◽  
Toyoyoshi Uchida ◽  
Takashi Funayama ◽  
Mika Watanabe ◽  
Makio Kusaoi ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Thyroid Hormones ◽  
Plasma Exchange ◽  
Fresh Frozen Plasma ◽  
Thyroid Storm ◽  
Extravascular Space ◽  
Before And After ◽  
Fresh Frozen ◽  
Thyroid Hormone Levels ◽  
Frozen Plasma

Abstract Plasma exchange (PE), which directly removes some plasma thyroid hormones, is a treatment option for thyroid storm. However, the effect of PE has not been accurately assessed yet. Here we assessed the effect of PE in a patient with thyroid storm while taking into consideration the distribution of thyroid hormones in the extravascular space. A 51-year-old woman with thyroid storm underwent 2 PE procedures at our hospital. By measuring changes in thyroid hormone levels in plasma, fresh frozen plasma (FFP) used, and waste fluid during each 2.5-hour PE procedure, we calculated the efficiency of thyroid hormone removal based on the hypothesis that total thyroid hormone content before and after PE is the same. During the patient’s first PE procedure, the estimated thyroxine (T4) balance in the extravascular space (ΔX) was −70 μg, which corresponds to approximately 19% of T4 in the waste fluid. During the second PE procedure, ΔX was −131 μg, which corresponds to approximately 52% of T4 in the waste fluid. These data indicated that the source of removed T4 during PE varies. The amount of T4 removed from the extravascular space should be taken into account during assessment of the effect of PE in thyroid storm.

Efficacy of Lower Dose Rituximab by Adding Fresh Frozen Plasma for the Treatment of Idiopathic Thrombocytopenic Purpura

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4682-4682
Author(s):  
Mei Sun ◽  
JIan Gu ◽  
Bin He ◽  
Xiao-Yan Xie ◽  
Bao-An Chen ◽  
...  
Keyword(s):  
B Cells ◽  
Idiopathic Thrombocytopenic Purpura ◽  
Conflicts Of Interest ◽  
Complete Response ◽  
Fresh Frozen Plasma ◽  
Thrombocytopenic Purpura ◽  
Median Response ◽  
Before And After ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Abstract 4682 OBJECTIVE: To evaluate the effectiveness and safety of lower dose rituximab by adding fresh frozen plasma in the treatment of patients with idiopathic thrombocytopenic purpura (ITP). METHODS: A prospective study was performed at Subei People,Hospital Affiliated to Yang Zhou University involving the use of lower dose rituximab combining fresh frozen plasma in 15 patients who had previously been treated with steroids, intravenous immunoglobulin (IVIG) or splenectomy. Fifteen patients with refractory ITP which were unresponsive to or relapse after the above said treatment were treated with two hundreds millilitre of fresh frozen plasma (FFP) followed with rituximab (100 mg/m2 per week for four weeks) and oral Medrol (24mg per day). Whole blood cell count in all cases and B cells of CD19 (+)/CD20 (+) were detected in eight cases before and after rituximab therapy. RESULTS: Complete response (CR) was achieved in 7 patients (46.67%), response (R) in 13(86.67%), and non-response (NR) in 2 (13.33%). The median follow-up time was 4 weeks. The median response and CR time were 7 and 14 days, respectively. CD19 (+) CD20 (+) B cells significantly decreased (P < 0.01). There were no severe adverse effects during rituximab therapy. CONCLUSION: Lower dose rituximab by adding fresh frozen plasma is effective and safe for ITP. Our therapeutic regimen is superior to other relative studies; however, a randomized control trial is needed to confirm the results of our study. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Nontraumatic Massive Spontaneous Hemothorax with Concomitant Warfarin Use

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Nurettin Özgür Doğan ◽  
Gül Pamukçu Günaydın ◽  
Mustafa Tekin ◽  
Yunsur Çevik
Keyword(s):  
Warfarin Therapy ◽  
Rare Condition ◽  
Fresh Frozen Plasma ◽  
Main Complaint ◽  
Mediastinal Shift ◽  
Hemorrhagic Complications ◽  
Fresh Frozen ◽  
Massive Hemothorax ◽  
History Of ◽  
Frozen Plasma

Hemorrhagic complications due to warfarin use are frequently seen in emergency departments. However, nontraumatic massive hemothorax is an unexpected complication. We report a 59-year-old woman with warfarin overdose, who had massive hemothorax in right lung without any history of trauma. Her main complaint was significant dyspnea, which has gradually increased in three days. On her physical examination, she was tachypneic and had decreased lung sounds on her right hemithorax. She took warfarin regularly for aortic and mitral valve replacement for 18 years. Her INR level was 12.9 (0.8–1.2). Computed tomography of thorax revealed massive hemothorax with mediastinal shift. Fresh frozen plasma infusion was started immediately. Tube thoracostomy was performed for reexpansion of right lung and 2000 cc blood was drained in 5 minutes. Although hemorrhagic complications can be expected in warfarin therapy, thoracic hemorrhage related to warfarin therapy is relatively rare (3% of all hemorrhagic complications due to warfarin therapy). To our knowledge, massive hemothorax due to warfarin use is an extremely rare condition.

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