How I treat warfarin-associated coagulopathy in patients with intracerebral hemorrhage

Blood ◽  
2011 ◽  
Vol 117 (23) ◽  
pp. 6091-6099 ◽  
Author(s):  
Lawrence Tim Goodnough ◽  
Aryeh Shander
Keyword(s):  
Intracerebral Hemorrhage ◽  
Clinical Care ◽  
Relevant Literature ◽  
Coagulation Factor ◽  
Optimal Dose ◽  
Prothrombin Complex Concentrates ◽  
Plasma Therapy ◽  
Common Life ◽  
Threatening Condition ◽  
Life Threatening

Abstract Intracerebral hemorrhage in patients with warfarin-associated coagulopathy is an increasingly common life-threatening condition that requires emergent management. The evolution of therapeutic options in this setting, as well as recently published guidelines, has resulted in some heterogeneity in recommendations by professional societies. This heterogeneity can be attributed to lack of evidence-based support for plasma therapy; the variability in availability of prothrombin complex concentrates; the variability in the coagulation factor levels and contents of prothrombin complex concentrates; ambiguity about the optimal dose and route of administration of vitamin K; and the lack of standardized clinical care pathways, particularly in community hospitals, for the management of these critical care patients. In this review, we summarize the relevant literature about these controversies and present recommendations for management of patients with warfarin-associated coagulopathy and intracerebral hemorrhage.

Should Newborns with Refractory Chylothorax Be Tried on Higher Dose of Octreotide?

Neonatology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Geza Vass ◽  
Ria Evans Fry ◽  
Charles C. Roehr
Keyword(s):  
Dose Range ◽  
Optimal Dose ◽  
Lipid Absorption ◽  
Management Approach ◽  
High Dose ◽  
Somatostatin Analogue ◽  
Sustained Reduction ◽  
Threatening Condition ◽  
Life Threatening ◽  
Prolonged Hospital

Chylothorax is a rare but life-threatening condition in newborns, often requiring a prolonged hospital stay. To date, no unified guidance exists for best management approach. Octreotide, a somatostatin analogue, has been used to treat neonatal chylothorax due to its effect on the splanchnic circulation and lipid absorption. It is administered either subcutaneously or intravenously; for the latter, a dose range between 1 and 10 µg/kg/h is most commonly used. However, the optimal dose and way of administration remain unclear. Here, we report 2 newborn cases with large volume chylothorax (>500 mL/day), one with congenital chylothorax and one following a repair of a congenital diaphragmatic hernia (post-operative form). In both cases, a significant and sustained reduction in the volume of evacuated chyle was only seen once the dose of intravenous octreotide was increased to 20 µg/kg/h. We suggest that high-dose octreotide can be considered in seemingly refractory cases of neonatal chylothorax.

Coagulation factor V and thrombophilia: Background and mechanisms

2007 ◽  
Vol 98 (09) ◽  
pp. 530-542 ◽  
Author(s):  
Kenneth Segers ◽  
Björn Dahlbäck ◽  
Gerry Nicolaes
Keyword(s):  
Activated Protein C ◽  
Coagulation Factor ◽  
Thromboembolic Disease ◽  
Factor V ◽  
Apc Resistance ◽  
Thrombosis Research ◽  
Coagulation Protein ◽  
Threatening Condition ◽  
Life Threatening ◽  
Coagulation Factor V

SummaryHuman coagulation factor V (FV) is an essential coagulation protein with functions in both the pro- and anticoagulant pathways. Failure to express and control FV functions can either lead to bleeding, or to thromboembolic disease. Both events may develop into a life-threatening condition. Since the first description of APC resistance, and in particular the description of the so-called factor VLeiden mutation, in which a prominent activated protein C cleavage site in FV has been abolished through a mutation in the FV gene, FV has been in the center of attention of thrombosis research. In this review we describe how the functions of FV are expressed and regulated and provide an extensive description of the role that FV plays in the etiology of thromboembolic disease.

Gastrointestinal Bleeding in Congenital Bleeding Disorders

2022 ◽  
Author(s):  
Amir Samii ◽  
Mahshaad Norouzi ◽  
Abbas Ahmadi ◽  
Akbar Dorgalaleh
Keyword(s):  
Gastrointestinal Bleeding ◽  
Management Strategies ◽  
Coagulation Factor ◽  
Bleeding Disorders ◽  
Individual Factor ◽  
Threatening Condition ◽  
Potential Risk Factors ◽  
Risk Patients ◽  
Life Threatening ◽  
Management Approaches

AbstractGastrointestinal bleeding (GIB) is serious, intractable, and potentially life-threatening condition. There is considerable heterogeneity in GIB phenotypes among congenital bleeding disorders (CBDs), making GIB difficult to manage. Although GIB is rarely encountered in CBDs, its severity in some patients makes the need for a comprehensive and precise assessment of underlying factors and management approaches imperative. Initial evaluation of GIB begins with assessment of hematological status; GIB should be ruled out in patients with chronic anemia, and in presentations that include hematemesis, hematochezia, or melena. High-risk patients with recurrent GIB require urgent interventions such as replacement therapy for treatment of coagulation factor deficiency (CFD). However, the best management strategy for CFD-related bleeding remains controversial. While several investigations have identified CBDs as potential risk factors for GIB, research has focused on assessing the risks for individual factor deficiencies and other CBDs. This review highlights recent findings on the prevalence, management strategies, and alternative therapies of GIB related to CFDs, and platelet disorders.

Comparison of Initial and Postlavage Bacterial Culture Results of Septic Peritonitis in Dogs and Cats

2018 ◽  
Vol 54 (5) ◽  
pp. 257-266
Author(s):  
Sarah Ruth Kalafut ◽  
Pamela Schwartz ◽  
Rachael Leigh Currao ◽  
Andrew Scott Levien ◽  
George E. Moore
Keyword(s):  
Peritoneal Lavage ◽  
Positive Culture ◽  
Source Control ◽  
Bacterial Isolates ◽  
Common Life ◽  
Significant Difference ◽  
Septic Peritonitis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Susceptibility Profiles

ABSTRACT Septic peritonitis is a common, life-threatening condition encountered in dogs and cats. Efficacy of peritoneal lavage has not been proven in veterinary studies. Our objective was to evaluate differences in bacterial identity and susceptibility in samples obtained pre- and postlavage in animals who underwent laparotomy for treatment of septic peritonitis and to assess the effect of empirical antimicrobial selection on survival. Culture samples were collected from the peritoneal surface pre- and postlavage from dogs and cats treated surgically for septic peritonitis. Culture results were compared for each patient with regard to bacterial isolates and bacterial susceptibility profiles. Survival to discharge was evaluated. Microbial growth occurred in at least one culture in 88.6% of patients. There was no significant difference in bacterial isolates or susceptibility profiles pre- versus postlavage. Positive culture pre- or postlavage and appropriate antimicrobial selection did not significantly affect survival. For individual animals, culture results differed between pre- and postlavage samples, although no definitive effect of peritoneal lavage was seen for the population as a whole. Antimicrobials most commonly effective against isolates were Cefotaxime, Ceftazidime, and Imipenem. If prompt surgical source control is employed, antibiotic choice may not affect clinical outcome.

scholarly journals Framing Effects on Decision-Making for Diagnostic Genetic Testing: Results from a Randomized Trial

Genes ◽  
2021 ◽  
Vol 12 (6) ◽  
pp. 941
Author(s):  
Andrew A. Dwyer ◽  
Hongjie Shen ◽  
Ziwei Zeng ◽  
Matt Gregas ◽  
Min Zhao
Keyword(s):  
Genetic Testing ◽  
Behavioral Control ◽  
Clinical Care ◽  
Framing Effects ◽  
Web Based ◽  
Common Life ◽  
Decision Frames ◽  
Opt Out ◽  
Life Threatening ◽  
Individual Self

Genetic testing is increasingly part of routine clinical care. However, testing decisions may be characterized by regret as findings also implicate blood relatives. It is not known if genetic testing decisions are affected by the way information is presented (i.e., framing effects). We employed a randomized factorial design to examine framing effects on hypothetical genetic testing scenarios (common, life-threatening disease and rare, life-altering disease). Participants (n = 1012) received one of six decision frames: choice, default (n = 2; opt-in, opt-out), or enhanced choice (n = 3, based on the Theory of Planned Behavior). We compared testing decision, satisfaction, regret, and decision cognitions across decision frames and between scenarios. Participants randomized to ‘choice’ were least likely to opt for genetic testing compared with default and enhanced choice frames (78% vs. 83–91%, p < 0.05). Neither satisfaction nor regret differed across frames. Perceived autonomy (behavioral control) predicted satisfaction (B = 0.085, p < 0.001) while lack of control predicted regret (B = 0.346, p < 0.001). Opting for genetic testing did not differ between disease scenarios (p = 0.23). Results suggest framing can nudge individuals towards opting for genetic testing. These findings have important implications for individual self-determination in the genomic era. Similarities between scenarios with disparate disease trajectories point to possible modular approaches for web-based decisional support.

Venous Thromboembolic Disease

2008 ◽  
Vol 6 (8) ◽  
pp. 716 ◽  
Author(s):  
_ _
Keyword(s):  
Cancer Patients ◽  
Perceived Risk ◽  
Common Life ◽  
Nccn Guidelines ◽  
Patients With Cancer ◽  
Venous Thromboembolic ◽  
Threatening Condition ◽  
Life Threatening ◽  
Risk For Bleeding ◽  
Work Up

Venous thromboembolism (VTE) is a common, life-threatening condition in patients with cancer, which includes both deep venous thrombosis (DVT) and pulmonary embolism. The occurrence of VTE has been reported to increase the likelihood of death for cancer patients by 2- to 8-fold. Pathophysiologic explanations for VTE in cancer include known hypercoagulability, vessel wall damage, and vessel stasis from direct compression, and the incidence of VTE in cancer is increased by additional risks factors. The NCCN guidelines specifically outline strategies to prevent and treat VTE in adult cancer patients. These guidelines are characterized by evaluations of the therapeutic advantages of pharmacologic anticoagulation measures based on both perceived risk for bleeding (i.e., contraindications to anticoagulation) and cancer status. Important updates for 2008 include new work-up recommendations and changes in the recommendations for outpatient prophylaxis and diagnosis and for treatment of heparin-induced thrombocytopenia. For the most recent version of the guidelines, please visit NCCN.org

scholarly journals Primary Hyperparathyroidism in Pregnancy—A Rare Cause of Life-Threatening Hypercalcemia: Case Report and Literature Review

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
S. Malekar-Raikar ◽  
B. P. Sinnott
Keyword(s):  
Case Report ◽  
Primary Hyperparathyroidism ◽  
Relevant Literature ◽  
Pregnant Patient ◽  
Second Trimester ◽  
Baby Girl ◽  
Healthy Baby ◽  
Intraoperative Pth ◽  
Threatening Condition ◽  
Life Threatening

Objective. To report a case of primary hyperparathyroidism in a pregnant patient, report the obstetric and neonatal outcomes, and review the relevant literature.Results. A 29-year-old primigravida was successfully treated for PHP with minimally invasive resection of a parathyroid adenoma in the second trimester of pregnancy. A healthy baby girl was delivered at 37-week gestation with an unremarkable neonatal course. To the best of our knowledge, this is the second case report in the literature utilizing intraoperative PTH during a parathyroidectomy in a pregnant woman.Conclusions. Primary hyperparathyroidism is a rare life-threatening condition that can present during pregnancy. The diagnosis can be difficult to establish during pregnancy, given the nonspecific symptoms related to hypercalcemia. However, a better understanding of the condition, improved diagnostic studies, and well-organized multidisciplinary management decisions can significantly reduce the morbidity and mortality associated with the disease during pregnancy. This case report is presented to highlight the value of early diagnosis and appropriate management of PHP during pregnancy.

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

Severe Alveolar Hemorrhage – What’s in it for the Gastroenterologist?

2016 ◽  
Vol 25 (4) ◽  
pp. 555-558
Author(s):  
Alina Popp
Keyword(s):  
Celiac Disease ◽  
International Normalized Ratio ◽  
Gluten Free Diet ◽  
Alveolar Hemorrhage ◽  
Severe Anemia ◽  
Gluten Free ◽  
Pulmonary Infiltrates ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening

Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were observed. Conclusion: Although the association is rare, celiac disease should be considered in a patient with idiopathic pulmonary hemosiderosis. In our case, severe anemia and alveolar infiltrates markedly improved with glucocorticoids and gluten-free diet. Abbreviations: APTT: activated partial thromboplastin time; BAL: bronchoalveolar lavage; CD: celiac disease; Cd: crypt depth; GFD: gluten-free diet; GI: gastrointestinal; IEL: intraepithelial lymphocyte; INR: international normalized ratio; IPH: idiopathic pu

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