Unveiling the Uncanny- Unusual Hemorrhagic Complications of Anticoagulant Therapy – Case Series

Abstract BACKGROUND It is debatable whether mechanical thrombectomy has benefits in a real-world setting outside the more rigid and selective clinical trial environment. OBJECTIVE To evaluate clinical outcomes, efficacy, and safety of mechanical thrombectomy in single-center retrospective cohort case series. METHODS We reviewed prospectively collected data from our large-vessel occlusion stroke database to identify patients undergoing mechanical thrombectomy using Penumbra catheters (Penumbra, Almeida, California) as first-line devices. The primary outcomes were the modified Rankin Scale score at 90 d and recanalization rate. The secondary outcomes included the rates of hemorrhagic complications and mortality. RESULTS The entire study population included 298 patients. Thrombolysis in Cerebral Infarction Scale ≥2b was achieved in 86.6% of patients. Fifty-five patients (18.5%) were outside the 6 hr time window and 82 patients (27.5%) were over 80-yr old. The posterior circulation thrombectomy rate was 12.4%. At 90 d from onset, 49.3% of patients had favorable outcomes. The parenchymal hemorrhage type 2 (PH2) and subarachnoid hemorrhage rates were 2.3% and 11.7%, respectively. In multivariate analyses, cerebral blood flow/cerebral blood volume mismatch (odds ratio [OR] = 9.418; 95% confidence interval [CI], 3.680-27.726; P < .0001), onset to recanalization time (OR = 0.995; 95% CI, 0.991-0.998; P = .0003), and hemorrhagic complications including PH2 and subarachnoid hemorrhage (OR = 0.186; 95% CI, 0.070-0.455; P = .0002) were associated with favorable outcomes. CONCLUSION A direct aspiration first pass technique with an adjunctive device demonstrated high recanalization rates in old Japanese patients. Our patient cohort may reflect the application of endovascular techniques in acute ischemic stroke treatment in a real-world setting.

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Pictorial Essay. CT of Hemorrhagic Complications of Anticoagulant Therapy

Journal of Computer Assisted Tomography ◽

10.1097/00004728-199701000-00010 ◽

1997 ◽

Vol 21 (1) ◽

pp. 44-51 ◽

Cited By ~ 19

Author(s):

E. Scott Pretorius ◽

Elliot K. Fishman ◽

S. James Zinreich

Keyword(s):

Anticoagulant Therapy ◽

Hemorrhagic Complications ◽

Pictorial Essay

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Hemorrhagic Complications of Long-term Anticoagulant Therapy

CHEST Journal ◽

10.1378/chest.95.2_supplement.26s ◽

1989 ◽

Vol 95 (2) ◽

pp. 26S-36S ◽

Cited By ~ 72

Author(s):

Mark N. Levine ◽

Gary Raskob ◽

Jack Hirsh

Keyword(s):

Anticoagulant Therapy ◽

Hemorrhagic Complications

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Prevention of Hemorrhagic Complications After Dental Extractions Into Open Heart Surgery Patients Under Anticoagulant Therapy: The Use of Leukocyte- and Platelet-Rich Fibrin

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-11-00001 ◽

2011 ◽

Vol 37 (6) ◽

pp. 681-690 ◽

Cited By ~ 43

Author(s):

Gilberto Sammartino ◽

David M. Dohan Ehrenfest ◽

Francesco Carile ◽

Mariano Tia ◽

Paolo Bucci

Keyword(s):

Anticoagulant Therapy ◽

Oral Anticoagulant ◽

Heart Surgery ◽

Therapeutic Option ◽

Oral Anticoagulant Therapy ◽

Open Heart Surgery ◽

Filling Material ◽

Platelet Rich Fibrin ◽

Delayed Bleeding ◽

Hemorrhagic Complications

Leukocyte- and platelet-rich fibrin (L-PRF) is a biomaterial commonly used in periodontology and implant dentistry to improve healing and tissue regeneration, particularly as filling material in alveolar sockets to regenerate bone for optimal dental implant placement. The objective of this work was to evaluate the use of L-PRF as a safe filling and hemostatic material after dental extractions (or avulsions) for the prevention of hemorrhagic complications in heart surgery patients without modification of the anticoagulant oral therapy. Fifty heart surgery patients under oral anticoagulant therapy who needed dental extractions were selected for the study. Patients were treated with L-PRF clots placed into 168 postextraction sockets without modification of anticoagulant therapy (mean international normalized ratio = 3.16 ± 0.39). Only 2 patients reported hemorrhagic complications (4%), all of which resolved a few hours after the surgery by compression and hemostatic topical agents. Ten patients (20%) showed mild bleeding, which spontaneously resolved or was resolved by minimal compression less than 2 hours after surgery. No case of delayed bleeding was reported. The remaining 38 patients (76%) showed an adequate hemostasis after the dental extractions. In all cases, no alveolitis or painful events were reported, soft tissue healing was quick, and wound closure was always complete at the time of suture removal one week after surgery. The proposed protocol is a reliable therapeutic option to avoid significant bleeding after dental extractions without the suspension of the continuous oral anticoagulant therapy in heart surgery patients. Other applications of the hemostatic and healing properties of L-PRF should be investigated in oral implantology.

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Hemorrhagic complications of long-term anticoagulant therapy for ischemic cerebral vascular disease.

Stroke ◽

10.1161/01.str.17.1.111 ◽

1986 ◽

Vol 17 (1) ◽

pp. 111-116 ◽

Cited By ~ 31

Author(s):

M Levine ◽

J Hirsh

Keyword(s):

Vascular Disease ◽

Anticoagulant Therapy ◽

Cerebral Vascular Disease ◽

Hemorrhagic Complications ◽

Cerebral Vascular

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EUS-guided gallbladder drainage using a lumen-apposing self-expandable metal stent in patients with coagulopathy or anticoagulation therapy: a case series

Endoscopy International Open ◽

10.1055/s-0043-118828 ◽

2017 ◽

Vol 05 (11) ◽

pp. E1100-E1103 ◽

Cited By ~ 7

Author(s):

Andrea Anderloni ◽

Fabia Attili ◽

Alessandro Sferrazza ◽

Mihai Rimbaș ◽

Guido Costamagna ◽

...

Keyword(s):

Anticoagulant Therapy ◽

Endoscopic Ultrasound ◽

Anticoagulation Therapy ◽

Case Series ◽

Metal Stent ◽

Ultrasound Guided ◽

Surgical Risk ◽

Gallbladder Drainage ◽

Risk Patients ◽

Self Expandable Metal Stent

Abstract Background and study aims We report our experience in endoscopic ultrasound-guided gallbladder drainage performed emergently in 4 prohibitive surgical risk patients with concurrent coagulopathy or on anticoagulant therapy using an electrocautery enhanced lumen apposing self expanding metal stent (LA-SEMS).

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Incidence of complications of antithrombotic treatment in patients with atrial fibrillation

Medicinski pregled ◽

10.2298/mpns1312470n ◽

2013 ◽

Vol 66 (11-12) ◽

pp. 470-475

Author(s):

Sladjana Novakovic-Anucin ◽

Sanja Gnip ◽

Visnja Canak ◽

Pavica Radovic ◽

Jelena Kovacev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Anticoagulant Therapy ◽

Vitamin K ◽

Oral Anticoagulant Therapy ◽

Vitamin K Antagonists ◽

Combined Treatment ◽

Thromboembolic Complications ◽

Antithrombotic Treatment ◽

Hemorrhagic Complications

Introduction. Atrial fibrillation increases the risk of ischemic stroke five fold, while the application of long-term anticoagulant therapy is associated with the occurrence of hemorrhagic complications. The aim of our study was to evaluate the incidence of thrombotic and hemorrhagic complications in patients with atrial fibrillation during antithrombotic treatment. Material and Methods. The study included 504 patients that were administered the primary (n=345) or secondary thromboprophylaxis after ischemic stroke (n=159), by applying vitamin K antagonists, or the combination of vitamin K antagonists and low-dose aspirin. The patients were followed for five months in the period of 24 years from 1988 to 2012, the total number of patient?s years being 1884, at the Clinical Center of Vojvodina. Thromboembolic and hemorrhagic complications were registered during regular check-up examinations. Results and Discussion. Our results indicate the low incidence of thromboembolic complications (0.01 patient per a year), with a lower incidence in the vitamin K antagonists group than in the group with the combination of vitamin K antagonists and aspirin (0.008 patient per a year versus 0.01 patient per a year). The incidence of hemorrhagic complications was higher in the group with the combined treatment compared to the group treated with vitamin K antagonists (0.1 patient per a year versus 0.06 patient per a year). The frequency of major bleeding was as low as 0.01 patient per a year and more frequent in the group with combined treatment (0.03 patient per a year). Conclusion. The overall incidence of complications in the study group was 0.08 patient per a year. The combined antithrombotic treatment increases the risk of hemorrhagic complications and affects the severity of bleeding. Oral anticoagulant therapy is more efficient in the prevention of ischemic stroke and thromboembolic complications in patients with atrial fibrillation.

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Hemorrhagic Complications of Anticoagulant Therapy: Role of Multidetector Computed Tomography and Spectrum of Imaging Findings From Head to Toe

Current Problems in Diagnostic Radiology ◽

10.1067/j.cpradiol.2012.05.001 ◽

2012 ◽

Vol 41 (6) ◽

pp. 233-247 ◽

Cited By ~ 6

Author(s):

Massimo Tonolini ◽

Sonia Ippolito ◽

Francesca Patella ◽

Marina Petullà ◽

Roberto Bianco

Keyword(s):

Computed Tomography ◽

Multidetector Computed Tomography ◽

Anticoagulant Therapy ◽

Imaging Findings ◽

Hemorrhagic Complications

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Screening for Barrett’s Esophagus in Patients with Cirrhosis Using WATS3D

Kansas Journal of Medicine ◽

10.17161/kjm.vol1415074 ◽

2021 ◽

Vol 14 ◽

pp. 206-208

Author(s):

Yasmine Hussein Agha ◽

Ali Taleb ◽

Sachin Srinivasan ◽

Nathan Tofteland ◽

William Salyers

Keyword(s):

Barrett’S Esophagus ◽

Gold Standard ◽

Barrett's Esophagus ◽

Case Series ◽

Neoplastic Progression ◽

Forceps Biopsy ◽

Endoscopic Findings ◽

Risk Of Bleeding ◽

Hemorrhagic Complications ◽

Cirrhotic Patients

The prevalence of gastroesophageal reflux disease and neoplastic progression in patients with cirrhosis is higher compared to patients without liver disease. The gold standard for screening for Barrett’s esophagus (BE) is esophagogastroduodenoscopy with forceps biopsy using the Seattle protocol. However, many physicians refrain from taking biopsies in cirrhotic patients and rely solely on endoscopic findings to avoid hemorrhagic complications secondary to variceal bleeding or coagulopathy. In this case series, we present seven cirrhotic patients at high risk of bleeding that underwent screening for BE by upper endoscopy using WATS3D with no postprocedural complications.

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The use of low molecular weight heparins in patients with acute ST-elevated myocardial infarction

Medicinski pregled ◽

10.2298/mpns0610476p ◽

2006 ◽

Vol 59 (9-10) ◽

pp. 476-481 ◽

Cited By ~ 2

Author(s):

Milovan Petrovic ◽

Gordana Panic ◽

Tibor Canji ◽

Ilija Srdanovic ◽

Vladimir Ivanovic ◽

...

Keyword(s):

Myocardial Infarction ◽

Molecular Weight ◽

Unfractionated Heparin ◽

Anticoagulant Therapy ◽

Fibrinolytic Therapy ◽

Low Molecular Weight ◽

Cardiac Events ◽

Low Molecular Weight Heparins ◽

Adverse Cardiac Events ◽

Hemorrhagic Complications

Introduction. According to the published guidelines for the management of acute coronary syndromes (ACS), treatment of acute ST-elevated myocardial infarction is based on rapid revascularization, either mechanical or pharmacological. Pharmacological revascularization consists of fibrinolytic therapy with antiplatelet and anticoagulant therapy. In regard to the anticoagulant therapy, low molecular weight heparins (LMWHs) are of special importance. LMWHs cause less complications (bleeding, thrombocytopenia, better bioviability) in comparison with unfractionated heparin (UFH). Some studies on use of LMWHs in ACS, show that LMWHs are equally efficient and safe as UFH, causing less complications (different types of hemorrhagic complications) (ESSENCE, TIMI 11B (enoxaparin), FRAXIS - fraxiparin), whereas some studies show better efficacy and safety of enoxaparin in therapy of acute ST-elevated myocardial infarction (ASSENT 3, ASSENT 3 PLUS, HART II, AMI-SK). Material and methods. Inclusion criteria: acute anterior myocardial infarction with ST-elevation, first myocardial infarction, no other structural heart defects, no signs of cardiogenic shock. Our study included 30 patients receiving fibrinolytic therapy with streptokinase, antiplatelet therapy and LMWH during 6 days, and 30 patients receiving UFH instead of LMWH. The follow-up period lasted for 6 months. Results. Significantly more patients receiving unfractionated heparin presented with major adverse cardiac events (73.3%) in regard to patients in the study group (44,2% nadroparin, 39.8% enoxaparin) (p=0.025). In the group receiving UFH, 6.7% patients had hemorrhagic complications, while none of patients receiving LMWHs. An equal number of patients died. Conclusion. Patients who were treated with LMWHs experienced less major adverse cardiac events and lower mortality. None suffered from hemorrhagic complications. .

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