scholarly journals Hemorrhagic Complications and Dental Management of Patients with Anticoagulant Therapy: Case Report.

2019 ◽  
Vol 6 (2) ◽  
pp. 55-59
Author(s):  
Claudio Bravo ◽  
Victor Rivas
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant Therapy ◽  
Hemorrhagic Complication ◽  
Oral Surgical Procedures ◽  
Blood Tests ◽  
Dental Management ◽  
Mandibular Region ◽  
The Right ◽  
Anticoagulated Patients ◽  
Carious Teeth

Introduction: There are different protocols for the management of anticoagulated patients that can be used when performing oral surgical procedures. Objective: To report the previous evaluation and management of a hemorrhagic complication in the maxillofacial region in a patient undergoing oral anticoagulant therapy and the recommendations described in the literature for these patients. Clinical Case: Sixty-eight year old male patient, hospitalized in the cardiology unit due to heart failure, pending surgery for valve replacement. Treating physician requests evaluation for dental infection foci by a maxillofacial surgeon. Prior to medical examination and corresponding blood tests, four carious teeth are extracted, controlling hemostasis with local measures. During the night of the same day, the patient is referred again to the dental unit because of an alveolorrhagia, being treated and controlled with new local measures; new standard blood tests are performed. Forty-eight hours later the patient presents an increase of volume in the right mandibular region compatible with hematoma and ecchymosis. It is decided to perform treatment, removing sutures, collagen and draining through the alveolus. Subsequently, new local measures are performed and the anticoagulant is suspended for 24 hrs. Conclusion: There are different care protocols for patients undergoing anticoagulant treatment in the literature, so each patient should be studied in advance to define what is the best therapeutic procedure to prevent complications.

Relationship Between Total Prothrombin, Native Prothrombin and the International Normalized Ratio (INR)

1992 ◽  
Vol 68 (02) ◽  
pp. 160-164 ◽  
Author(s):  
P J Braun ◽  
K M Szewczyk
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Inverse Relationship ◽  
Low Dose ◽  
Oral Anticoagulant Therapy ◽  
International Normalized Ratio ◽  
Antigen Assay ◽  
Dose Oral ◽  
Anticoagulated Patients ◽  
Sensitive Method

SummaryPlasma levels of total prothrombin and fully-carboxylated (native) prothrombin were compared with results of prothrombin time (PT) assays for patients undergoing oral anticoagulant therapy. Mean concentrations of total and native prothrombin in non-anticoagulated patients were 119 ± 13 µg/ml and 118 ± 22 µg/ml, respectively. In anticoagulated patients, INR values ranged as high as 9, and levels of total prothrombin and native prothrombin decreased with increasing INR to minimum values of 40 µg/ml and 5 µg/ml, respectively. Des-carboxy-prothrombin increased with INR, to a maximum of 60 µg/ml. The strongest correlation was observed between native prothrombin and the reciprocal of the INR (1/INR) (r = 0.89, slope = 122 µg/ml, n = 200). These results indicated that native prothrombin varied over a wider range and was more closely related to INR values than either total or des-carboxy-prothrombin. Levels of native prothrombin were decreased 2-fold from normal levels at INR = 2, indicating that the native prothrombin antigen assay may be a sensitive method for monitoring low-dose oral anticoagulant therapy. The inverse relationship between concentration of native prothrombin and INR may help in identification of appropriate therapeutic ranges for oral anticoagulant therapy.

scholarly journals The breast necrosis caused by oral anticoagulant therapy

2020 ◽  
Vol 148 (5-6) ◽  
pp. 372-375
Author(s):  
Aleksandar Guzijan ◽  
Radoslav Gajanin ◽  
Bozana Babic ◽  
Vesna Gajanin ◽  
Bojan Jovanic
Keyword(s):  
Anticoagulant Therapy ◽  
Breast Tissue ◽  
Oral Anticoagulant Therapy ◽  
Pectoral Muscle ◽  
Left Breast ◽  
Limited Mobility ◽  
Small Vessels ◽  
The Right ◽  
Two Stages ◽  
First Time

Introduction. Described in 1943 for the first time, breast necrosis during anticoagulant therapy is only rarely encountered in clinical practice. The objective of the article is to describe a patient who underwent anticoagulant therapy and developed breast necrosis during it. Case outline. A 57-year-old female patient was admitted to hospital with pain in her left breast, which upon examination showed to be erythematous, swelled, and hard. She had started experiencing the symptoms a few days earlier, and denied having had a fever. Over the previous four weeks she had received anticoagulant treatment (acenocoumarol) as popliteal embolectomy prophylaxis. The breast was firm, edematous, of limited mobility, and with no pectoral muscle infiltration. The breast ultrasound showed a homogeneous mass, with no signs of fluid retention or suspicious lesions. Upon admission, the patient began receiving intravenous antibiotic treatment and underwent blood tests. The second day upon admission, the patient?s breast revealed a clearly demarcated area of necrotic skin. Surgical treatment was indicated. The surgery was performed in two stages, the first of which included a partial resection of the necrotic breast tissue, and the second simplex mastectomy. Histological analysis showed severe superficial necrosis, with underlying diffuse deep venous thrombosis and marked arteritis of medium and small vessels. Focal areas of extensive necrosis were found deep in the breast parenchyma. Conclusion. Considering that breast necrosis is extremely rare, it is usually not suspected initially. Learning about the patient?s undergoing anticoagulant therapy is of crucial importance for reaching the right diagnosis. Breast abscesses should also be ruled out. Surgery is the treatment of choice, as changes to the breast tissue are usually irreversible.

scholarly journals Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events

2019 ◽  
Author(s):  
Jose Andonegui ◽  
Ferran Capdevila ◽  
Alicia Zubicoa ◽  
Berta Ibáñez
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Perioperative Complications ◽  
Oral Anticoagulant Therapy ◽  
Vitreoretinal Surgery ◽  
Control Group ◽  
Thromboembolic Events ◽  
Retrobulbar Anaesthesia ◽  
Anticoagulated Patients ◽  
Visual Results

Abstract Background Vitreoretinal surgery in anticoagulated patients is a challenging situation for vitreoretinal surgeons, who have to choose between being faced with the systemic thromboembolic risks that the interruption of anticoagulation involves, or the intra and postoperative haemorrhagic risks associated with maintenance of this therapy. So far, no trial has compared, in a prospective and randomized manner, perioperative complications and the visual results associated with continuation or interruption of oral anticoagulant therapy before pars plana vitrectomy under retrobulbar anaesthesia. The main objective of this trial is to compare haemostasis-related perioperative complications of PPV in patients maintaining anticoagulant therapy before surgery compared to patients who interrupt this therapy before surgery. Methods Ninety six patients will be randomly assigned to either the control group, to whom oral anticoagulant therapy will be interrupted and substituted with subcutaneous heparin according to local clinical practice, or the intervention group to whom oral anticoagulant therapy will not be interrupted before surgery. Patients will be stratified according to the oral anticoagulant they were taking (direct or indirect anticoagulation). They will be followed-up for 12 weeks, and the primary outcome, and haemorrhagic complications until 15 days after surgery, will be evaluated. Discusion This trial will provide novel information on the possibility of continuing anticoagulant therapy during PPV. The benefits expected from the change in the current surgical management paradigm for anticoagulated patients would be a decreased risk in the incidence of perioperative thromboembolic events and the possibility of performing surgery without delay and without the need for patients to change their usual anticoagulation protocol to the more complex and less safe substitutive therapy.

scholarly journals New Cancer Diagnosis After Bleeding in Anticoagulated Patients With Atrial Fibrillation

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Sergio Raposeiras Roubín ◽  
Emad Abu Assi ◽  
Cristina Barreiro Pardal ◽  
María Cespón Fernandez ◽  
Isabel Muñoz Pousa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Cancer Diagnosis ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Bleeding Events ◽  
Using Data ◽  
Anticoagulated Patients

Background Bleeding is frequent in patients with atrial fibrillation (AF) treated with oral anticoagulant therapy, and may be the first manifestation of underlying cancer. We sought to investigate to what extent bleeding represents the unmasking of an occult cancer in patients with AF treated with oral anticoagulants. Methods and Results Using data from CardioCHUVI‐AF (Retrospective Observational Registry of Patients With Atrial Fibrillation From Vigo's Health Area), 8753 patients with AF aged ≥75 years with a diagnosis of AF between 2014 and 2017 were analyzed. Of them, 2171 (24.8%) experienced any clinically relevant bleeding, and 479 (5.5%) were diagnosed with cancer during a follow‐up of 3 years. Among 2171 patients who experienced bleeding, 198 (9.1%) were subsequently diagnosed with cancer. Patients with bleeding have a 3‐fold higher hazard of being subsequently diagnosed with new cancer compared with those without bleeding (4.7 versus 1.4 per 100 patient‐years; adjusted hazard ratio [HR], 3.2 [95% CI, 2.6–3.9]). Gastrointestinal bleeding was associated with a 13‐fold higher hazard of new gastrointestinal cancer diagnosis (HR, 13.4; 95% CI, 9.1–19.8); genitourinary bleeding was associated with an 18‐fold higher hazard of new genitourinary cancer diagnosis (HR, 18.1; 95% CI, 12.5–26.2); and bronchopulmonary bleeding was associated with a 15‐fold higher hazard of new bronchopulmonary cancer diagnosis (HR, 15.8; 95% CI, 6.0–41.3). For other bleeding (nongastrointestinal, nongenitourinary, nonbronchopulmonary), the HR for cancer was 2.3 (95% CI, 1.5–3.6). Conclusions In patients with AF treated with oral anticoagulant therapy, any gastrointestinal, genitourinary, or bronchopulmonary bleeding was associated with higher rates of new cancer diagnosis. These bleeding events should prompt investigation for cancers at those sites.

scholarly journals Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jose Andonegui ◽  
Ferran Capdevila ◽  
Alicia Zubicoa ◽  
Berta Ibáñez
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Perioperative Complications ◽  
Oral Anticoagulant Therapy ◽  
Vitreoretinal Surgery ◽  
Control Group ◽  
Thromboembolic Events ◽  
Retrobulbar Anaesthesia ◽  
Anticoagulated Patients ◽  
Visual Results

Abstract Background Vitreoretinal surgery in anticoagulated patients is a challenging situation for vitreoretinal surgeons, who have to choose between being faced with the systemic thromboembolic risks that the interruption of anticoagulation involves, or the intra- and postoperative haemorrhagic risks associated with maintenance of this therapy. So far, no trial has compared, in a prospective and randomized manner, perioperative complications and the visual results associated with continuation or interruption of oral anticoagulant therapy before pars plana vitrectomy (PPV) under retrobulbar anaesthesia. The main objective of this trial is to compare haemostasis-related perioperative complications of PPV in patients maintaining anticoagulant therapy before surgery compared to patients with an interruption in this therapy before surgery. Methods Ninety-six patients will be randomly assigned to either the control group, in whom oral anticoagulant therapy will be interrupted and substituted with subcutaneous heparin according to local clinical practice, or the intervention group in whom oral anticoagulant therapy will not be interrupted before surgery. Patients will be stratified according to the oral anticoagulant they were taking (direct or indirect anticoagulation). They will be followed up for 12 weeks, and the primary outcome, and haemorrhagic complications until 15 days after surgery, will be evaluated. Discussion This trial will provide novel information on the possibility of continuing anticoagulant therapy during PPV. The benefits expected from the change in the current surgical management paradigm for anticoagulated patients would be a decreased risk in the incidence of perioperative thromboembolic events and the possibility of performing surgery without delay and without the need for patients to change their usual anticoagulation protocol to the more complex and less safe substitutive therapy. Trial registration Clinical Trials Register EudraCT, 2018–000753-45. Registered on 11 November 2018.

A Comparison Between Thrombotest And Factor-X Amidolytic Activity In Stable And Non-Stable Anticoagulated Patients

1981 ◽  
Author(s):  
E M van Wijk ◽  
L H Kahlé ◽  
A Jeletich ◽  
J W ten Cate
Keyword(s):  
Anticoagulant Therapy ◽  
Vitamin K ◽  
Oral Anticoagulant Therapy ◽  
Factor Vii ◽  
Factor X ◽  
Amidolytic Activity ◽  
High Turnover ◽  
Long Term Treatment ◽  
Anticoagulated Patients

We tested a mechanized amidolytic factor-X assay in 2222 patients on long term anticoagulant therapy. A good correlation was found between this assay and the routinely performed Thrombotest (r= 0.78). With a therapeutic range between 150 and 300 units/L of factor-X amidolytic activity we obtained the same information about the state of anticoagulation in 81 % of these 2222 patients. Factor-X activity was assayed in 32 stable anticoagulated patients together with Thrombotest on at least three subsequent occasions in each patient. A fairly constant Thrombotest-factor X ratio was observed.(mean 0.38±0.06) Changes in Thrombotest and factor-X amidolytic activity ran consistently parallel in a group of 20 unstable anticoagulated patients.(mean ratio 0.45±0.08) Changes in Thrombotest were occasionally more pronounced than changes in factor-X activity in some patients, which could be due to the high turnover of factor VII. Relative very high or low factor-VII levels as compared to the other vitamin-K dependent factors disturbed the balance between Thrombotest and factor X. The therapeutic consequence in these unbalanced states is, that the prescribed dosage scheme of the anti-vitamin K drug could depend on the very moment of blood sampling. As a result of the high turnover of factor VII, bloodsampling one day earlier or later would then result in another dosage scheme of the drug. Therefore it might be concluded that oral anticoagulant therapy, guided by a factor-X assay could result in more stable long term treatment. Large prospective comparative trials are required to support this hypothesis.

scholarly journals The Relative Importance of the Factors II, VII, IX and X for the Prothrombinase Activity in Plasma of Orally Anticoagulated Patients

1989 ◽  
Vol 62 (02) ◽  
pp. 788-791 ◽  
Author(s):  
Ma Xi ◽  
S Béguin ◽  
H C Hemker
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Thrombin Generation ◽  
Oral Anticoagulant Therapy ◽  
Factor Ix ◽  
Factor Vii ◽  
Clotting Factors ◽  
Factor Ii ◽  
Anticoagulated Patients ◽  
Prothrombinase Activity

AbstractThe individual importance of each of the four vitamin Independent clotting factors on the generation of prothrombinase activity in the plasma of orally anticoagulated patients has been investigated.Addition of purified factors VII, IX or X to plasma from deeply anticoagulated patients (International Normalized Ratio 2.8-4.8) did not influence the amount of prothrombinase activity or the amount of thrombin formed. Only the prothrombin level in the plasma determines the course of thrombin generation. Addition of increasing amounts of purified factor II, VII, IX or X to plasmas deficient in respectively factor II, VII, IX or X showed that the prothrombinase activity increases linearily with the concentration of factor II added and that the concentration below which the factors VII, IX and X start to have a measurable effect on prothrombinase activity are 5%, 20% and 30%, respectively. Half maximal prothrombinase activity was found at about 1% factor VII, 5% factor IX and 8% factor X respectively.From these observations we conclude that primarily the variation in factor II level determines thrombin generation and hence presumably the antithrombotic effect of oral anticoagulant therapy. It therefore seems likely that, for the control of oral anticoagulant therapy, tests that reflect factor II activity would be suitable.

scholarly journals Randomised controlled trial on vitreoretinal surgery with and without oral anticoagulants: surgical complications, visual results and perioperative thromboembolic events

2019 ◽  
Author(s):  
Jose Andonegui ◽  
Ferran Capdevila ◽  
Alicia Zubicoa ◽  
Berta Ibáñez
Keyword(s):  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Perioperative Complications ◽  
Oral Anticoagulant Therapy ◽  
Vitreoretinal Surgery ◽  
Control Group ◽  
Thromboembolic Events ◽  
Retrobulbar Anaesthesia ◽  
Anticoagulated Patients ◽  
Visual Results

Abstract Abstract Background Vitreoretinal surgery in anticoagulated patients is a challenging situation for vitreoretinal surgeons, who have to choose between being faced with the systemic thromboembolic risks that the interruption of anticoagulation involves, or the intra and postoperative haemorrhagic risks associated with maintenance of this therapy. So far, no trial has compared, in a prospective and randomized manner, perioperative complications and the visual results associated with continuation or interruption of oral anticoagulant therapy before pars plana vitrectomy under retrobulbar anaesthesia. The main objective of this trial is to compare haemostasis-related perioperative complications of PPV in patients maintaining anticoagulant therapy before surgery compared to patients who interrupt this therapy before surgery. Methods Ninety six patients will be randomly assigned to either the control group, to whom oral anticoagulant therapy will be interrupted and substituted with subcutaneous heparin according to local clinical practice, or the intervention group to whom oral anticoagulant therapy will not be interrupted before surgery. Patients will be stratified according to the oral anticoagulant they were taking (direct or indirect anticoagulation). They will be followed-up for 12 weeks, and the primary outcome, and haemorrhagic complications until 15 days after surgery, will be evaluated. Discusion This trial will provide novel information on the possibility of continuing anticoagulant therapy during PPV. The benefits expected from the change in the current surgical management paradigm for anticoagulated patients would be a decreased risk in the incidence of perioperative thromboembolic events and the possibility of performing surgery without delay and without the need for patients to change their usual anticoagulation protocol to the more complex and less safe substitutive therapy.

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