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Changes in serial laboratory test results in snakebite patients: when can we safely exclude envenoming?

OBJECTIVES: To determine which laboratory tests are first associated with severe envenoming after a snakebite, when (ie, how long after the bite) the test results become abnormal, and whether this can determine a safe observation period after suspected snakebite. DESIGN, PATIENTS AND SETTING: Prospective cohort study of 478 patients with suspected or confirmed snakebite recruited to the Australian Snakebite Project from January 2002 to April 2009, who had at least three sets of laboratory test results and at least 12 hours of observation in hospital after the bite. Severe envenoming was defin

Huge intrathyroidal hematoma causing airway obstruction: a multidisciplinary challenge.

Thyroid hemorrhage is a relatively frequent event that in most cases causes pain and discomfort only, while rarely can cause significant nec … y compromise and the risk for exacerbation of bleeding in the light of significant elevation in the international normalized ratio (INR), make any airway management decisions very difficult. The importance of managing the airway and the haemostatic problem with the help of a multidisciplinary team is discussed.

The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.

This article concerning the pharmacokinetics and pharmacodynamics of vitamin K antagonists (VKAs) is part of the Seventh American College of … een 5 and 10 mg for the first 1 or 2 days for most individuals, with subsequent dosing based on the international normalized ratio (INR) response (Grade 2B). In the elderly and in other patient subgroups with an elevated bleeding risk, we suggest a starting dose at < or = 5 mg (Grade 2C). We recommend basing subsequent doses after the initial two or three doses on the results o …

Spinal subdural haematoma: how relevant is the INR?

STUDY DESIGN: Case report. OBJECTIVE: To report a rare cause of spinal cord compression. SETTING: University Hospital, Wales, UK. CASE RE … rk reflexes were absent, plantars were equivocal and anal sphincter tone was reduced. The patient's international normalized ratio (INR) was 4.1. An MR scan showed an extensive intradural haematoma compressing the cauda equina. The anticoagulation was reversed and an urgent T12-L2 laminectomy was performed; findings were a circumferential haematoma at L1 extending in the anteri …

Hemorrhagic Pericardial Effusion From Apixaban Use: Case Report and Literature Review.

Direct oral anticoagulants (DOACs) have revolutionized therapy for stroke prophylaxis in patients with non-valvular atrial fibrillation. These medications are generally well tolerated and are not associated with the inconvenience of repeat international normalized ratio (INR) checks. While bleeding in general is a common side effect associated with DOACs, especially from a gastrointestinal source, spontaneous hemorrhagic pericardial effusions are not seen frequently. Herein, we present a case of a patient who developed a hemorrhagic pericardial effusion three days after the initiation of apixa…

Phlegmasia cerulea dolens superimposed on disseminated intravascular coagulation in COVID-19.

COVID-19 infection has several cardiovascular implications, and coagulopathy is a common abnormality in these patients, often coupled with e … 9 pneumonia who developed PCD despite constantly elevated activated partial thromboplastin time and international normalized ratio.

Acute Disseminated Intravascular Coagulation After Prophylactic Nailing of the Femur in a Patient with Metastatic Prostate Cancer: A Case Report.

CASE: We present a case of acute disseminated intravascular coagulation (DIC) after prophylactic femoral intramedullary stabilization in a patient with metastatic prostate cancer. Preoperative international normalized ratio of 1.4 was attributed to malnutrition, and the patient was not medically optimized. DIC developed 1 hour postoperatively and was managed with blood product resuscitation. At the 4-month follow-up, the patient presented with bilateral pulmonary emboli and was transitioned to palliative care. CONCLUSIONS: DIC after intramedullary stabilization in patients with metastatic bon…

[Reinforcement of warfarin action in a patient administered S-1].

A case showing reinforcement of the action of warfarin and potassium in a patient administered S-1 is reported.The patient was a 71-year-old man with left upper gingival cancer.He had ventricular tachycardia (VT), hypertrophic cardiomyopathy, and a cerebellar infarction.He underwent a pacemaker implantation, and was administered warfarin.After the operation, in mid-March 2010, he was administered with S-1 and warfarin. However, the international normalized ratio of prothrombin time (PT-INR) increased to an extremely high level of 5.82, and S-1 and warfarin were stopped. They were re-administer…

Transversus abdominis plane block for an emergency laparotomy in a high-risk, elderly patient.

A 72-year-old male patient with gall bladder perforation and small intestinal obstruction from impacted gall stone was posted for emergency laparotomy. He had congestive heart failure, severe hypertension at admission and history of multiple other coexisting diseases. On admission, he developed pulmonary oedema from systolic hypertension which was controlled by ventilatory support, nitroglycerine and furosemide. Preoperative international normalized ratio was 2.34 and left ventricular ejection fraction was only 20%. Because of risk of exaggerated fall in blood pressure during induction of anae…

Vena porta thrombosis in patient with inherited factor VII deficiency.

Most clotting factor VII (FVII)-deficient patients suffer from bleeding episodes and occasionally thromboembolic complications after surgical interventions or replacement therapy. However, thromboses without apparent triggering factors may occur as well. We report a case of a pregnant woman with inherited FVII deficiency and chronic vena porta thrombosis. She presented at 32 weeks of gestation with spontaneously increased international normalized ratio, severe thrombocytopenia and very few unspecific symptoms. The extensive examination of the patient revealed cavernous transformation of the po…

Aortic and mitral valve replacement in a patient with hemophilia B.

A 25-year-old man with factor IX deficiency had an aortic and mitral valve replacement using a 2M Starr Edwards valve in the mitral position … being administered. Oral anticoagulation with acenocoumarol (Acitrom) was started, maintaining the international normalized ratio between 1.5 and 2. He was doing well at follow-up 9 months later.

Underlying Chronic Lymphocytic Leukemia in a Case of Vivax Malaria With Thrombocytopenia: A Case Report.

Thrombocytopenia is a very commonly known complication of malaria. A 64-year-old male presented with high-grade fever, extensive petechial rashes, subconjunctival hemorrhage, and mucosal oral bleeds. Laboratory tests revealed severe thrombocytopenia (platelet count: 15,000 per cubic millimeter), leukocytosis (total leukocyte count (TLC): 29,100 per microliter), and coagulopathy (international normalized ratio: 4.2). Infection was ruled out by negative cultures. The smear was positive for Plasmodium vivax. Flow cytometry was done, and a diagnosis of chronic lymphocytic leukemia (CLL) was made. …

Evolution of Hepatitis A-Related Acute Liver Failure in North America Over 22 years.

INTRODUCTION: Hepatitis A virus (HAV) is a rare cause of acute liver failure (ALF) that carries a relatively good prognosis for recovery. In recent years, overall numbers of HAV cases have declined, likely because of increased hepatitis A vaccination rates. METHODS AND RESULTS: We reviewed the Acute Liver Failure Study Group registry for the number HAV-related ALF cases over 24 years. DISCUSSION: Overall, the number of HAV ALF cases enrolled steeply declined. After 2010, when we began recording acute liver injury (ALI: International normalized ratio ≥ 2 but no encephalopathy), an apparent in…

Case Report: One-stop procedure for atrial fibrillation patients with dextrocardia.

We present the case of an elderly woman with congenital dextrocardia who experienced severe palpitations. An electrocardiogram revealed paroxysmal atrial fibrillation, and her medical history unveiled cerebral infarction and renal failure. In the treatment of paroxysmal atrial fibrillation, anticoagulation is a key requirement. Although non-vitamin K antagonist oral anticoagulants are recommended by guidelines, their efficacy is compromised in patients undergoing dialysis due to renal metabolism. In addition, warfarin may cause fluctuations in international normalized ratio, which is not condu…

Неонатальная острая недостаточность печени: проблема диагностики.

Неонатальная острая недостаточность печени - это редкое, очень серьезное заболевание с высоким уровнем смертности. Она клинически и этиологически отличается от острой недостаточности печени, наблюдаемой у детей и взрослых старшего возраста. Коагулопатия с международным нормализованным коэффициентом ≥3 является критическим параметром, который его определяет. Наиболее распространенными причинами являются аллоиммунный гепатит плода, который ранее назывался неонатальным гемохроматозом, вирусными инфекциями, метаболическими расстройствами и гемофагоцитическим лимфохистиоцитозом. Существует группа и

Совпадение в аннотации оригинала
Neonatal acute liver failure is a rare, very severe disease with a high rate of mortality. It is clinically and etiologically different from acute liver failure seen in older children and adults. Coagulopathy with an international normalized ratio ≥ 3 is the critical parameter that defines it. The most common causes are fetal alloimmune hepatitis, previously…

Possible unaware intoxication by anticoagulant rodenticide.

Superwarfarin toxicity may be a serious problem. It needs high clinical suspicious in patients with bleeding diathesis without hematologic or liver diseases even in patients with apparent negative history of warfarin or other anticoagulant accessibility. Here we reported a patient with a negative history of any medical diseases or drug administration who was referred with generalized ecchymosis. Increased international normalized ratio and decreased vitamin K-dependent coagulation factors were detected in this patient. His hematologic and liver evaluations were normal. Clinical pharmacist emph…

Resolution of left atrial appendage thrombus with apixaban.

Left atrial appendage (LAA) thrombosis is an important cause of cardiogenic cerebral thromboembolism. Apixaban is a member of the class of n … mbus resolution. In this study, soluble fibrin and D-dimer levels decreased without prolongation of international normalized ratio (INR) and activated partial thromboplastin time (APTT).

Should we test the prothrombin time in anticoagulated epistaxis patients?

Epistaxis is one of the most frequent emergencies in rhinology. Patients using anticoagulative medication are at increased risk for epistaxis. We evaluated the prothrombin time and the international normalized ratio (INR) in anticoagulated epistaxis patients. Patients suffering from epistaxis were prospectively included in a database and results from prothrombin testing were analyzed in the context of anticoagulation. One hundred sixteen of 591 epistaxis cases were identified to be on oral anticoagulation. The INR was found to be above therapeutic levels in 19 (16%) of these cases. We strongly…

Effects of combination therapy with warfarin and bucolome for anticoagulation in patients with atrial fibrillation.

BACKGROUND: Bucolome, a nonsteroidal antiinflammatory drug, enhances the effects of warfarin. In the present study, the effects of combination therapy (bucolome+warfarin) vs. warfarin alone on atrial fibrillation were investigated. METHODS AND RESULTS: Combined therapy resulted in a decrease in the warfarin dose to approximately one-third. The fluctuations of the international normalized ratio and the time in therapeutic range were similar in both groups. There was no adverse effect in either group. Interestingly, uric acid was lower in the bucolome group. CONCLUSIONS: Bucolome enhanced the …

Anticoagulation in venous thrombosis.

Major studies addressing various aspects of the treatment of deep vein thrombosis are reviewed. It has lately been demonstrated that heparin should be dosed according to body weight and is preferably given as subcutaneous injections twice daily. Alternatively, low-molecular-weight heparins may be given in a fixed dose once daily, which does not require monitoring. Oral anticoagulation should be started concomitantly with heparin and targeted at an international normalized ratio of 2.0-3.0. This treatment should continue for a longer duration than previously accepted, in many cases for 6 months…