Anticoagulants ; adverse effects ; pharmacology ; Blood Coagulation Disorders ; chemically induced ; Drug Interactions ; Humans ; Warfarin ; adverse effects ; pharmacology

Chemical and Drug Induced Liver Injury ; pathology ; Hepatitis, Autoimmune ; pathology ; Humans ; Warfarin ; adverse effects

Administration, Oral ; Anticoagulants/adverse effects* ; Atrial Fibrillation/drug therapy* ; Humans ; Stroke ; Vascular Calcification/drug therapy* ; Warfarin

Hemobilia is a hemorrhage into the biliary tract that may follow surgical trauma, liver biopsy, aneurysms, extra- or intra-hepatic tumors of the biliary tract, gallstones, and inflammatory lesion of liver, especially helminthic or pyogenic. Sometimes, it is associated with primary liver cancer. An 84 year-old woman was admitted because of continuous right upper quadrant pain 4 days before admission. Physical examination revealed decreased skin turgor, icteric sclerae and severe tenderness on right upper quadrant abdomen. She had no hepatosplenomegaly, and no rebound tenderness. She has been taking warfarin for 3 weeks before admission because of atrial fibrillation. On admission, serum bilirubin and transaminase were elevated. The level of hemoglobin and hematocrit were 11.3 g/dL and 37.4%, respectively. HBsAg was negative, but IgG anti-HBc and anti-HBs were positive and anti-HCV was negative. Parasite skin test and stool ova count demonstrated non-specific findings. Stool occult blood was strongly positive, and prothrombin time was markedly prolonged. According to endoscopic retrograde cholangiopancreatography, common bile duct was dilated, and filled with blood clot but there was no stone in bile tree. After two weeks, serum transaminase, bilirubin, hemoglobin, hematocrit, and CA19-9 were normalized. We report a case of hemobilia, occurring in a patient with continuous warfarin use.
Aged ; Aged, 80 and over ; Anticoagulants/*adverse effects ; Cholangiopancreatography, Endoscopic Retrograde ; English Abstract ; Female ; Hemobilia/*chemically induced/diagnosis ; Humans ; Warfarin/*adverse effects

Abdominal Wall ; blood supply ; Anticoagulants ; adverse effects ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; Hematoma ; diagnosis ; etiology ; Humans ; Male ; Middle Aged ; Warfarin ; adverse effects

A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.
Aged ; Anticoagulants/*adverse effects/therapeutic use ; Cerebral Hemorrhage/*chemically induced/drug therapy/surgery ; Drug Interactions ; Drugs, Chinese Herbal/*adverse effects ; Hematoma/*chemically induced/drug therapy/surgery ; Humans ; Male ; Treatment Outcome ; Vitamin K 1/therapeutic use ; Warfarin/*adverse effects/*therapeutic use

A 71-year-old man was stable on warfarin (2.25 mg daily) therapy with an international normalized ratio (INR) of 1.8-2.2 after a heart valve replacement surgery. Recently, he consumed the liquid-like herbal product called shengmai-yin (10 mL daily) against medical advice. Seven days after the daily consumption of shengmai-yin, he was admitted to the intensive care unit because of consciousness disturbance [Glasgow Coma Scale (GCS) score 7] with an INR of 5.08. Head computed topography revealed intracerebral hematoma in the left temporoparietal region. Both warfarin therapy and the herbal product were withdrawn. At the same time, therapy with intravenous vitamin K1 40 mg was started. On the second day of admission, craniectomy was performed to remove the intacerebral hematoma under general anesthesia. He remained confused and restless for 2 days, but then showed progressive recovery in the consciousness level as well as motor and verbal functions. Shengmai-yin contains herbal ingredients that can interact with warfarin. The Drug Interaction Probability Scale (DIPS) indicated that warfarin and shengmai-yin were highly probable causes of intracerebral hematoma. Patients on warfarin therapy should be discouraged from taking herbal medicines, especially preparations that are already known to have antiplatelet and antithrombotic effects.
Aged ; Anticoagulants/*adverse effects/therapeutic use ; Cerebral Hemorrhage/*chemically induced/drug therapy/surgery ; Drug Interactions ; Drugs, Chinese Herbal/*adverse effects ; Hematoma/*chemically induced/drug therapy/surgery ; Humans ; Male ; Treatment Outcome ; Vitamin K 1/therapeutic use ; Warfarin/*adverse effects/*therapeutic use

A 27-yr-old woman who had been taking warfarin for 10 yr after mitral valve replacement became pregnant. After knowing her pregnancy, she received heparinization for nine weeks instead of warfarin, and took oral anticoagulant again. At 24 weeks of gestation, fetal ultrasound and MRI showed a left subdural hematoma, and the pregnancy was terminated. Subdural hematoma was demonstrated on autopsy. Fatal bleeding of the fetus is a rare complication of maternal warfarin medication, occurring mostly in the second or third trimester. There is no alternative regimen available, so that regular monitoring by fetal ultrasound and strict control of warfarin dose with regular measurement of prothrombin time are the best way to prevent intrauterine fetal death due to bleeding.
Adult ; Anticoagulants/*adverse effects ; Ductus Arteriosus, Patent/surgery ; Female ; Fetal Diseases/*chemically induced ; Heart Valve Diseases/therapy ; Hematoma/chemically induced ; Heparin/adverse effects ; Human ; Intracranial Hemorrhages/*chemically induced ; Maternal Exposure ; Pregnancy ; Pregnancy Complications, Hematologic ; Prothrombin Time ; Warfarin/*adverse effects

OBJECTIVETo investigate the feasibility of continuing warfarin when international normalized ratio (INR) was less than 2.5 before tooth extraction in the elderly.

METHODSOne hundred elderly outpatients with prolong use of warfarin and maintaining INR < 2.5 before tooth extraction served as observation group, 200 elderly outpatients without taking anticoagulant and antiplatelet medicine served as control group. All the patients underwent a single non-impacted tooth extraction. Postoperative bleeding at different time was observed.

RESULTSThere was significant difference in postoperative bleeding at 5, 10, 30 min, 24 h after extraction and there was no significant difference at 48 h between control group and observation group (P < 0.05) and no bleeding was found in either group at 48 h (incidence of bleeding were 0%).

CONCLUSIONSIt was feasible to continue warfarin for the elderly maintaining INR < 2.5 undergoing a single non-impacted tooth extraction by monitoring postoperative bleeding and hemostatic treatment measures.

Age Factors ; Aged ; Aged, 80 and over ; Anticoagulants ; administration & dosage ; adverse effects ; Female ; Humans ; International Normalized Ratio ; Male ; Middle Aged ; Postoperative Hemorrhage ; etiology ; Tooth Extraction ; adverse effects ; Warfarin ; administration & dosage ; adverse effects

BACKGROUNDWarfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation (AF). There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF (NVAF). The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy.

METHODSFrom January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate (eGFR) was calculated from baseline and follow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a ≥25% decline in eGFR (hereafter, endpoint), while Cox models estimated hazard ratios (HR s) and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a ≥25% decline in eGFR.

RESULTSAfter a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin (n = 655) and no anticoagulation groups (n = 296) and 120 (12.6%) patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups (χ2 = 0.178, log-rank P= 0.67), but patients with systolic blood pressure (SBP) <140 mmHg have significant difference with patients with SBP ≥140 mmHg (χ2 = 4.903, log-rank P= 0.03). Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HR s of 1.00, and 1.02, respectively.

CONCLUSIONIn patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.

TRIAL REGISTRATIONChinese Clinical Trial Registry (No. ChiCTR-OCH-13003729); http://www.chictr.org.cn/showproj.aspx?proj = 5831.

Aged ; Anticoagulants ; adverse effects ; therapeutic use ; Atrial Fibrillation ; drug therapy ; physiopathology ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Kaplan-Meier Estimate ; Kidney ; drug effects ; Male ; Middle Aged ; Prospective Studies ; Warfarin ; adverse effects ; therapeutic use