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Cureus Mar 2023Coumarin derivatives are the most used class of oral anticoagulants, and almost 1-2% of adults worldwide take it in the form of warfarin (WA) or acenocoumarol (AC)....
Coumarin derivatives are the most used class of oral anticoagulants, and almost 1-2% of adults worldwide take it in the form of warfarin (WA) or acenocoumarol (AC). Cutaneous necrosis is a rare and severe complication of oral anticoagulant therapy. Most commonly, it occurs in the first 10 days, and the incidence peaks between the third and sixth day of starting treatment. Cutaneous necrosis due to AC therapy is underreported in the literature, and studies refer to this condition as "coumarin-induced skin necrosis"; however, this term is not totally accurate, as coumarin itself has no anticoagulant properties. We report a case of a 78-year-old female patient with AC-induced skin necrosis, who presented with cutaneous ecchymosis purpura over her face, arms, and lower extremities 3 hours after AC intake.
PubMed: 37131576
DOI: 10.7759/cureus.36960 -
Cureus Jan 2024Acenocoumarol is one of the most common drugs used as a part of the management of patients undergoing cardiac surgery. Linezolid, on the other hand, is an antibiotic...
Acenocoumarol is one of the most common drugs used as a part of the management of patients undergoing cardiac surgery. Linezolid, on the other hand, is an antibiotic prescribed post-operatively. Reports of any interaction between the two are very few. Here, we are presenting four case reports of patients admitted to the Cardio Thoracic and Vascular Surgery Department of a tertiary healthcare center in North East India. Drug-drug interactions can lead to long-term and life-threatening effects, and also hamper the management of patients post-operatively. Due to the limited literature, assessing such interactions is difficult. The cases reported here were treated with fresh frozen plasma, and the patients responded well to the treatment and were discharged without further complications.
PubMed: 38264177
DOI: 10.7759/cureus.52753 -
Journal of Medicine and Life 2018Iron deficiency has been known to cause significant functional impairment, lower quality of life and higher morbidity and mortality. The aim of this study was to...
Iron deficiency has been known to cause significant functional impairment, lower quality of life and higher morbidity and mortality. The aim of this study was to estimate the prevalence and significance of iron deficiency in our patients and medical staff. We performed a prospective cross-sectional study: In July 2016, 383 persons were screened for the presence of iron deficiency (ID): 325 patients and 58 people from the medical staff. Transferrin saturation (TSAT), serum ferritin (SF) and complete blood count were performed. Absolute ID was diagnosed if SF <100 ng/ml and TSAT <20%. Relative ID was defined by SF >100 ng/ml and TSAT <20%. The group of medical staff was younger and had a greater proportion of women. The prevalence of absolute ID was 22.5% in patients and 43.1% in medical staff; relative ID was present in 15% of patients and 1.7% of medical staff. Among patients, the absolute ID was significantly correlated with the female sex (p=0.002) and pre-menopausal status (p=0.01) but did not correlate with diagnosis, age, BMI, nonsteroidal anti-inflammatory drug (NSAID), aspirin or acenocoumarol consumption. The relative ID is associated with advanced age (p=0.03) and diagnosis of cancer and liver cirrhosis (p=0.01). Absolute ID had a high prevalence among patients (22.5%), but there was even a bigger issue among the medical staff (43.1%). Absolute ID was correlated with female sex and pre-menopausal status. Relative ID was related to advanced age, cancer and liver cirrhosis. serum ferritine- SF, transferrin saturation coefficient- TSAT, iron deficiency- ID, inflammatory bowel diseases- IBD, quality of life- QoL, GI- gastrointestinal.
Topics: Adult; Aged; Cross-Sectional Studies; Demography; Female; Gastroenterology; Humans; Iron Deficiencies; Male; Middle Aged; Prevalence; Prospective Studies; Quality of Life; Romania; Tertiary Care Centers
PubMed: 29696062
DOI: No ID Found -
European Review For Medical and... 2014Drug interactions can cause many clinical problems, particularly when the drugs are administered in combination with anticancer agents.
INTRODUCTION
Drug interactions can cause many clinical problems, particularly when the drugs are administered in combination with anticancer agents.
CASE REPORT
A patient required two hospitalizations due to risk of bleeding with altered INR probably due to an interaction between gefitinib and acenocoumarol, which resulted in the potentiation of the effect of the latter and acenocoumarol dose adjustment was needed. A causality assessment between the drug-drug interaction and the augmented INR was conducted according to Naranjo algorithm and was classified as a definite adverse drug reaction.
CONCLUSIONS
Patient's management recommended is to closely monitor for changes in the effects of coumarin derivatives, if administered concomitantly with antineoplasic agents.
Topics: Acenocoumarol; Adenocarcinoma; Aged; Anticoagulants; Antineoplastic Agents; Atrial Fibrillation; Carcinoma, Non-Small-Cell Lung; Drug Interactions; Gefitinib; Heart Failure; Humans; International Normalized Ratio; Lung Neoplasms; Male; Protein Kinase Inhibitors; Quinazolines
PubMed: 24992614
DOI: No ID Found -
Scientific Reports Aug 2015Coumarin derivatives are an important class of C6-C3 plant metabolites that show a variety of bioactivities. Currently, most clinical anticoagulant agents are coumarins,...
Coumarin derivatives are an important class of C6-C3 plant metabolites that show a variety of bioactivities. Currently, most clinical anticoagulant agents are coumarins, such as warfarin, dicoumarol and acenocoumarol, and patients taking these drugs must be monitored for adverse reactions. In a search for safe and effective anticoagulant compounds from Chinese herbal medicine, a screening procedure on the whole plant of Ainsliaea fragrans was performed. The phytochemical investigation of this plant afforded five new coumarin derivatives, including a pair of natural 4-hydroxycoumarin enantiomers (1), a pair of coumarin enantiomers with a rare polycyclic pyrano[3-2c] carbon skeleton (2) and a 7-hydroxycoumarin derivative (3), together with 5 known biogenetically related compounds (4-8). Enantioseparation of 1 and 2 produced optically pure compounds 1a, 1b, 2a and 2b. The absolute configurations of the new compounds were confirmed by single-crystal X-ray diffraction analysis. In addition, we evaluated the anticoagulant activity of all isolates via activated partial thromboplastin time (APTT), thrombin time (TT) and prothrombin time (PT) assays in vitro and in vivo. Of note, compound 3 displayed potent anticoagulant activity and no significant hepatic or renal toxicity, which could make it a promising agent for further preclinical evaluation for preventing abnormal blood clotting.
Topics: Animals; Anticoagulants; Asteraceae; Blood Coagulation; Carbon-13 Magnetic Resonance Spectroscopy; Circular Dichroism; Coumarins; Humans; Proton Magnetic Resonance Spectroscopy; Rats, Wistar; Stereoisomerism
PubMed: 26315062
DOI: 10.1038/srep13544 -
American Journal of Hematology Nov 2001Vasoocclusion is a continuous process in sickle cell disease (SCD) and accumulates to significant end organ damage, mostly irrespective of the occurrence of manifest... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Vasoocclusion is a continuous process in sickle cell disease (SCD) and accumulates to significant end organ damage, mostly irrespective of the occurrence of manifest acute vasoocclusive events. As there are indications that reversing the hypercoagulable state may be of clinical benefit in sickle cell patients, we performed a randomized, double blind, placebo-controlled, cross-over pilot study to assess the efficacy and safety of low-adjusted dose acenocoumarol therapy (International Normalized Ratio: 1.6-2.0) in SCD. Treatment consisted of either acenocoumarol or placebo for 14 weeks, after which treatment was discontinued for a period of five weeks. Then, patients initially on acenocoumarol received placebo (and vice versa) for 14 weeks. Therapy efficacy was assessed by comparing the frequency of vasoocclusive complications, the occurrence of bleeding, and clotting activation between acenocoumarol and placebo treatment of each individual patient. Twenty-two patients (14 homozygous [HbSS] and 8 double heterozygous sickle-C [HbSC]; aged 20-59 years) completed the entire study. Acenocoumarol treatment did not result in a significant reduction of acute vasoocclusive events (three painful crises during acenocoumarol, five painful crises during placebo). There was a marked reduction of the hypercoagulable state (depicted by a decrease in plasma levels of prothrombin F1.2 fragments [P = 0.002], thrombin-antithrombin complexes [P = 0.003], and D-dimer fragments [P = 0.001]) without the occurrence of major bleeding. Even though no clinical benefit (pertaining to the frequency of painful crises) was detected in this pilot study, the value of low adjusted-dose acenocoumarol for preventing specific events (such as strokes) and as a long-term treatment of sickle cell patients should be subject of further study.
Topics: Acenocoumarol; Adult; Anemia, Sickle Cell; Anticoagulants; Antifibrinolytic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Humans; Middle Aged; Pilot Projects; Thrombophilia; Treatment Outcome
PubMed: 11754399
DOI: 10.1002/ajh.1175 -
Hematology/oncology Clinics of North... Apr 2014Recent studies suggest that sickle cell disease (SCD) is a hypercoagulable state contributing to vaso-occlusive events in the microcirculation, resulting in acute and... (Review)
Review
Recent studies suggest that sickle cell disease (SCD) is a hypercoagulable state contributing to vaso-occlusive events in the microcirculation, resulting in acute and chronic sickle cell-related organ damage. In this article, we review the existing evidence for contribution of hemostatic system perturbation to SCD pathophysiology. We also review the data showing increased risk of thromboembolic events, particularly newer information on the incidence of venous thromboembolism. Finally, the potential role of platelet inhibitors and anticoagulants in SCD is briefly reviewed.
Topics: Acenocoumarol; Anemia, Sickle Cell; Anticoagulants; Hemostasis; Hemostatics; Humans; Thromboembolism; Treatment Outcome
PubMed: 24589271
DOI: 10.1016/j.hoc.2013.11.011 -
Journal of Health Economics and... 2016The aim of this study was to evaluate, from the Spanish National Health System perspective, the cost-effectiveness of rivaroxaban (20 mg/day) versus use of...
The aim of this study was to evaluate, from the Spanish National Health System perspective, the cost-effectiveness of rivaroxaban (20 mg/day) versus use of acenocoumarol (5 mg/day) for the treatment of patients with non-valvular atrial fibrillation (NVAF) at moderate to high risk for stroke. A Markov model was designed and populated with local cost estimates, efficacy and safety of rivaroxaban in stroke prevention in NVAF compared with adjusted-dose warfarin clinical results from the pivotal phase III ROCKET AF trial and utility values obtained from the literature. Warfarin and acenocoumarol were assumed to have therapeutic equivalence. Rivaroxaban treatment was associated with fewer ischemic strokes and systemic embolisms (0.289 vs. 0.300 events), intracranial bleeds (0.051 vs. 0.067), and myocardial infarctions (0.088 vs. 0.102) per patient compared with acenocoumarol. Over a lifetime time horizon, rivaroxaban led to a reduction of 0.041 life-threatening events per patient, and increases of 0.103 life-years and 0.155 quality-adjusted lifeyears (QALYs) versus acenocoumarol treatment. This resulted in an incremental cost-effectiveness ratio of €7045 per QALY and €10 602 per life-year gained. Sensitivity analysis indicated that these results were robust and that rivaroxaban is cost-effective compared with acenocoumarol in 89.4% of cases should a willingness-to-pay threshold of €30 000/QALY gained be considered. The present analysis suggests that rivaroxaban is a cost-effective alternative to acenocoumarol therapy for the prevention of stroke and systemic embolisms in patients with NVAF in the Spanish healthcare setting.
PubMed: 37663009
DOI: 10.36469/9823 -
Cardiovascular Therapeutics Oct 2010Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance found in clinical practice, increasing in prevalence with age. AF is often associated... (Review)
Review
Atrial fibrillation (AF) is the most common sustained cardiac rhythm disturbance found in clinical practice, increasing in prevalence with age. AF is often associated with structural heart disease, although a significant proportion has no detectable heart disease. In the last 2 decades, there has been an increase of 66% in hospitalizations for AF, and it is an extremely costly public health problem. AF is associated with an increased long-term risk of stroke, heart failure, and all-cause mortality. In fact, the mortality rate in patients with AF is about double that of patients in normal sinus rhythm. Antithrombotic therapy is recommended for all patients with AF to prevent thromboembolism, except those with lone AF or contraindications. Selection of the antithrombotic agent should be based upon the absolute risks of stroke and bleeding and the relative risk and benefit for a given patient. However, despite oral anticoagulation with vitamin K antagonists (warfarin or acenocoumarol) some patients still have thromboembolic events. Furthermore, for the majority of patients, international normalized ratio (INR) monitoring may be an inconvenience. This is why new anticoagulants, such as the direct thrombin inhibitors, are being investigated. The results of the RE-LY trial have recently been published. In this study, in a population of patients with AF, dabigatran at 110 mg b.i.d was associated with stroke and systemic embolism rates similar to those associated with warfarin, and with lower rates of major hemorrhage. However, when dabigatran was administered at a dose of 150 mg, lower rates of stroke and systemic embolism and similar rates of major hemorrhage were found compared with warfarin. The aim of this review is to update information on the prevention of thromboembolic events in patients with AF and how dabigatran may change daily clinical practice.
Topics: Anticoagulants; Atrial Fibrillation; Benzimidazoles; Blood Coagulation; Dabigatran; Hemorrhage; Humans; Risk Assessment; Thrombin; Thromboembolism; Treatment Outcome; beta-Alanine
PubMed: 20718760
DOI: 10.1111/j.1755-5922.2010.00216.x -
International Journal of Surgery Case... 2019The spinal subdural hematoma (SSH) is an extremely rare entity which represents only 4.1% of all spinal hematomas. It needs accurate diagnosis and rapid intervention...
BACKGROUND
The spinal subdural hematoma (SSH) is an extremely rare entity which represents only 4.1% of all spinal hematomas. It needs accurate diagnosis and rapid intervention because of the major neurological risk induced by spinal compression. Several etiologies have been reported: anticoagulant treatments, haematological disorders, arterio-venous malformation, repeated attempts at lumbar punctures and tumors. We report the case of an 82-year-old patient under acenocoumarol for atrial fibrillation who presented with paraplegia secondary to SSH.
CASE REPORT
An 82-year-old patient with a history of ischemic heart disease and atrial fibrillation under acenocoumarol was admitted to emergency department with sudden onset of paraplegia and intense back pain associated with urinary incontinence and anal sphincter disorder. On examination his lower limb power was MRC grade 0 out of 5 in all ranges of movement bilaterally and a complete bilateral anesthesia reaching the T12 dermatome was noted. Biological test results showed an International Normalized Ratio at 10. Magnetic resonance imaging revealed a posteriorly located spinal hematoma at T12 level, measuring 36 mm with spinal cord compression. After correction of hemostasis disorders the patient was admitted to the operating room for a T11-L1 laminectomy with evacuation of the subdural hematoma. Muscle power showed a gradual improvement in the lower limbs estimated at 3/5 with regression of sphincter disorders but unfortunately a sequellar sensory impairment persisted.
CONCLUSION
SSH is a rare situation of acenocoumarol bleeding incident, it should be evoked in any patient treated by this molecule with signs of spinal cord compression.
PubMed: 31100481
DOI: 10.1016/j.ijscr.2019.04.053