Document Detail

Successful control of massive coumarol-induced acute upper gastrointestinal bleeding and correction of prothrombin time by recombinant active factor VII (Eptacog-alpha, NovoSeven) in a patient with a prosthetic aortic valve and two malignancies (chronic lymphoid leukaemia and lung cancer).
MedLine Citation:
PMID:  15060425     Owner:  NLM     Status:  MEDLINE    
Severe, life-threatening acute upper gastrointestinal bleeding may occasionally occur in patients receiving coumarol prophylaxis for prosthetic heart valves. These patients are exposed to two potential, serious risks: bleeding due to the severe blood loss induced by excessive anticoagulant effect or as a consequence of the cessation of anticoagulation subsequent thrombotic occlusion of the valve and loss of patency. Herein a short case report is presented. The elderly male patient had a prosthetic valve in the aortic position and also suffered from two malignant diseases: chronic lymphocytic leukaemia and a more recently developed lung cancer with metastatic spread into both lungs. The patient had a major gastrointestinal bleed, leading to a sudden fall of haematocrit (0.09), and to a collapse of peripheral circulation due to too excessive a coumarol effect (International Normalized Ratio > 8). An acute left ventricular failure developed during the early period of the emergency blood transfusion, so the correction of prothrombin time by fresh-frozen plasma (due to the large volume requirement) was not feasible. The patient received 50 microg/kg intravenous bolus of NovoSeven (recombinant active factor VII) in an almost desperate situation. The International Normalized Ratio changed to 2.1 in 30 min; bleeding had stopped immediately. There was neither evidence of disseminated intravascular coagulation (in spite of the age and underlying diseases) nor loss of valve patency or infective endocarditis during follow-up. This modest report may call attention to the potential use of recombinant active factor VII in the coumarol-induced severe bleeding episodes of prosthetic heart valve patients.
Miklos Udvardy; Bela Telek; Gabriella Mezey; Peter Batar; Istvan Altorjay
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis     Volume:  15     ISSN:  0957-5235     ISO Abbreviation:  Blood Coagul. Fibrinolysis     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-04-02     Completed Date:  2005-01-04     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  9102551     Medline TA:  Blood Coagul Fibrinolysis     Country:  England    
Other Details:
Languages:  eng     Pagination:  265-7     Citation Subset:  IM    
2nd Department of Medicine, University Health and Medical Science Centre, Debrecen University, Hungary.
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MeSH Terms
Acute Disease
Aortic Valve
Coumarins / adverse effects*
Factor VII / therapeutic use*
Factor VIIa
Gastrointestinal Hemorrhage / chemically induced*,  drug therapy
Heart Valve Prosthesis / adverse effects*
International Normalized Ratio
Leukemia, Lymphocytic, Chronic, B-Cell / complications*
Lung Neoplasms / complications*
Prothrombin Time
Recombinant Proteins / therapeutic use*
Upper Gastrointestinal Tract
Ventricular Dysfunction, Left
Reg. No./Substance:
0/Coumarins; 0/Recombinant Proteins; 0/recombinant FVIIa; 9001-25-6/Factor VII; EC VIIa

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