| 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). | |
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MedLine Citation:
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PMID: 15060425 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Miklos Udvardy; Bela Telek; Gabriella Mezey; Peter Batar; Istvan Altorjay |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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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:
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Created Date: 2004-04-02 Completed Date: 2005-01-04 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 9102551 Medline TA: Blood Coagul Fibrinolysis Country: England |
Other Details:
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Languages: eng Pagination: 265-7 Citation Subset: IM |
Affiliation:
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2nd Department of Medicine, University Health and Medical Science Centre, Debrecen University, Hungary. mudvardy@jaguar.dote.hu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Aged Aortic Valve Coumarins / adverse effects* Factor VII / therapeutic use* Factor VIIa Gastrointestinal Hemorrhage / chemically induced*, drug therapy Heart Valve Prosthesis / adverse effects* Humans International Normalized Ratio Leukemia, Lymphocytic, Chronic, B-Cell / complications* Lung Neoplasms / complications* Male Premedication Prothrombin Time Recombinant Proteins / therapeutic use* Upper Gastrointestinal Tract Ventricular Dysfunction, Left |
| Chemical | |
Reg. No./Substance:
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0/Coumarins; 0/Recombinant Proteins; 0/recombinant FVIIa; 9001-25-6/Factor VII; EC 3.4.21.21/Factor VIIa |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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