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Chundankuzhiyil Mathew A, Poothankandi A, Khader R, Chandrasekhar D. Clopidogrel-induced hemarthrosis following knee replacement. J Basic Clin Physiol Pharmacol 2019; 30:jbcpp-2019-0104. [PMID: 31469657 DOI: 10.1515/jbcpp-2019-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/30/2019] [Indexed: 06/10/2023]
Abstract
Background Clopidogrel is an adenosine diphosphate receptor antagonist used in patients with atherosclerotic vascular disease to reduce the incidence of ischemic events. Case Presentation A 62-year-old woman developed a spontaneous hemarthrosis of her left knee following clopidogrel treatment. To date, no case of spontaneous hemarthrosis following clopidogrel monotherapy was reported. Prompt aspiration after discontinuing clopidogrel by conservative management can assist early diagnosis and prevent further damage to the joint. The assessment of the causality of the event was carried out via Naranjo Causality Assessment Scale. A score of 5 was reported for this patient, indicating clopidogrel as a probable cause of this reaction. Conclusion We conclude that spontaneous hemarthrosis is a possible complication following clopidogrel therapy and it needs assessment when appropriate clinical symptoms (e.g. intra-articular effusion, pain) are present.
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Affiliation(s)
- Abel Chundankuzhiyil Mathew
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna, Kerala 679322, India, Phone: +91-9645002373
| | - Athira Poothankandi
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna, Kerala, India
| | - Rahana Khader
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna, Kerala, India
| | - Dilip Chandrasekhar
- Department of Pharmacy Practice, Al Shifa College of Pharmacy, Perinthalmanna, Kerala, India
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Bohm NM, Crosby B. Hemarthrosis in a patient on warfarin receiving ceftaroline: a case report and brief review of cephalosporin interactions with warfarin. Ann Pharmacother 2012; 46:e19. [PMID: 22764328 DOI: 10.1345/aph.1q771] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To report a possible interaction between warfarin and ceftaroline, resulting in hemarthrosis, and provide readers with an understanding of mechanisms of interaction between cephalosporins and warfarin. CASE SUMMARY Ceftaroline was prescribed for an 85-year-old female with a therapeutic international normalized ratio (INR) hospitalized for the treatment of cellulitis. She was subsequently readmitted with shoulder pain and a supratherapeutic INR. The patient was diagnosed with hemarthrosis, presumably related to elevated INR. Evaluation using the drug interaction probability scale for warfarin and ceftaroline yielded a score consistent with a possible or probable interaction. DISCUSSION Cephalosporins may interact with warfarin through a variety of mechanisms, including potentiation of hypoprothrombinemia related to certain side chain groups, inhibition of P-glycoprotein, or alteration of gastrointestinal flora. All mechanisms reported in the medical literature as of April 2012 are briefly examined, but the latter is the most reasonable mechanism for a ceftaroline interaction with warfarin. CONCLUSIONS Health care providers should consider closely monitoring patients receiving antibiotics with activity against Enterobacteriaceae and warfarin, even if no direct mechanism of interaction has been reported. Further research regarding a ceftaroline-warfarin interaction is warranted.
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Affiliation(s)
- Nicole M Bohm
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, USA.
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Tan YK, Lai HK, Chong YY. Use of radiosynovectomy in recurrent warfarin-related haemarthrosis in degenerative arthritis. Singapore Med J 2011; 52:e184-e186. [PMID: 21947161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Radiosynovectomy is a local and minimally invasive radiotherapy for treating various chronic inflammatory arthritis such as rheumatoid arthritis, osteoarthritis and haemophilic arthropathy. In haemophilic arthropathy, it reduces the frequency of haemarthrosis and delays the development of severe joint destruction, which ultimately requires surgical intervention. Its role in warfarin-related haemarthrosis is less clear. Haemarthrosis is an uncommon complication of warfarin use, and anticoagulation may need to be discontinued. We describe yttrium-90 radiosynovectomy use in a 74-year-old man with underlying ischaemic heart disease, atrial fibrillation, previous embolic stroke and recurrent haemarthrosis of an osteoarthritic right knee. Anticoagulation was vital and could not be permanently stopped. Due to continuing anticoagulation, he had multiple hospitalisations with recurrent right knee haemarthrosis. Intraarticular right knee yttrium-90 citrate colloid injection led to a cessation of haemarthrosis for eight months. We examined the available literature for the role of radiosynovectomy in such circumstances.
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Affiliation(s)
- Y K Tan
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore 169608.
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Kuperman A, Brenner B. [Warfarin therapy and hemarthrosis]. Harefuah 2010; 149:268-337. [PMID: 20929063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Bleeding in patients on oral anticoagulant treatment is not uncommon, but hemarthrosis has been described only in few patients. This is a case report of a patient on warfarin due to recurrent venous and arterial thromboembolism, with congenital thrombophilia and Behcet's disease. This report presents knee hemarthrosis during warfarin therapy, reviews the literature and discusses this issue.
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Affiliation(s)
- Amir Kuperman
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa.
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Abstract
INTRODUCTION Superwarfarins are widely used as rodenticides. They are similar to warfarin, but they are more potent and act longer. In case of poisoning, they cause severe bleeding, usually from multiple sites. CASE REPORT A 67-yr-old man was admitted with melaena, epistaxis and haemarthrosis in his left knee. PT, INR and aPTT were markedly increased. Initially, the patient was treated with blood and fresh frozen plasma (FFP) transfusions. However at the second day, PT, INR and aPTT were even worse. The combination of persistent coagulopathy, normal mixing studies, normal liver function tests and absence of hepatic failure or malabsorption syndromes lead to the suspicion of vitK dependent clotting factors deficiency due to superwarfarin poisoning. Indeed, the patient admitted a suicide attempt with rodenticide, although he had previously denied it. Psychiatric evaluation revealed a disturbed personality. Melaena stopped after 7 d. Then, the patient was administered 30 mg of vitK daily for a total period of 4 months. CONCLUSIONS Superwarfarin poisoning leads to severe bleeding, usually from multiple sites. Prolonged treatment with high doses of vitK is necessary. Haemarthrosis, as a complication of superwarfarin poisoning, is presented here for the first time in literature.
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Affiliation(s)
- Panagiotis Kotsaftis
- 1st Department of Propedeutics in Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Galiana Martín D, Nuño Mateo FJ, Noval Menéndez J, Menéndez Calderón MJ. [Spontaneous hemarthrosis associated to anticoagulant therapy]. An Med Interna 2004; 21:571-2. [PMID: 15538917 DOI: 10.4321/s0212-71992004001100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Pearse EO, Klass B, Bendall SP. Pigmented villonodular synovitis of the ankle occurring in a patient on anticoagulation therapy. J Surg Orthop Adv 2004; 13:217-9. [PMID: 15691183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A case report is presented of a 45-year-old woman with an 18-month history of pain and swelling in her right ankle. There was no history of trauma. Routine investigations failed to elicit a diagnosis. The patient had been on warfarin anticoagulation therapy for 12 years. The onset of symptoms coincided with a period of poor control of her anticoagulation therapy and her international normalized ratio was recorded at 5 or above on three occasions. A diagnosis of pigmented villonodular synovitis (PVNS) was made on arthroscopic examination of her ankle; this was confirmed histologically. The etiology of PVNS remains controversial. Hemarthrosis has been suggested as an etiological factor. Although there are reports of PVNS in patients with hemophilia, there are no reports of PVNS occurring in patients on anticoagulation therapy. This case report supports a possible role for hemarthrosis in the etiology of PVNS.
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Affiliation(s)
- Eyiyemi O Pearse
- Department of Trauma and Orthopaedics, Princess Royal Hospital, Lewes Road, Haywards Heath, West Sussex RH16 4EX, United Kingdom.
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Salvati G, Punzi L, Pianon M, Valvason C, Schiavon F, Noal N, Todesco S. [Frequency of the bleeding risk in patients receiving warfarin submitted to arthrocentesis of the knee]. Reumatismo 2003; 55:159-63. [PMID: 14513115 DOI: 10.4081/reumatismo.2003.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the potential bleeding risks of arthrocentesis in patients with different arthropathies and taking oral anticoagulants. MATERIALS AND METHODS Fifteen consecutive patients, 8 males and 7 females, treated with anticoagulant therapy for atrial fibrillation (9 pts), deep venous thrombosis (4 pts) and replacement of cardiac valves (3 pts) were submitted to arthrocentesis for synovial fluid effusion due to different arthropathies. In all patients INR was </= 5. Nine of them were assuming AINS for the joint pain. RESULTS Two of fifteen patients have hemarthrosis, the first only lightly, the second more frankly. Both the patients were in therapy with AINS and INR was 3.8 and 5, respectively. CONCLUSIONS The hemarthrosis or bleeding frequency associated with intraarticular injections in patients taking anticoagulant therapy seems not very high. Therefore the therapy with oral anticoagulants would not be an absolute contraindication to the arthrocentesis execution.
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Affiliation(s)
- G Salvati
- Cattedra e Divisione di Reumatologia, Università degli Studi di Padova, Italia.
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Abstract
A sixty-four-year-old male patient was studied who had acute coronary syndrome with ST segment elevation experienced bilateral hemarthrosis of the knees after administration of streptokinase and acetylsalicylic acid.
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Keays AC, Mason M, Keays SL, Newcombe PA. The effect of anticoagulation on the restoration of range of motion after total knee arthroplasty: enoxaparin versus aspirin. J Arthroplasty 2003; 18:180-5. [PMID: 12629608 DOI: 10.1054/arth.2003.50024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Anticoagulation used for thromboembolic prophylaxis following total knee arthroplasty (TKA) could interfere with movement. This study compares the effect of 2 anticoagulants, enoxaparin and aspirin, on restoration of range of motion (ROM) after TKA. Two groups of 75 consecutive patients, matched for age, arthritic severity, and preoperative ROM, underwent TKA. Flexion and extension milestone measures were recorded daily. Results show a highly statistically significant difference (P<.001) between the 2 groups when comparing the days on which these milestones were achieved. Group 1 (enoxaparin) reached 90 degrees, 100 degrees and 110 degrees of flexion in 8.4, 10.4, and 12.4 days, respectively. Group 2 (aspirin) reached the same goals in 6.8, 8.5, and 10.6 days, respectively. At 15 months after surgery, no statistically significant difference in flexion was seen between the groups (122 degrees vs 121 degrees ). Enoxaparin delayed the return of early but not long-term flexion after TKA.
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Affiliation(s)
- A C Keays
- Nambour Selangor Hospital, Queensland, Australia
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Abstract
We report a case of a 76-year-old-man who developed spontaneous hemarthrosis of his right knee following clopidogrel-aspirin treatment. Clopidogrel is an ADP receptor antagonist and in combination with aspirin widely used in patients with atherosclerotic vascular disease to reduce the incidence of ischemic events. To date, no case of spontaneous hemarthrosis following clopidogrel-aspirin therapy has been reported. Prompt aspiration after discontinuing the ADP receptor antagonist-aspirin combination therapy can assist early diagnosis and may prevent further damage to the joint. In conclusion, spontaneous hemarthrosis is a possible complication following clopidogrel-aspirin therapy and is recommended to be evaluated when appropriate clinical symptoms (e.g., intraarticular effusion) present.
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Affiliation(s)
- J Gille
- Department of Orthopaedics, University Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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Castellino G, Cuadrado MJ, Godfrey T, Khamashta MA, Hughes GR. Characteristics of patients with antiphospholipid syndrome with major bleeding after oral anticoagulant treatment. Ann Rheum Dis 2001; 60:527-30. [PMID: 11302880 PMCID: PMC1753629 DOI: 10.1136/ard.60.5.527] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the demographic and clinical characteristics of patients with antiphospholipid syndrome (APS) with serious haemorrhagic complications of anticoagulant treatment in an attempt to establish risk factors for bleeding. METHODS Patients with APS who were attending our lupus unit and who presented with severe bleeding while receiving oral anticoagulation were studied retrospectively. Severe bleeding was defined by the need for admission to hospital. Demographic data, clinical features, concomitant diseases and drugs, warfarin doses, duration of anticoagulation, and International Normalised Ratios (INR) at the time of bleeding were collected. RESULTS Fifteen patients were included in the study (12 with systemic lupus erythematosus (SLE) plus APS and 3 with primary APS). The median age was 41.7 (range 27-66) and the median duration of the disease was 12.9 years (range 3-22). Duration of anticoagulation was between 10 days and 17 years. The INR at the time of bleeding was under 3 in 4 patients, between 3 and 4 in 5 patients and above 4 in 6 patients. There were 4 episodes of subdural haematoma, 4 episodes of renal haematoma (two after renal biopsy), 2 episodes of ovarian haemorrhage, 2 episodes of rectal haemorrhage, 1 episode of menorrhagia, 1 episode of haemarthrosis, and 1 episode of spinal haematoma. Concomitant drugs were aspirin in 9 patients, antibiotics in 2 patients, and azathioprine in 3 patients. In 6 patients hypertension was present as a concomitant disease. There were no deaths due to bleeding. Anticoagulant treatment was restarted in all patients and 3 of them had a new episode of bleeding. CONCLUSION No relation was established between age, duration of oral anticoagulant treatment, and bleeding. Concomitant drugs, mainly aspirin, and high blood pressure were present at the time of bleeding in a large number of patients.
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Affiliation(s)
- G Castellino
- Lupus Research Unit, The Rayne Institute, St Thomas's Hospital, London, UK
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Chuansumrit A, Isarangkura P, Angchaisuksiri P, Sriudomporn N, Tanpowpong K, Hathirat P, Jorgensen LN. Controlling acute bleeding episodes with recombinant factor VIIa in haemophiliacs with inhibitor: continuous infusion and bolus injection. Haemophilia 2000; 6:61-5. [PMID: 10781189 DOI: 10.1046/j.1365-2516.2000.00380.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The efficacy of recombinant activated factor VII (rFVIIa, NovoSeven) in five Haemophiliacs (four Haemophilia A, one Haemophilia B), with high inhibitors ranging from 70 to 1900 Bethesda units, was evaluated. The treatment regimen was divided into two groups: group I, continuous infusion of 16.5 microg h-1 kg-1 body weight (bw) after the initial bolus of 90 microg kg-1 bw in three episodes of severe bleeding and group II, bolus injection 80-150 microg kg-1 bw every 3 hours for a maximum of four doses in six haemarthroses. The bleeding was effectively controlled within 1 to 48 h in five of nine bleeding episodes. One patient in group I, who had active arterial bleeding requiring sutures, had an ineffective response and three patients in group II had partially effective responses because the rFVIIa was given after the onset of bleeding at 36, 44 and 72 h, respectively. The prothrombin time was shortened and the FVII:C levels were successfully achieved at approximately 10 U mL-1. The continuous infusion reduced the total dose of rFVIIa by 50%. Recurrent bleeding episodes were found in three patients; two occurred at the same site after ceasing rFVIIa for 51 h and while receiving rFVIIa at 144 h and one occurred at a new site after ceasing rFVIIa for 12 h. Our experience would suggest that rFVIIa is effective in controlling acute bleeding episodes in Haemophiliacs with high inhibitors either by continuous infusion or bolus injection.
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Affiliation(s)
- A Chuansumrit
- Department of Paediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
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Abstract
Concomitant therapy with warfarin and nonsteroidal antiinflammatory drugs (NSAIDs) is of concern due to the potential for increased bleeding. Nonsteroidal antiinflammatory drugs may alter patient response to warfarin by pharmacodynamic or pharmacokinetic interactions. A man receiving long-term, stable warfarin therapy experienced a significant increase in international normalized ratio 1 week after nabumetone was added to his regimen. Despite prompt reduction of the warfarin dosage, he experienced hemarthrosis of his right knee. Previous reports suggested lack of interaction between nabumetone and warfarin. Caution and close monitoring are advisable when the two agents are administered concomitantly.
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Affiliation(s)
- V C Dennis
- Department of Pharmacy Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA
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Abstract
We describe a 45-year-old man who developed a spontaneous hemarthrosis of his right knee following thrombolytic therapy with streptokinase and rtPA for acute myocardial infarction. Surprisingly, despite the wide use of thrombolytic therapy, only four cases of spontaneous hemarthrosis following thrombolysis have been previously reported. Prompt aspiration of the joint, after stopping anticoagulant therapy, and splinting will provide early diagnosis and may prevent further damage to the joint.
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Affiliation(s)
- Y Birnbaum
- Cardiology Department, Beilinson Medical Center, Petah-Tikva, Israel
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Neuzil KM, Morgan HJ. Hemarthrosis and oral anticoagulants. J Tenn Med Assoc 1991; 84:180-1. [PMID: 1865684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Oldroyd KG, Hornung RS, Jones AM, Andrews NP, Dawes PT, Carson PH. Spontaneous haemarthrosis following thrombolytic therapy for myocardial infarction. Postgrad Med J 1990; 66:387-8. [PMID: 2371191 PMCID: PMC2426857 DOI: 10.1136/pgmj.66.775.387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Two cases of haemarthrosis following thrombolytic therapy for acute myocardial infarction are described. Both patients had active pre-existing inflammatory disease in the affected joints at the time of presentation. This complication of thrombolytic therapy has not been previously reported.
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Affiliation(s)
- K G Oldroyd
- Department of Medical Cardiology, Royal Infirmary, Glasgow, UK
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Riley SA, Spencer GE. Destructive monarticular arthritis secondary to anticoagulant therapy. Clin Orthop Relat Res 1987:247-51. [PMID: 3652583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hemarthrosis secondary to anticoagulant therapy is a well-known clinical problem. The pathologic process usually occurs in large joints and is reversible with the discontinuation of the anticoagulant medication. The condition presented for consideration here is unusual for two reasons. First, it is relatively uncommon for the ankle joint to be involved. Second, the destructive arthritis progressed after the medication was discontinued. Resting the involved joint until symptoms subside is often adequate treatment for anticoagulant-induced hemarthrosis. In an 84-year-old man, an arthrodesis was necessary to achieve a symptom-free ankle joint. Hemarthrosis secondary to anticoagulant medication may not be a benign disease process.
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Affiliation(s)
- S A Riley
- St. Luke's Hospital, Cleveland, OH 44104
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22
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Romashov SS. [Late hemorrhage during butadione treatment]. Klin Med (Mosk) 1984; 62:122-123. [PMID: 6471788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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23
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Andes WA, Edmunds JO. Hemarthroses and warfarin: joint destruction with anticoagulation. Thromb Haemost 1983; 49:187-9. [PMID: 6879506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A 56 year old man was seen because of recurrent right shoulder hemarthroses and a superior vena caval syndrome. Intermittent symptoms had occurred for six years and resulted in marked destructive changes in the right shoulder. Arthroscopy added pathological evidence of this unusual mechanism of arthropathy. Patients on anticoagulants deserve close attention to symptoms of occult bleeding.
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Bellah JR, Weigel JP. Hemarthrosis secondary to suspected warfarin toxicosis in a dog. J Am Vet Med Assoc 1983; 182:1126-7. [PMID: 6863130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sparacia A, Di Chiara A. [Complications of anticoagulant and thrombolytic therapy]. Minerva Anestesiol 1981; 47:115-22. [PMID: 6454086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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26
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Hale WB, Moorthy AV, Middleton WS. Hemarthrosis from heparin therapy. JAMA 1980; 244:30. [PMID: 7382051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Gerster JC, Wauters JP, Waldburger M, Saudan Y. [Hemarthroses complicating anticoagulant therapy (heparin, oral anticoagulants)]. Schweiz Med Wochenschr 1977; 107:1170-2. [PMID: 897653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Three patients with hemarthrosis complicating anticoagulant therapy are described. Two had acute hemarthrosis of the knee joint occurring during long term oral anticoagulant therapy for cardiovascular disorders. Joint symptoms disappeared rapidly after arthrocentesis and diminution of the dose of oral anticoagulant medication. The third patient has been on chronic hemodialysis for the last three years. After 2 years of this therapy he developed periarthritis of the right shoulder, followed suddenly by hemarthrosis of the right shoulder which remained symptomatic for 9 months in spite of several joint aspirations and reduction in the dosage of heparin administered during hemodialysis. Resolution of the hemarthrosis of the right shoulder occurred only when the vascular access for the dialysis sessions was displaced from the right to the left forearm. It is assumed that there was communication in the venous draining territories of the arterio-venous fistula and the shoulder articulation.
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Abstract
Three patients with hemarthrosis of the knee joint complicating sodium warfarin oral anticoagulation therapy are described. In all 3 the prothrombin time was at least 2.4 times the control value at the time of hemarthrosis. After initial bleeding was controlled, 2 patients had recurrences at times when their prothrombin times were again more than 2.5 times greater than those of the normal control subject. Joint symptoms persisted in all patients until the warfarin dose was substantially decreased or discontinued. Underlying joint disease was present in 1 individual and may have predisposed him to the occurrence of hemarthrosis. No long-term joint damage was recognized as resulting from the hemarthrosis at followup 1 to 2 years later. The authors conclude that hemathrosis associated with oral anticoagulant therapy occurs when the prothrombin time is excessively prolonged any may remain symptomatic until anticoagulation is reduced or discontinued. Management includes careful diagnostic aspiration, despite the prolonged prothrombin time, and discontinuation of anticoagulation.
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Eibel P. Painless arthropathy complicated by massive hemorrhagic effusion. Clin Orthop Relat Res 1968; 60:149-57. [PMID: 5703286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Guicciardi E, Manenti W. [Effect of blood on the joint cartilage of the knee in rabbits. Experimental study]. Minerva Ortop 1968; 19:16-20. [PMID: 5736963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Guicciardi E, Little K. Some observations on the effects of blood and a fibrinolytic enzyme on articular cartilage in the rabbit. J Bone Joint Surg Br 1967; 49:342-50. [PMID: 6026519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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