Related Experiment Videos
Reversible endotension associated with excessive warfarin anticoagulation
Vikram S Iyer1, Kent S Mackenzie, Marc-Michel Corriveau
1Division of Vascular Surgery, McGill University, Montréal, Québec, Canada.
Journal of Vascular Surgery
|February 27, 2007
Summary
Endovascular stent grafts successfully treated aortic aneurysms, but excessive warfarin anticoagulation caused sac enlargement. Therapeutic anticoagulation levels restored aneurysm sac regression, highlighting the need for strict monitoring.
Area of Science:
- Vascular Surgery
- Cardiovascular Medicine
- Medical Device Technology
Background:
- Endovascular aneurysm repair (EVAR) using stent grafts is a common treatment for aortic aneurysms.
- Maintaining appropriate anticoagulation is crucial for patients undergoing EVAR, particularly those on warfarin therapy.
Observation:
- A patient treated with an endovascular stent graft for an aortic aneurysm showed initial sac diameter reduction.
- At 29 months post-EVAR, the patient experienced aneurysm sac enlargement, coinciding with excessive warfarin anticoagulation (international normalized ratio > 3).
- No endoleak was detected despite the sac enlargement.
Findings:
- Excessive anticoagulation with warfarin was identified as the cause of aneurysm sac enlargement in a patient post-EVAR.
- Reversal of excessive anticoagulation to therapeutic levels (international normalized ratio of 2 to 3) resulted in progressive aneurysm sac regression.
- This complication, linked to warfarin over-anticoagulation after EVAR, has not been previously reported.
Implications:
- Strict monitoring of coagulation profiles (international normalized ratio) is essential for patients with aortic aneurysms undergoing EVAR and requiring warfarin.
- Optimizing anticoagulation management can prevent potential complications like aneurysm sac enlargement after EVAR.
- This case highlights a previously unreported adverse event associated with warfarin therapy post-endovascular aortic repair.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
01:30Venous Thrombosis I: Introduction
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
01:30Venous Thrombosis IV: Nursing Management
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...