Title: Unveiling the Uncanny- Unusual Hemorrhagic Complications of Anticoagulant Therapy – Case Series
Authors: Dr Mangalanandan.S, Dr Amith Itty, Dr Jose, Dr Geena Benjamin
DOI: https://dx.doi.org/10.18535/jmscr/v9i11.37
Abstract
Introduction
The modern clinical practice would be incomplete without the use of multitude of anticoagulants. These anticoagulants are however associated with a definite risk of hemorrhage. The risk of hemorrhage increases with advanced age and the comorbidity status of the patient. The choice of anticoagulants and the duration and dosage are also seen to have an effect on the possibility of developing a hemorrhagic complication. The clinical manifestations are often deceiving and often cross sectional imaging is mandatory for effective diagnosis of such hemorrhagic complications. Prompt identification and diagnosis these complications aid the clinicians to act on time and take necessary steps for timely intervention. In some of the cases interventional procedures may be needed. The choice of the modality may also be influenced by the imaging findings. Few such characteristic cases are presented here before you giving preference to the images.
References
- Linkins LA, Choi PT, Douketis JD. Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: A meta-analysis. Ann Intern Med 2003;139:893-900.
- Hylek EM. Complications of oral anticoagulant therapy: Bleeding and nonbleeding, rates and risk factors. Semin VascMed 2003;3:271-8.
- Beyth RJ. Hemorrhagic complications of oral anticoagulant ClinGeriatr Med 2001;17:49-56.
- Jacobs LG. Warfarin pharmacology, clinical management, and evaluation of hemorrhagic risk for the elderly. Cardiol Clin2008;26:157-67, v.
- Nazarian LN, Lev-Toaff AS, Spettell CM, et al. CT assessment of abdominal hemorrhage in coagulopathic patients: Impact on clinical management. Abdom Imaging 1999;24: 246-9.
- Furlan A, Fakhran S, Federle MP. Spontaneous abdominal hemorrhage: Causes, CT findings, and clinical implications. Am J Roentgenol 2009;193:1077-87.
- Schulman S, Beyth RJ, Kearon C, et al. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 suppl): 257S-98S.
- Pretorius ES, Fishman EK, Zinreich SJ. CT of hemorrhagic complications of anticoagulant therapy. J Comput Assist Tomogr 1997;21:44-51.
- Seseke S, Schreiber M, Rebmann U, Seseke F. Spontaneperirenale Hämatomebei Patientenmit Koagulopath-enoderunter Antikoagulanzientherapie [Spontaneous perirenal hematomas in patients taking anticoagulation medication or having a bleeding diathesis]. Aktuelle Urol. 2008 May;39(3):215-8. German. doi: 10.1055/s-2007-1016433. PMID: 18478495.
- Cañadas MV, Vilacosta I, Ferreirós J, Bustos A, Díaz-Mediavilla J, Rodríguez E. Intramural aortic hematoma and anticoagulation. Revista Española de Cardiología (English Edition). 2007 Jan 1;60(2):201-4.
- Subhash R, Unnikrishnan G, Balakrishnan D, Sudheer OV, Dhar P, Sudhindran S. Gastrointestinal intramural hematoma--analysis of clinical and radiological features for early differentiation from mesenteric ischemia. Indian J Gastroenterol. 2014 Jul;33(4):364-8. doi: 10.1007/s12664-014-0449-z. Epub 2014 Mar 28. PMID: 24671723