Four-factor prothrombin complex concentrate for life-threatening bleeds or emergent surgery: A retrospective evaluation

2016 ◽  
Vol 36 ◽  
pp. 166-172 ◽  
Author(s):  
Jonathan H. Sin ◽  
Karen Berger ◽  
Christine A. Lesch
Keyword(s):  
Prothrombin Complex Concentrate ◽  
Retrospective Evaluation ◽  
Life Threatening ◽  
Emergent Surgery

scholarly journals Placement of a transjugular intrahepatic portosystemic shunt in addition to recanalization of acute and chronic portomesenteric vein occlusions – a retrospective evaluation

2020 ◽  
Vol 9 (10) ◽  
pp. 205846012096407
Author(s):  
Charlotte Ebeling Barbier ◽  
Fredrik Rorsman ◽  
Lars-Gunnar Eriksson ◽  
Per Sangfelt ◽  
Reza Sheikhi ◽  
...  
Keyword(s):  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Venous Stasis ◽  
Radiology Department ◽  
Retrospective Evaluation ◽  
Vein Thrombosis ◽  
Portomesenteric Vein Thrombosis ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
Interventional Radiology Department

Background Portomesenteric vein thrombosis may be life-threatening due to bowel ischemia caused by venous stasis, or variceal bleeding caused by portal hypertension. Purpose To evaluate the effectiveness and safety of recanalization combined with transjugular intrahepatic portosystemic shunt in acute and chronic portomesenteric vein thrombosis in patients with and without liver cirrhosis. Material and Methods 21 consecutive patients (5 women, 16 men; mean 48 years) with portomesenteric vein thrombosis (8 acute, 13 chronic) treated at the Interventional Radiology department between March 2014 and September 2018 were retrospectively reviewed. The main portal vein was completely obliterated and the portomesenteric vein thrombosis extended into the superior mesenteric vein in all patients. The portomesenteric vein thromboses were recanalized transhepatically, a transjugular intrahepatic portosystemic shunt was inserted, thrombectomy was performed in acute portomesenteric vein thrombosis, and angioplasty with or without additional stenting was performed in chronic portomesenteric vein thrombosis. Results Recanalization was successful in 8/8 patients (100%) with acute portomesenteric vein thrombosis, and in 11/13 patients (85%) with chronic portomesenteric vein thrombosis. In 12 patients, blood flow was restored in one session. Several sessions were more frequently needed in patients with acute portomesenteric vein thrombosis compared to those with chronic portomesenteric vein thrombosis ( p = 0.003). Re-occlusion occurred and was recanalized in 10/19 patients and was more frequent in patients with chronic ( n = 8/11) than on those with acute ( n = 2/8) portomesenteric vein thrombosis ( p = 0.04). Adverse events occurred in five patients. There was no 30-day mortality. Conclusion Recanalization and insertion of a transjugular intrahepatic portosystemic shunt is safe and effective in patients with acute and chronic portomesenteric vein thrombosis with or without cirrhosis. Recanalization was more likely to stay patent in acute compared with chronic portomesenteric vein thrombosis.

956: FOUR-FACTOR PROTHROMBIN COMPLEX CONCENTRATE DOSING STRATEGIES: A RETROSPECTIVE EVALUATION

2020 ◽  
Vol 48 (1) ◽  
pp. 457-457
Author(s):  
Breyanna Reachi ◽  
Abby Hickman ◽  
Marie Rapier ◽  
Jenna Negrelli
Keyword(s):  
Prothrombin Complex Concentrate ◽  
Retrospective Evaluation ◽  
Dosing Strategies

Acquired FVIII and FIX Inhibitors after Pregnancy: A Case Report

2016 ◽  
Vol 136 (4) ◽  
pp. 229-232 ◽  
Author(s):  
Murat Kose ◽  
Oguz Kagan Bakkaloglu ◽  
Shirkhan Amikishiyev ◽  
Timur Selcuk Akpınar ◽  
Basak Saracoglu ◽  
...  
Keyword(s):  
Case Report ◽  
Prothrombin Complex Concentrate ◽  
Clinical Presentation ◽  
Coagulation Factors ◽  
Bleeding Disorder ◽  
Acquired Hemophilia ◽  
Fviii Inhibitor ◽  
Activated Prothrombin Complex Concentrate ◽  
Life Threatening

Acquired hemophilia is a relatively rare clinical presentation, and most cases present with acquired FVIII inhibitor. The co-occurrence of inhibitors to multiple coagulation factors is uncommon. These autoantibodies may induce spontaneous life-threatening bleeding in patients who have had no previous bleeding disorder. Herein, we present a patient with postpartum acquired FVIII and FIX inhibitors who developed intramuscular hematoma and hemothorax during follow-up. She was then treated with activated prothrombin complex concentrate and methylprednisolone.

scholarly journals Trying to Survive A Serious Heart Condition in Time of COVID-19

2021 ◽  
Vol 24 (2) ◽  
pp. E372-E374
Author(s):  
Josip Varvodic ◽  
Verica Mikecin ◽  
Irzal Hadzibegovic ◽  
Marko Kutlesa ◽  
Carla Coric ◽  
...  
Keyword(s):  
Heart Failure ◽  
Infective Endocarditis ◽  
Aortic Root ◽  
The Past ◽  
Cardiac Decompensation ◽  
The World ◽  
Life Threatening ◽  
Emergent Surgery ◽  
Large Abscess ◽  
Heart Condition

The world has suffered over the past year under COVID-19. Unfortunately, people still are getting sick from other, also severe, diseases. Although the COVID-19 infection is present, patients need treatment for other life-threatening conditions. We present the case of a 36-year-old patient with severe infective endocarditis with a large abscess of the aortic root, who also is COVID-19 positive. Definitive diagnostics and treatment were avoided due to COVID-19 infection. In the end, emergent surgery was indicated due to acute cardiac decompensation and the development of heart failure symptoms, and the patient recovered uneventfully after surgery.

Real-Life Applications and Challenges of Andexanet Alfa for Life-Threatening Bleeding and Reversal Prior to Surgery

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Modi K ◽  
◽  
Attar D ◽  
Rimsans J ◽  
Connors JM ◽  
...  
Keyword(s):  
Real World ◽  
Real Life ◽  
The United States ◽  
High Dose ◽  
Reversal Agent ◽  
Number Of Patients ◽  
Life Threatening ◽  
Hemostatic Efficacy ◽  
Andexanet Alfa ◽  
Emergent Surgery

Andexanet alfa is a targeted reversal agent for apixaban and rivaroxaban for life-threatening or uncontrolled bleeding. There are few multicenter, real world studies that also include patients with off-label use who require emergent surgery. The objective was to describe hemostatic efficacy, thrombotic events, clinical applications, pharmaceutical challenges, and mortality associated with reversing apixaban and rivaroxaban with andexanet alfa in clinical practice. Retrospective descriptive observational cohort study of andexanet alfa use at 2 academic medical centers in the United States from July 1, 2018 to September 30, 2019. Ninety patients received 91 doses of andexanet alfa including 6 for reversal prior to surgery. Effective hemostasis was achieved in 72.9% of bleeding episodes and all patients that received andexanet alfa preoperatively were deemed to have effective hemostasis. Thrombotic events occurred in 7 of 90 patients (7.7%) and 2 of these events occurred the day after administration. Incorrect high-dose andexanet alfa was given 11 times with an estimated excess expenditure of $272,250. Thirty-two of 90 (35.5%) patients died, and most deaths occurred during the initial hospitalization. Our real-world experience with andexanet alfa in bleeding patients is similar to the non-comparative trial that led to Food and Drug Administration approval, and our findings show good hemostatic efficacy in a small number of patients requiring emergent surgery. We highlight the importance of appropriate dose based on time of ingestion and factor Xa inhibitor dose. Our 2 institutions spent over a quarter of a million dollars on excess andexanet alfa in a year and a half.

A 14-Year Experience in the Management of Patients with Acquired Immune Thrombotic Thrombocytopenic Purpura in Northern Israel

2015 ◽  
Vol 134 (3) ◽  
pp. 170-176 ◽  
Author(s):  
Nadav Rinott ◽  
Tatiana Mashiach ◽  
Netanel A. Horowitz ◽  
Liliana Schliamser ◽  
Galit Sarig ◽  
...  
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
Median Number ◽  
Retrospective Evaluation ◽  
Thrombocytopenic Purpura ◽  
Major Benefit ◽  
Life Threatening ◽  
Complicated Course ◽  
Relapse Rates

Acquired idiopathic thrombotic thrombocytopenic purpura (I-TTP) is a life-threatening microangiopathic disorder usually treated with therapeutic plasma exchange (TPE). The current study assessed the role of rituximab in the treatment of complicated I-TTP. The sequence of TTP events was compared in a group of I-TTP patients treated with TPE and a cohort of refractory or relapsed patients who also received rituximab. This retrospective evaluation included 45 I-TTP patients, treated between January 2000 and October 2013, who underwent at least 3 TPE procedures and were followed up until December 2013 or death. Thirty-one patients with an uncomplicated course received TPE only. Fourteen patients had a complicated course due to either a primary refractory/exacerbated disease (n = 5) or relapse (n = 9) and received rituximab together with TPE. The median number of TPE procedures performed in the first TTP episode in the uncomplicated cohort and groups with primary refractory or relapsed TTP was 11, 27 and 45, respectively. The relapse rates per follow-up year in the uncomplicated I-TTP, primary refractory and relapsed I-TTP groups were 0.18, 0.2 and 0.6 episodes, respectively. After rituximab therapy this rate dropped to 0.2 per year in the relapsed subgroup. In conclusion, about a quarter of patients with I-TTP had a complicated course and experienced a major benefit from rituximab in terms of effectiveness and safety.

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