Interaction between Warfarin and Trazodone

2000 ◽  
Vol 34 (6) ◽  
pp. 734-736 ◽  
Author(s):  
Nancy L Small ◽  
Kathy A Giamonna
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
International Normalized Ratio ◽  
Potential Interaction ◽  
Case Summary ◽  
Subsequent Decrease ◽  
Clinically Significant ◽  
Few Data ◽  
Time To Onset ◽  
Potentially Clinically Significant

BACKGROUND: It is well known that there are many drug interactions involving warfarin. However, few data have been supplied to guide clinicians concerning the interaction between trazodone and warfarin. CASE SUMMARY: Three clinically significant cases of suspected trazodone and warfarin interactions were identified in a retrospective chart review based on changes in the prothrombin time (PT) and international normalized ratio (INR) that were not explained by other factors. In each of the cases, the INR changed by ≥1.0 after the initiation or discontinuation of trazodone. In the patients who started trazodone, a subsequent decrease in the PT and INR resulted; conversely, the PT and INR increased in the patient who stopped trazodone therapy. Although none of the patients experienced adverse effects due to the marked changes in PT and INR, the warfarin dosages had to be adjusted accordingly on initiation and discontinuation of trazodone. DISCUSSION: These cases show that there is a potentially clinically significant interaction between trazodone and warfarin. The time to onset of the interaction is variable; the mechanism behind it is not known, but it may involve substrate or protein-binding competition. CONCLUSIONS: The use of trazodone on an as-needed basis for sleep is strongly discouraged in patients who are receiving warfarin, due to the difficulty of achieving a therapeutic PT and INR. Until more is known, patients and clinicians should be educated about this potential interaction and monitor for changes in the anticoagulant effects when trazodone is initiated or stopped.

scholarly journals The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Aaron Burnett ◽  
Dolly Panchal ◽  
Bjorn Peterson ◽  
Eric Ernest ◽  
Kent Griffith ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
T Test ◽  
Medical Services ◽  
Demographic Differences ◽  
Chemical Restraint ◽  
Emergency Medical ◽  
Clinically Significant ◽  
The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints.  Haloperidol is employed for chemical restraint in many EMS services.  Recently, ketamine has been introduced as an alternate option for prehospital sedation.  On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review.  On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups.  On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.  

scholarly journals Occipital headaches and neuroimaging in children

Neurology ◽  
2017 ◽  
Vol 89 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Joshua J. Bear ◽  
Amy A. Gelfand ◽  
Peter J. Goadsby ◽  
Nancy Bass
Keyword(s):  
Cohort Study ◽  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Radiographic Evidence ◽  
Head Pain ◽  
Neurology Clinic ◽  
The Common ◽  
Clinically Significant

Objective:To investigate the common thinking, as reinforced by the International Classification of Headache Disorders, 3rd edition (beta), that occipital headaches in children are rare and suggestive of serious intracranial pathology.Methods:We performed a retrospective chart review cohort study of all patients ≤18 years of age referred to a university child neurology clinic for headache in 2009. Patients were stratified by headache location: solely occipital, occipital plus other area(s) of head pain, or no occipital involvement. Children with abnormal neurologic examinations were excluded. We assessed location as a predictor of whether neuroimaging was ordered and whether intracranial pathology was found. Analyses were performed with cohort study tools in Stata/SE 13.0 (StataCorp, College Station, TX).Results:A total of 308 patients were included. Median age was 12 years (32 months–18 years), and 57% were female. Headaches were solely occipital in 7% and occipital-plus in 14%. Patients with occipital head pain were more likely to undergo neuroimaging than those without occipital involvement (solely occipital: 95%, relative risk [RR] 10.5, 95% confidence interval [CI] 1.4–77.3; occipital-plus: 88%, RR 3.7, 95% CI 1.5–9.2; no occipital pain: 63%, referent). Occipital pain alone or with other locations was not significantly associated with radiographic evidence of clinically significant intracranial pathology.Conclusions:Children with occipital headache are more likely to undergo neuroimaging. In the absence of concerning features on the history and in the setting of a normal neurologic examination, neuroimaging can be deferred in most pediatric patients when occipital pain is present.

scholarly journals Postoperative Complications of Hip Fractures Patients on Chronic Coumadin: A Comparison Based on Operative International Normalized Ratio

Geriatrics ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. 43
Author(s):  
Michael S. Kain ◽  
David Saper ◽  
Kyle Lybrand ◽  
Kasey-Jean Bramlett ◽  
Paul Tornetta III ◽  
...  
Keyword(s):  
Hip Fractures ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
International Normalized Ratio ◽  
Blood Transfusions ◽  
Current Clinical Practice ◽  
Trauma Centers ◽  
Orthopedic Surgeons ◽  
Significant Difference ◽  
Geriatric Hip Fracture

In current clinical practice, orthopedic surgeons often delay the surgery intervention on geriatric hip fracture patients to optimize the international normalized ratio (INR), in order to decrease the risk of postoperative hematological complications. However, some evidence suggests that full reversal protocols may not be necessary, especially for patients with prior thromboembolic history. Our study aims to compare the surgical outcomes of patients with normal versus elevated INR values. We conducted a retrospective chart review on 217 patients who underwent surgeries on hip fractures at two academic trauma centers. We found that in our group (n = 124) of patients with an INR value of 1.5–3.0, there was only one reoperation for a hematoma, but there was a trend for more blood transfusions. There was no statistically significant difference in the odds of reoperation or overall complications. Nevertheless, there were significantly more events of postoperative anemia in this high INR patient group.

Combined Open Septorhinoplasty and Functional Endoscopic Sinus Surgery

2005 ◽  
Vol 133 (3) ◽  
pp. 436-440 ◽  
Author(s):  
Jonathan H. Lee ◽  
David A. Sherris ◽  
Eric J. Moore ◽  
Jonathan H. Lee ◽  
David A. Sherris ◽  
...  
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Complication Rates ◽  
Patients Âgés ◽  
Increased Risk ◽  
Clinically Significant ◽  
The Individual

OBJECTIVE: To compare perioperative and early postoperative complication rates of performing open septorhinoplasty (OSR) and functional endoscopic sinus surgery (FESS) concomitantly or individually. STUDY DESIGN AND SETTING: Retrospective chart review of 55 patients treated at an academic referral center who had undergone combined OSR and FESS. Complication rates for the combined procedures were compared with published complication rates for the individual procedures. RESULTS: Patients’ ages ranged from 14 to 77 years (average, 43 years). Among the 55 cases, there were no major complications and 6 (11%) minor complications: 4 cases of cellulitis (7%; previously published risk, 1%-3%) and 2 cases of postoperative epistaxis (4%). CONCLUSION: OSR and FESS may be performed safely in combination without a clinically significant increased risk of complications. SIGNIFICANCE: The slightly increased risk of cellulitis may warrant the use of intraoperative sinus irrigation and postoperative antibiotic prophylaxis after combined OSR and FESS.

scholarly journals Eosinophilic Polymyositis: A Rare Cause of Atraumatic Compartment Syndrome of the Forearm

2019 ◽  
Vol 12 (S 01) ◽  
pp. S67-S69
Author(s):  
Michael K. Boyajian ◽  
Lauren O. Roussel ◽  
Galam Khan ◽  
Edward Stopa ◽  
Reena Bhatt
Keyword(s):  
Case Report ◽  
Connective Tissue ◽  
Compartment Syndrome ◽  
Rare Case ◽  
Chart Review ◽  
Surgical Intervention ◽  
Retrospective Chart Review ◽  
Definitive Diagnosis ◽  
Pertinent Literature ◽  
Case Summary

Abstract Background Eosinophilic polymyositis is a rare disorder in which eosinophils infiltrate muscle and supporting connective tissue structures, resembling autoimmune or immunologically mediated disease. This disorder can be associated with muscle inflammation and death, and can be a cause of atraumatic compartment syndrome. Methods This is a retrospective chart review of a case report as well as review of pertinent literature. Results This report presents a rare case of atraumatic compartment syndrome of the forearm caused by eosinophilic polymyositis. It provides a case summary and histological examination of this patient. Conclusion This is an important case to report because it highlights eosinophilic polymyositis as a unique etiology of compartment syndrome. In appropriate clinical situations where patients do not improve despite standard interventions, one should consider the rare and unusual etiology of compartment syndrome due to eosinophilic polymyositis. Furthermore, primary surgical intervention should not be delayed while waiting to ascertain a definitive diagnosis.

scholarly journals Bacterial coinfections with coronavirus disease 2019 (COVID-19)

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Glen Huang ◽  
Daisuke Furukawa ◽  
Bryant D. Yang ◽  
Brian J. Kim ◽  
Arthur C. Jeng
Keyword(s):  
Antibiotic Stewardship ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Blood Cultures ◽  
Procalcitonin Level ◽  
Good Target ◽  
Clinically Significant ◽  
Time Of Presentation ◽  
Respiratory Coronavirus

Abstract Background: The pandemic caused by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) has dramatically increased cheshospitalizations, and it is often difficult to determine whether there is a bacterial or fungal coinfection at time of presentation. In this study, we sought to determine the rates of coinfection and utilization of antibiotics in SARS-CoV-2 disease. Methods: Retrospective chart review of patients hospitalized with COVID-19 pneumonia from April 13, 2020, to July 14, 2020. Results: In total, 277 patients were hospitalized for COVID-19 pneumonia during this period. Patients that received antibiotics within 48 hours of presentation were more likely to be febrile (59.3% vs 41.2%; P = .01) and to have leukocytosis (23.9% vs 5.9%; P < .01) and were less likely to have a procalcitonin level <0.25 ng/mL (58.8% vs 74.5%; P = .04). In total, 45 patients had positive blood cultures collected during hospitalization, 16 of which were clinically significant. Of the clinically significant blood cultures, 5 were collected <48 hours of admission. Moreover, 18 sputum cultures were clinically significant, 2 of which were collected within 48 hours of admission. Conclusion: Bacterial and fungal coinfections in COVID-19 appear to be rare on presentation; thus, this factor may be a good target for enhanced antibiotic stewardship.

Bosentan and Warfarin Interaction

2003 ◽  
Vol 37 (7-8) ◽  
pp. 1028-1031 ◽  
Author(s):  
Lisa M Murphey ◽  
Elizabeth H Hood
Keyword(s):  
Primary Pulmonary Hypertension ◽  
African American Woman ◽  
American Woman ◽  
Warfarin Dose ◽  
International Normalized Ratio ◽  
Over The Counter ◽  
Herbal Products ◽  
Case Summary ◽  
History Of ◽  
Clinically Significant

OBJECTIVE: To report a case of decreased international normalized ratio (INR) in a patient receiving warfarin and bosentan. CASE SUMMARY: A 35-year-old African American woman with a history of primary pulmonary hypertension managed with warfarin, diltiazem, and hydrochlorothiazide was initiated on bosentan therapy. The patient's INR had been stable and within therapeutic range (goal 2.0–3.0) for the previous 3 months with warfarin 27.5 mg/wk, but became subtherapeutic after 10 days of bosentan therapy. Addition of over-the-counter medications, herbal products, vitamins, or dietary changes was denied. The INR remained subtherapeutic for 5 weeks despite weekly warfarin dose increases. After these 5 weeks of dosage increases, the INR became supratherapeutic for 3 weeks, resulting in a subsequent dosage decrease. The resultant warfarin dose required to maintain a therapeutic INR was 45 mg/wk, a 63.6% dosage increase after the initiation of bosentan. DISCUSSION: This case shows that a clinically significant interaction between bosentan and warfarin may exist. An objective causality assessment revealed that the interaction was probable. Although the possibility of this interaction has been noted, no previously documented occurrence of this interaction has been identified. CONCLUSIONS: Bosentan may significantly decrease the anticoagulant properties of warfarin. The INR should be monitored more frequently when bosentan is initiated, adjusted, or discontinued in patients taking warfarin.

scholarly journals Refractive Changes Induced by Strabismus Corrective Surgery in Adults

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Daphna Mezad-Koursh ◽  
Ari Leshno ◽  
Tomer Ziv-Baran ◽  
Chaim Stolovitch
Keyword(s):  
Postoperative Period ◽  
Side Effect ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Spherical Equivalent ◽  
Corrective Surgery ◽  
Significant Side Effect ◽  
Refractive Change ◽  
Clinically Significant

Purpose. To investigate refractive changes after strabismus correction procedures among adults.Methods. Retrospective chart review of adult patients who had horizontal recti muscles surgery with preoperative and postoperative cycloplegic refraction measurements. The preoperative refraction was mathematically subtracted from the postoperative refraction, and the induced refractive changes were statistically analyzed. Vector analysis was used to examine the magnitude of the toric change. The proportion of clinically significant refractive change was evaluated as well.Results. Thirty-one eyes from 22 subjects met the criteria and were included in the final analysis. A significant postoperative refractive change of the spherical equivalent towards myopia and a change of the astigmatism in the with-the-rule direction were observed. In a subset of 9 cases a third cycloplegic refraction measurement demonstrated stable refraction compared to the 1-month postoperative measurement. In 10 cases of single eye surgery, significant refractive changes were observed only in the operated side when compared to the sound eye. The induced surgical refractive change was of clinical significance (≥0.5 D) in 11 eyes of 9 patients (40.9% of patients).Conclusions. Refractive changes are a significant side effect of horizontal strabismus corrective surgery among adults. Therefore, patients should be informed about it prior to surgery and should be rerefracted in the postoperative period.

Neutropenia in Children Treated With Ketogenic Diet Therapy

2021 ◽  
pp. 088307382098406
Author(s):  
Kristen Munro ◽  
Anne E. Keller ◽  
Helen Lowe ◽  
Enza Ferrara ◽  
Robyn Whitney ◽  
...  
Keyword(s):  
Ketogenic Diet ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Diet Therapy ◽  
Inclusion Criteria ◽  
Suspected Infection ◽  
Clinically Significant ◽  
Sick Children ◽  
The Relationship

Objectives: The objectives were to investigate the relationship between ketogenic diet therapy and neutropenia in children with epilepsy. Methods: A retrospective chart review of children who initiated ketogenic diet at the Hospital for Sick Children between January 1, 2000, and May 1, 2018 was performed. Factors associated with the development of neutropenia during ketogenic diet therapy were evaluated and the relationship between development of a significant or suspected infection and neutrophil count was analyzed. Results: One hundred two children met inclusion criteria and were followed on the diet for up to 24 months. Thirteen of 102 (13%) children were neutropenic at diet initiation. In the remaining 89 children, 27 developed neutropenia. Developing neutropenia was significantly associated with the ketogenic diet at 6 (13%), 12 (23%), and 24 (25%) months follow-up. Developing neutropenia was associated with higher urinary ketones (OR = 4.26, 95% CI: 1.27, 14.15) and longer duration of ketogenic diet therapy (OR = 3.29, 95% CI: 1.42, 7.96). There was no significant association between development of a clinically significant infection and neutropenia. Conclusion: Ketogenic diet therapy is associated with neutropenia in children with epilepsy, however, it does not have a significant clinical impact. Concern regarding neutropenia should not discourage the use of the ketogenic diet in children.

scholarly journals Warfarin Quality Metrics for Hospitalized Older Adults

TH Open ◽  
2018 ◽  
Vol 02 (03) ◽  
pp. e242-e249 ◽  
Author(s):  
Jessica Cohen ◽  
Liron Sinvani ◽  
Jason Wang ◽  
Andrzej Kozikowski ◽  
Vidhi Patel ◽  
...  
Keyword(s):  
Chart Review ◽  
Adverse Drug Events ◽  
Retrospective Chart Review ◽  
International Normalized Ratio ◽  
Quality Metrics ◽  
Management Tools ◽  
Older Inpatients ◽  
History Of ◽  
Hospitalized Older Adults ◽  
Overall Mortality

Background Warfarin's adverse drug events are dangerous, common, and costly. While outpatient warfarin management tools exist, there is a dearth of guidance for inpatients. Objectives We sought to describe a health system's chronic warfarin quality metrics in older inpatients, defined by international normalized ratio (INR) control, explore associations between INR overshoots and clinical outcomes, and identify factors associated with overshoots. Patients/Methods Data on patients 65 years and older who were prescribed chronic warfarin and admitted during January 1, 2014, to June 30, 2016, were extracted through retrospective chart review. We defined overshoots as INRs 5 or greater after 48 hours of hospitalization. Logistic regression modeling was used to determine risks for overshoots and multivariate analysis for overshoots' association with length of stay (LOS), bleeding, and mortality. Results Of the 12,107 older inpatients on chronic warfarin, most were 75 years or older (75.7%), female (51.2%), and white (70.0%). While 1,333 (11.0%) of patients had overshoots during the admission, 449 (33.7%) of these reached overshoots after 48 hours. When stratified by overshoots versus no overshoots, LOS more than doubled (15.6 vs. 6.8 days) and the bleed rate was significantly higher (27.4 vs. 8.3%) in the overshoot group. While overall mortality was small (0.4%), the overshoot group's mortality was significantly higher (3.12 vs. 0.28%). Black race and weight were protective against overshoots; history of heart failure and antibiotic/amiodarone exposure were predictive of overshoots. Conclusion This is the largest study examining warfarin quality metrics for hospitalized adults, specifically older inpatients. Our model may serve as the basis for identifying high-risk warfarin patients to target interventions to reduce adverse drug events.

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