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Vitamin Deficiencies – Diagnosis and Treatment
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Patients on anticoagulant therapy may require closer monitoring, as warfarin and vitamin K counteract each other. Anticoagulant doses are adjusted to achieve a therapeutic international normalized ratio (INR). INR is calculated based on prothrombin time (PT), which measures how long it takes for a clot to form in a blood sample. Once the goal INR is met, daily vitamin K intake should remain consistent. Without warfarin dose adjustments, increased vitamin K intake leads to an increased risk of blood clots, whereas decreased vitamin K intake could increase the risk of bleeding. The INR is the most common laboratory test used to monitor warfarin therapy and detect potential bleeding problems, while plasma phylloquinone is measured to assess vitamin K status. Normal fasting phylloquinone levels in healthy adults are 0.15 to 1.0 μg/L.1
Venous Thromboembolism in Pregnancy
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Aflah Sadikeen
The aims of anticoagulant therapy are to prevent the clot from propagating and to prevent the formation of new clots. When there is a high suspicion of VTE, anticoagulant treatment should be commenced, unless there is a strong contraindication to its use, and continued for one week. This must be done even if the initial duplex ultrasound and V/Q scan or CTPA are negative, at which point PE should definitely be excluded by appropriate investigations. When there is low suspicion of DVT but no suspicion of PE, anticoagulant therapy can be discontinued if the duplex ultrasound is negative. However, duplex ultrasound should be repeated on days 3 and 7 if clinical suspicion of DVT remains high. Anticoagulant treatment should be recommenced if the repeat duplex ultrasound confirms the diagnosis of DVT.
Supraventricular rhythms
Published in Andrew R Houghton, Making Sense of the ECG, 2019
Patients can score between 0 and 9 points. For those with a score of 0, no anticoagulant therapy is recommended. With a score of 1 or more, oral anticoagulant therapy (using warfarin or one of the non-vitamin K antagonist oral anticoagulants [NOACs], such as apixaban) is recommended. However, female patients who are aged <65 years and have lone AF (i.e. those who have a CHA2DS2-VASc score of 1 only as a result of female gender) are low-risk and do not require an oral anticoagulant.
Isolated corpus callosum lesion associated with cytokine storm in COVID-19
Published in Baylor University Medical Center Proceedings, 2022
Fatma Akkoyun Arıkan, Gönül Akdağ, Mustafa Çetiner, Niyazi Uysal, Sibel Canbaz Kabay
Cytotoxic lesions of the corpus callosum have been described by a variety of pathologies, including drug-related conditions, trauma, malignancy, metabolic disorders, and various viruses such as adenovirus, H1N1 influenza, Epstein-Barr, and rotavirus.9 When cytokine release and inflammation are present in sufficient levels within the brain, astrocytes are stimulated to release glutamate as well as block the reuptake of this neurotransmitter.9–11 The greatly increased amount of glutamate within the extracellular space leads to excitotoxic action on multiple glutamate receptors, sodium-potassium pumps, and aquaporins, resulting in an influx of water trapped within the cells.9,12,13 These effects manifest on imaging as diffusion restriction, as seen in our patient. It is believed that the corpus callosum is vulnerable to cytokine-induced injury due to the high density of cytokine, glutamate, and other receptors present within this region of the brain, particularly the splenium.9,14,15 These previously described mechanisms, combined with our patient’s extremely elevated markers for acute-phase reactants, suggest initial autoimmune injury from a cytokine storm. However, it should be kept in mind that both cytokine storm and SARS-CoV-2 infection may also cause ischemia in the splenium. Therefore, anticoagulant therapy should be continued.
High incidence of venous thromboembolism after acute cervical spinal cord injury in patients with ossification of the posterior longitudinal ligament
Published in The Journal of Spinal Cord Medicine, 2022
Nana Ichikawa, Gentaro Kumagai, Kanichiro Wada, Hitoshi Kudo, Toru Asari, Liu Xizhe, Yasuyuki Ishibashi
Patients admitted from February 2015 to April 2017 were tested prospectively for VTE by D-dimer monitoring (as for the previous patients) plus ultrasound screening conducted 7 days after admission (or surgery) by an experienced examiner using a Prosound Alpha-7 (Aloka, Tokyo, Japan). All patients were given elastic stockings and an intermittent pneumatic compression foot/calf pump (Kendal SCD EXPRESS, Dublin, Ireland) at admission and started rehabilitation therapy immediately. Patients were carefully observed for PE symptoms, such as chest pain, dyspnea, tachypnea, tachycardia, and a decrease in blood pressure, and for DVT symptoms, such as changes in skin color and swelling, pain, or cramping in the calf.8 If ultrasonography indicated DVT or if the D-dimer level increased to ≥10 µg/mL at any point after admission, the patient was immediately screened by contrast CT (Discovery HD 750; GE Healthcare, Waukesha, WI, USA) from the lower limbs to the chest, and the results were assessed by radiologists in our hospital. If VTE was diagnosed, the elastic stockings and foot/calf pump were removed, and a vascular surgeon examined the patient to determine appropriate treatment. Non-organized thromboses were treated with anticoagulant therapy such as heparin, warfarin, or edoxaban.7
Determination of fibrin clot growth and spatial thrombin propagation in the presence of different types of phospholipid surfaces
Published in Platelets, 2021
Ekaterina M. Koltsova, Anna D. Kuprash, Natalya M. Dashkevich, David M. Vardanyan, Artem V. Chernyakov, Maria A. Kumskova, Sukesh C. Nair, Alok Srivastava, Fazoil I. Ataullakhanov, Mikhail A. Panteleev, Anna N. Balandina
The plasma of patients receiving anticoagulant therapy with heparins (unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH)), vitamin K antagonists (warfarin) or with direct oral anticoagulants (DOACs) (rivaroxaban or dabigatran) was obtained at City Clinical Hospital No. 15 (Moscow). All patients were hospitalized with a diagnosis of deep vein thrombosis (DVT) of the lower extremities. The following therapy was prescribed to patients: UFH 150 IU/kg 3 times a day (local standard of anticoagulation with UFH), LMWH (enoxaparin 4000 anti-Xa IU or nadroparin 5700 anti-Xa IU) 2 times a day, warfarin 2.5–6.5 mg/day (previously selected effective dosage according to INR), rivaroxaban 15 mg 2 times a day or dabigatran 150 mg 2 times a day. In all patients, blood sampling was performed before the start of therapy and at the peak of the drug’s effect (in patients on UFH, 6 hours after administration, measured APTT ratio was 0.9–1.3, dosage was fixed and not corrected according to APTT ratio; in patients on LMWH, 4 hours after administration; in patients on warfarin, on the background of monotherapy with warfarin with INR = 2–3; and in patients on rivaroxaban and dabigatran, 2 hours after administration).