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An Overview of Drug-Induced Nephropathies *
Published in Robin S. Goldstein, Mechanisms of Injury in Renal Disease and Toxicity, 2020
Jean Paul Fillastre, Michel Godin
Phenindione is now much less prescribed than in last years and this probably explains why no recent cases of acute interstitial nephritis due to this drug were described. Typically, patients presented with fever, rash, eosinophilia, oliguria, and often jaundice. The outcome was severe, most patients dying, but these observations are old and hemodialysis was not performed in some patients. Chronic interstitial nephritis could appear.
Heart disease in the elderly
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Anticoagulants antagonise the effects of vitamin K. They take 24–48 hours to become effective. Warfarin is the most commonly used anticoagulant in the UK. Phenindione is rarely used. Coumadin is used in the USA.
Drug allergy in lung disease
Published in Philippe Camus, Edward C Rosenow, Drug-induced and Iatrogenic Respiratory Disease, 2010
Amitava Ganguli, Munir Pirmohamed
The mechanism of a type IV hypersensitivity reaction involving the lung has recently been investigated with the anticoagulant phenindione.41 Phenindione causes hypersensitivity in 1.5–3 per cent of patients. A 46-year-old female, 30 days after starting phenindone, developed a generalized maculopapular erythematous rash associated with a temperature of 39°C, generalized lymphadenopathy, mild jaundice, and bilateral patchy consolidation on the chest X-ray. Her eosinophil count was elevated at 2.5 × 109/L (normal range 0–0.4), whereas alanine aminotransferase level peaked at over 30 times the upper limit of normal. T-cells taken from the patient proliferated in the presence of phenindione, but not from four controls. T-cell clones generated from the patient were characterized as being MHC class Ii restricted, and CD4+ bearing the αβ T-cell receptor. The clones secreted IFN-γ (consistent with this being a Th1 response) and IL5 (consistent with the eosinophilia). In terms of the mechanism of antigen presentation, two types of clones were detected, those that bound the drug directly on the MHC and those that bound processed peptide. The reasons why the lung was involved were not investigated – it would be interesting to determine whether CCR6 and CXCR3, which regulate antigen-induced T-cell homing to human asthmatic airways,42 are also implicated in drug-induced pneumonitis. This investigation of phenindione hypersensitivity leading to pneumonitis represents the most comprehensive investigation that has been performed to date with respect to drug-induced lung allergy.
Thirteen-year trend in the persistence with vitamin K antagonists for venous thromboembolism in the UK: a cohort study
Published in Current Medical Research and Opinion, 2018
Carlos Martinez, Anja Katholing, Kerstin Folkerts, Stephan Rietbrock
VKA treatment initiation was defined by the first prescription or medical code for a VKA. Patients who were initiated on VKA treatment within 30 days after the incident VTE were then followed for the duration of oral anticoagulation therapy5. Exposure to VKA was assessed by one or more of the following: a prescription for acenocoumarol, phenindione or warfarin, a medical code or an international normalized ratio test result indicating the use of VKAs. The duration of a single prescription of a VKA was derived from the median number of days between consecutive VKA prescriptions using data from all patients. Repeat prescriptions for VKAs were combined when the subsequent VKA prescription was issued within the calculated supply of the previous prescription. To account for any remaining medication, lack of patient compliance or residual drug effect, a grace period of 30 days for each prescription was added.
The role of prognostic stratification on prescription of anticoagulants in older patients with atrial fibrillation: a multicenter, observational, prospective European study (EUROSAF)
Published in Annals of Medicine, 2022
Alberto Pilotto, Nicola Veronese, Maria Cristina Polidori, Timo Strandberg, Eva Topinkova, Alfonso J. Cruz-Jentoft, Carlo Custodero, Stefania Maggi
Participants were divided into three categories according to the prescription of anticoagulants. Using the ATC codes, vitamin K antagonists (VKAs) included warfarin, acenocumarol, dicoumarol, phenindione, whilst DOACs included dabigatran, rivaroxaban, apixaban, and edoxaban. Participants not taking VKAs or DOACs were categorised as having no treatment.