Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019079 (hemoptysis)
 6,129 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Oral contraceptive (OC) use is a risk factor for developing deep venous thromboses (DVT) in adolescents, especially among those undergoing surgery. OCs increase venous distensibility, affect the intimal proliferation of venous walls, and increase blood coagulability. All of these factors affect thrombus formation. Adolescent females frequently use OCs to meet contraceptive and noncontraceptive ends. This paper describes the development of a DVT in a 17-year old female presenting for elective surgery to correct recurrent shoulder subluxation. Up to the day of admission, this patient used OCs containing 35 or 50 mcg ethinyl estradiol and 1.0 mcg norethindrone. She denied having chest pain, leg pain, hemoptysis, and headaches. There was no history of extended bed rest before surgery and no family history of thromboembolic disease. The operation was conducted without event. Nevertheless, the patient developed a DVT in the left popliteal vein. which was resolved with supportive measures and anticoagulation therapy using heparin and coumadin. Adolescent females using OCs should not take contraceptive pills for at least 1 month before and after elective surgery and attendant immobilization. Contraceptive counseling should be provided for these youths to help them adopt another form of contraception over this minimal 2-month period. Associated literature is briefly reviewed.
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PMID:Oral contraceptives and venous thromboses in adolescents undergoing elective surgery: a case report, and review of the literature. 142 Feb 20

A 48-year-old woman was admitted because of increased bloody sputum. Since she had had a history of repeated thrombotic episodes including venous thrombosis in the lower limbs (21 year old) and pulmonary emboli developing into pulmonary infarction (41 years old), the patient was treated with anti-coagulant therapy using Warfarin for 7 years. Warfarin was discontinued after admission and heparin was administered instead at a relatively low dose of 5,000 units daily, resulting in a considerable diminution of hemoptysis. Unfortunately however, it caused a relapse of active thrombosis associated not only with a significant increase of the product of fibrinolysis (FDP), LDH and GOT but with a concomitant decrease of the platelet count. Hematological examinations concerning coagulation and fibrinolysis remained within a normal range except for the serum concentration of antithrombin III (AT III) and its functional property with regard to the heparin cofactor, which were 8.8 mg/dl and 48%, respectively. Since the findings were consistent with congenital deficiency of AT III, some members of her family were also examined. The concentration of AT III and its activity in the patient's son and her daughter deteriorated in a similar manner, indicating that this was a definite case of congenital deficiency of AT III. The clinical manifestations of 87 cases with congenital AT III deficiency, belonging to 24 families reported in Japan were reviewed.
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PMID:[A case of congenital antithrombin II deficiency with pulmonary infarction]. 203 2

A 66-year-old man with mitral stenosis on coumadin presents with hemoptysis caused by a capillary hemangioma of the proximal airways. Argon plasma coagulation was utilized to treat the lesions resulting in resolution of hemoptysis. Tracheobronchial capillary hemangiomas are rare in adults, but are easily discovered and treated with bronchoscopic intervention. The literature to date is reviewed pertaining to adult tracheobronchial capillary hemangiomas.
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PMID:Endobronchial capillary hemangioma: case report and review of the literature. 1726 68

With increasing availability of valve surgery, a pool of patients requiring chronic anticoagulation is emerging in our environment. The lower blood coagulability with low temperatures, though rare, can occur, putting patients at risk of bleeding. Recently, the author lost two patients with prosthetic valves on anticoagulation at the peak of the cold harmattan season. Before their death, despite dose reduction, the International Normalised Ratio (INR) kept increasing and they were reported to have died suddenly at home. This triggered the need to draw attention of clinicians especially in the tropics to this difficulty, so as to anticipate and confront it when necessary. Case 1 was a 42-year-old male hypertensive on life-style measures with Moduretic once daily and weekly 20 mg Propranolol to control his blood pressure. He had surgery in India for aortic aneurysm with placement of prosthetic valve in 2013, and was placed on an oral anticoagulant - Acitrom. In 2015 while on 3 mg daily dose, he had an INR of 2.8. By October, INR rose to 3.95 prompting a dose reduction to 2 mg daily. Early in January 2016 (peak of cold harmattan season), the INR went higher to 4.19. He was asked to skip doses on Saturday and Sunday. After a forthnight he was reported to have died suddenly at home and no autopsy was done. Case 2 was a 40-year-old female with mitral stenosis. She had mitral valve surgery with prosthetic valve placement in India in 2010 where she was put on warfarin. In 2015, she had episode of ecchymosis and INR returned 2.07. With dose reduction, the INR dipped to 1.21 prompting a dose increase to 6 mg. The INR increased to 2.73. By October of 2015, her INR rose to 3.72, prompting de-escalation to 5 mg daily. While on this, she presented in a peripheral centre with haemoptysis where her Warfarin was further de-escalated and Co-trimoxazole prescribed. Again, within a fortnight she was reported to have died suddenly; and no autopsy was done The curious similarity here is the increasing INR despite anticoagulant de-escalation in the cold harmattan season. This experience has not been reported locally to the knowledge of the author. Some workers have reported that clotting times are longer with cold; clotting times being 3 times longer at 27 degrees Centigrade than 37 degrees.1 The phenomenon of decreasing temperature progressively delaying thrombus initiation began at 30 degrees Centigrade, progressing rapidly below that; and reaching statistical significance at 24 degrees.2 However, significant inter-individual variability in this response has been observed and explains conflicting result of studies on this subject.3 One could understand, therefore, why such observation may be made in Jos where harmattan temperatures can drop to single digits.
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PMID:Anticoagulation During the Cold Harmattan Season:Need for Extra Caution. 3318 71

Non-valvular atrial fibrillation(NVAF) is the most common arrhythmia. It is of a high disability and death rate, and seriously affects quality of life. Although NOACs are recommended for anticoagulation therapy of atrial fibrillation, they are not widely used for the high cost and limited availability. Warfarin is effective and economical. The risk of thromboembolism and anticoagulant hemorrhage is higher in patients >65 years with NVAF. So it is of great clinical significance to explore the optimal anticoagulation intensity of warfarin in patients >65 years of China, and other ethnicities. Some studies suggested that low intensity INR has similar antithrombotic efficacy comparing to standard intensity INR, while bleeding risk was significantly reduced. But others showed conflicting results. We pooled the efficacy and safety data of low and standard intensity warfarin therapy for patients over 65 years with NVAF by meta-analysis, as to evaluate optimal INR intensity of warfarin therapy in patients over 65 years. We identified 18 studies providing data of 2105 patients receiving anticoagulation therapy with warfarin. On meta-analysis (odds ratio[OR] [95% confidence interval{CI}]), low intensity INR conferred similar efficacy to standard intensity INR on all thrombosis(1.28 [0.90-1.81]), stroke(1.09 [0.67-1.77]), other thromboembolism [peripheral and pulmonary embolism] (2.26 [0.89-5.79]) and all cause death(1.38 [0.94-2.02]). Low intensity INR conferred better safety profile than standard intensity INR in major bleeding[intracranial and gastrointestinal hemorrhage] (0.32 [0.19-0.52]), minor bleeding[gum, nasal cavity and conjunctival hemorrhage, skin ecchymosis, hematuria, hemoptysis] (0.30 [0.20-0.45]) and all bleeding(0.30 [0.22-0.40]). In conclusion, low intensity INR(1.5-2.0) of warfarin therapy is as effective as standard intensity INR(2.0-3.0) therapy in reducing thromboembolic risk in patients>65 years with NVAF, and has an safer profile of bleeding.
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PMID:Meta-Analysis Evaluating the Efficacy and Safety of Low-Intensity Warfarin for Patients >65 Years of Age with Non-Valvular Atrial Fibrillation. 3330 15