A rare combination of CYP2C9*3/*3 and VKORC1 1639AA in a patient had myxoma and thromboembolism.

We report a case of intolerance to warfarin. A 20-year-old woman with toe pain was diagnosed as myxoma with multiple systemic embolism. She was prescribed warfarin for remaining embolic pain after myxoma excision and mitral annuloplasty. Even on 1 mg of warfarin, INR was much increased. The patient have the Cytochrome P450 2C9 (CYP2C9)*3/*3 and vitamin K epoxide reductase complex subunit 1 (VKORC1) 1639AA genotype, extremely rare in Koreans. Based on this result, we assessed the potential risks and benefits of warfarin, and decided to switch to aspirin because the risk of bleeding was considered to be too high. PMID: 31520636 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research

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Authors: Gong M, Zhao B, He X, Gu J, Chen G Abstract The aim of the present study was to investigate whether the rescue of thrombolysis with the recombinant tissue plasminogen activator (rt-PA) alteplase was an effective and safe therapeutic option in patients who did not respond to urokinase. Between February 2016 and February 2017, 26 patients with deep venous thrombosis (DVT) underwent rescue thrombolysis with alteplase. Unsuccessful thrombolysis with urokinase was defined as a lack of improvement in the degree of thrombotic removal with a lysis rate 3 million units of total urokinase, or>7 days infusion dura...
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
We present a case of a 68-year-old Hispanic female with a history of factor VII deficiency who presented with shortness of breath, chest pain, and palpitations and was found to have pulmonary embolism. Our patient did not have any of the above-mentioned thrombotic risk factors. Our case and review of the literature show that factor VII deficiency does not provide protection against thrombosis. PMID: 31590173 [PubMed - as supplied by publisher]
Source: Acta Haematologica - Category: Hematology Authors: Tags: Acta Haematol Source Type: research
CONCLUSIONS: There is very low-certainty evidence regarding the use of GECS for treatment of PTS as assessed by two small studies of short duration. One study reported beneficial haemodynamic effects, while one found no benefits on PTS severity compared to control/placebo stockings. There is very limited evidence for adverse effects, patient satisfaction, QoL, and compliance rates. There is low-certainty evidence favouring use of intermittent pneumatic compression devices compared to a control device for the treatment of severity owing to different measurements used by the studies reporting on this outcome and small studie...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
r M Abstract OBJECTIVE: Fast track concepts are used to reduce the risk of perioperative and postoperative complications after total knee arthroplasty. INDICATIONS: The described concepts are used for patients with indications for the implantation of a total knee prosthesis. CONTRAINDICATIONS: Contraindications for fast track concepts are aged patients, dementia, American Society of Anesthesiologists (ASA) grade IV and implantation of large revision or tumor prostheses. Contraindications for tranexamic acid are bleeding in the urinary tract, caution in cases of known epilepsy, individual risk assessment ...
Source: Operative Orthopadie und Traumatologie - Category: Orthopaedics Authors: Tags: Oper Orthop Traumatol Source Type: research
We report a case of intolerance to warfarin. A 20-year-old woman with toe pain was diagnosed as myxoma with multiple systemic embolism. She was prescribed warfarin for remaining embolic pain after myxoma excision and mitral annuloplasty. Even on 1 mg of warfarin, INR was much increased. The patient have the Cytochrome P450 2C9 (CYP2C9)*3/*3 and vitamin K epoxide reductase complex subunit 1 (VKORC1) 1639AA genotype, extremely rare in Koreans. Based on this result, we assessed the potential risks and benefits of warfarin, and decided to switch to aspirin because the risk of bleeding was considered to be too high.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
We describe two Japanese brothers with immunoglobulin-A vasculitis (IgAV) who met the diagnostic criteria of LAHPS. They presented with palpable purpura and abdominal pain, and had a prolonged activated partial thromboplastin time (APTT) and prothrombin deficiency with the presence of lupus anticoagulant. Pediatric LAHPS was reviewed in abstracts from the Japan Medical Abstracts Society that were written in Japanese and PubMed or Web of Science-listed articles in English between 1996 and 2019. Including our cases, pediatric LAHPS has been reported in 40 Japanese and 46 non-Japanese patients. We summarized the clinical and ...
Source: Rheumatology International - Category: Rheumatology Source Type: research
This study aims to address whether the low-dose acetylsalicylic acid increases bleeding and occurrence of postoperative complications after laparoscopic inguinal hernia repair when it was only ceased on the operation day.MethodFrom July 2017 to January 2019, 901 patients including 781 (86.7%) male and 120 (13.3%) female patients underwent laparoscopic inguinal hernia repair using trans-abdominal preperitoneal (TAPP) technique were recruited, among whom 152 (16.9%) had been taking low-dose (100  mg per day) acetylsalicylic acid which was continued during hospitalization except the operation day. The intra-operative ble...
Source: Hernia - Category: Sports Medicine Source Type: research
ConclusionDespite the decrease in IBL with a tourniquet, no difference was found in TBL. In conclusion, not using a tourniquet or only using it during the cementation of implants was preferable based on the faster functional recovery, lower rate of DVTs and complications compared with using a tourniquet throughout the TKA procedure.Level of evidenceI.
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
Case submitted by Dr. James AlvaA middle aged male called EMS for chest pain. EMS arrived and confirmed that the patient was complaining of chest pain and shortness of breath.They recorded this prehospital ECG:What do you think?Normal QRS complex rhythm with hyperacute T-waves in V2-V6, I and aVL. Slight STE in V2 only, with significant STD and thus de-Winter pattern in V4-V6. Leads II and III show reciprocal depression of the ST segment (II) and T-wave (III). This is diagnostic of acute myocardial infarction of the anterolateral walls, with the most likely etiology being Occlusion of the LAD. In other words, this ECG show...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Abstract A difference in clinical manifestations of paroxysmal nocturnal hemoglobinuria (PNH) among different races has been suggested. The aim of this study was to clarify whether the clinical characteristics of patients with PNH in the International PNH Registry differ by ethnic background. Patients, who were eculizumab naïve at baseline and had ≥ 1% PNH clone size, were eligible for this analysis. Totally, 1793 patients were enrolled and divided into two cohorts, Asian (N = 246) and non-Asian (N = 1547). The Asian cohort was further divided into Asians in Asia c...
Source: International Journal of Hematology - Category: Hematology Authors: Tags: Int J Hematol Source Type: research
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