Warfarin is a widely used anticoagulant.Interindividual differences in drug response,a narrow therapeutic range and the risk of bleeding render warfarin difficult to use clinically.An 18-year-old woman with antiphosph...Warfarin is a widely used anticoagulant.Interindividual differences in drug response,a narrow therapeutic range and the risk of bleeding render warfarin difficult to use clinically.An 18-year-old woman with antiphospholipid syndrome received long-term warfarin therapy for a recurrent deep vein thrombosis.Six years later,she developed right flank pain.We diagnosed intrahepatic and subgaleal hemorrhages secondary to anticoagulation therapy.After stopping oral anticoagulation,a follow-up computed tomography showed improvement in the hemorrhage.After restarting warfarin because of a recurrent thrombosis,the intrahepatic hemorrhage recurred.We decided to start clopidogrel and hydroxychloroquine instead of warfarin.The patient has not developed further recurrent thrombotic or bleeding episodes.Intrahepatic hemorrhage is a very rare complication of warfarin,and our patient experienced intrahepatic and subgaleal hemorrhage although she did not have any risk factors for bleeding or instability of the international normalized ratio control.展开更多
Endoscopic epinephrine injection is relatively easy,quick and inexpensive.Furthermore,it has a low rate of com-plications,and it is widely used for the management of nonvariceal upper gastrointestinal bleeding.There h...Endoscopic epinephrine injection is relatively easy,quick and inexpensive.Furthermore,it has a low rate of com-plications,and it is widely used for the management of nonvariceal upper gastrointestinal bleeding.There have been several case reports of gastric ischemia after en-doscopic injection therapy.Inadvertent intra-arterial in-jection may result in either spasm or thrombosis,leading to subsequent tissue ischemia or necrosis,although the stomach has a rich vascular supply and the vascular reserve of the intramural anastomosis.In addition to endoscopic injection therapy,smoking,hypertension and atherosclerosis are risk factors of gastric ischemia. We report a case of gastric ischemia after submucosal epinephrine injection in a 51-year-old woman with hy-pertension and liver cirrhosis.展开更多
文摘Warfarin is a widely used anticoagulant.Interindividual differences in drug response,a narrow therapeutic range and the risk of bleeding render warfarin difficult to use clinically.An 18-year-old woman with antiphospholipid syndrome received long-term warfarin therapy for a recurrent deep vein thrombosis.Six years later,she developed right flank pain.We diagnosed intrahepatic and subgaleal hemorrhages secondary to anticoagulation therapy.After stopping oral anticoagulation,a follow-up computed tomography showed improvement in the hemorrhage.After restarting warfarin because of a recurrent thrombosis,the intrahepatic hemorrhage recurred.We decided to start clopidogrel and hydroxychloroquine instead of warfarin.The patient has not developed further recurrent thrombotic or bleeding episodes.Intrahepatic hemorrhage is a very rare complication of warfarin,and our patient experienced intrahepatic and subgaleal hemorrhage although she did not have any risk factors for bleeding or instability of the international normalized ratio control.
文摘Endoscopic epinephrine injection is relatively easy,quick and inexpensive.Furthermore,it has a low rate of com-plications,and it is widely used for the management of nonvariceal upper gastrointestinal bleeding.There have been several case reports of gastric ischemia after en-doscopic injection therapy.Inadvertent intra-arterial in-jection may result in either spasm or thrombosis,leading to subsequent tissue ischemia or necrosis,although the stomach has a rich vascular supply and the vascular reserve of the intramural anastomosis.In addition to endoscopic injection therapy,smoking,hypertension and atherosclerosis are risk factors of gastric ischemia. We report a case of gastric ischemia after submucosal epinephrine injection in a 51-year-old woman with hy-pertension and liver cirrhosis.
