RESUMO
Severe hemorrhagic diathesis due to lupus anticoagulant complicated by hypoprothrombinaemia resulting from prothrombin autoantibodies is a rare disorder and is often associated with systemic lupus erythematosus (SLE). We report a case in which a 15-year-old girl with SLE developed marked haemorrhagic manifestations due to menorrhagia and nosebleeds. The acute bleeding episode was treated with SAGM, tranexamic acid and recombinant factor VIIa. Lupus anticoagulant, cardiolipin antibodies and antiprothrombin antibodies were successfully depressed within weeks after corticosteroid therapy was begun.
Assuntos
Hemorragia/etiologia , Hipoprotrombinemias/complicações , Inibidor de Coagulação do Lúpus/sangue , Lúpus Eritematoso Sistêmico/complicações , Adolescente , Epistaxe/tratamento farmacológico , Epistaxe/etiologia , Epistaxe/imunologia , Feminino , Hemorragia/tratamento farmacológico , Hemorragia/imunologia , Humanos , Hipoprotrombinemias/sangue , Hipoprotrombinemias/tratamento farmacológico , Hipoprotrombinemias/imunologia , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Menorragia/tratamento farmacológico , Menorragia/etiologia , Menorragia/imunologiaAssuntos
Bebidas , Fármacos do Sistema Nervoso Central/intoxicação , Medicina Legal , Intoxicação , Intoxicação Alcoólica/diagnóstico , Intoxicação Alcoólica/etiologia , Intoxicação Alcoólica/terapia , Fármacos do Sistema Nervoso Central/análise , Vítimas de Crime/estatística & dados numéricos , Dinamarca/epidemiologia , Humanos , Intoxicação/diagnóstico , Intoxicação/epidemiologia , Intoxicação/etiologia , Intoxicação/terapia , Guias de Prática Clínica como Assunto , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
INTRODUCTION: A few case-stories claim that the anti-oxidant Coenzyme Q10 and possibly also Ginkgo biloba interact with warfarin treatment. A decreased response to warfarin in the Coenzyme Q10 cases and an increased response in the Ginkgo biloba case have been described. MATERIAL AND METHODS: Twenty-four outpatients on stable, long-term warfarin treatment were included in a randomised, double blind, placebo-controlled crossover trial. Coenzyme Q10 100 mg daily, Ginkgo-Biloba 100 mg daily and placebo were given in random order over treatment periods of four weeks, each followed by a two week wash out period. The international normalized ratio (INR) INR was kept between 2.0 and 4.0 by appropriate adjustment of the warfarin dosage. RESULTS: Fourteen women and ten men, median ages 64.5 years (33-79) were included. Three patients withdrew from the study for personal reasons. The INR was stable during all treatment periods. The geometric mean dosage of warfarin did not change during the treatment periods: Ginkgo biloba 36.7 mg/week (95% confidence interval: 29.2-46.0); CoQ10 36.5 mg/week (29.1-45.8); placebo 36.0 mg/week (28.6-45.1). CONCLUSION: The study indicated that Coenzyme Q10 and Ginkgo biloba do not influence the clinical effect of warfarin.
