[Reversal of acenocoumarol anticoagulation with activated factor VII in massive hemorrhage following rupture of a splenic artery pseudoaneurysm].
A 66-year-old man with a metallic valve and under treatment with acenocoumarol developed hypovolemic shock after rupture of a splenic artery pseudoaneurysm. We managed to reverse anticoagulation within 60 minutes by administering 20 mg of vitamin K and 4.8 mg of activated recombinant factor VII. No thromboembolic adverse events were observed. We discuss the pharmacologic effects of coumarin derivatives and their antagonists, as well as the use of activated factor VII in the reversal of anticoagulation by these drugs.
Varela
C A
CA
Servicio de Anestesia, Hospital Universitario de Madrid-Montepríncipe, Madrid. carlosvarelac@yahoo.es
Gómez
J M
JM
Reina
M A
MA
López
A
A
Galindo
S
S
Arruga
A M
AM
D000074:Acenocoumarol / Q000009:adverse effects* / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D000368:Aged; D017541:Aneurysm, False / Q000150:complications*; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D003131:Combined Modality Therapy; D000077324:Crystalloid Solutions; D004359:Drug Therapy, Combination; D004621:Embolization, Therapeutic; D017707:Erythrocyte Transfusion; D015942:Factor VIIa / Q000008:administration & dosage / Q000627:therapeutic use*; D006350:Heart Valve Prosthesis; D006465:Hemoperitoneum / Q000139:chemically induced / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D006801:Humans; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012422:Rupture, Spontaneous; D013157:Splenic Artery / Q000473:pathology*; D010837:Vitamin K 1 / Q000008:administration & dosage / Q000627:therapeutic use*
D000925:Anticoagulants; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D011994:Recombinant Proteins; D010837:Vitamin K 1; D015942:Factor VIIa; D000074:Acenocoumarol