title: Pacemaker lead thrombosis and disseminated intravascular coagulation following warfarin therapy: case report and review of the literature.
abstract: A 54-year-old male with a permanent pacemaker was admitted to the intensive care unit due to a stroke. This occurred six days following the initiation of warfarin therapy for paroxysmal atrial fibrillation. The patient presented with profuse bleeding through the sites of venipuncture and laboratory evidence of disseminated intravascular coagulation. Echocardiography revealed multiple thrombi adjacent to the pacemaker leads. Underlying thrombophilia and/or any other systemic disorders were excluded. Thereafter, he exhibited multiple organ failure and despite all therapeutic efforts he expired. In the absence of any thrombophilia, the rare patient with a preexisting intracardiac device, in whom warfarin is prescribed, might experience thrombotic events. The latter could be linked with the preexisting device and/or could be triggered by the initiation of warfarin treatment, but this is merely a hypothesis.
authors.affiliation: Intensive Care Unit, University Hospital of Thessaly, Larissa, Thessaly, Greece. y_papanikolaou@hotmail.com
authors.forename: John
authors.initials: J
authors.lastname: Papanikolaou
authors.forename: Andreas
authors.initials: A
authors.lastname: Karabinis
authors.forename: Triantafillia
authors.initials: T
authors.lastname: Koukoubani
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karakitsos
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Zakynthinos
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D003328:Coronary Thrombosis / Q000175:diagnosis / Q000209:etiology*; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin