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Öğe Development of pacemaker lead thrombosis in a patient with atrial fibrillation during apixaban treatment(Tehran Heart Center, 2019) Adar, A.; Önalan, O.; Cakan, F.Apixaban was introduced in clinical use for nonvalvular atrial fibrillation as an alternative to warfarin. There is a dearth of information regarding apixaban use in patients suffering from atrial fibrillation with intracardiac foreign bodies such as pacemaker leads. In this report, we describe a 72-year-old female patient with a complaint of weakness in both legs of a few days’ duration. She was detected to have a thrombus over the pacemaker lead and inside the left atrial appendage during apixaban treatment. After the discontinuation of apixaban and the commencement of warfarin, the thrombus was resolved. Our case is the first report to show that apixaban treatment (5 mg, twice daily) may not prevent the development of pacemaker lead thrombosis in patients with atrial fibrillation. © 2019, Tehran Heart Center. All rights reserved.Öğe An unusual case of asymptomatic diffuse alveolar hemorrhage related to amiodarone induced INR elevation(Ondokuz Mayis Universitesi, 2019) Adar, A.; Onalan, O.; Cakan, F.Pulmonary adverse effects of amiodarone are among the important causesof morbidity. Such effects may rarely manifest as diffuse alveolar hemorrhage. Another important amiodarone-induced adverse effect is hepatotoxicity. Hepatotoxicity mostly presents as asymptomatic elevation of the liver enzymes. To the best of our knowledge, in amiodarone-induced hepatotoxicity, AST and ALT elevations are well known; however, there are no clear data regarding the high International Normalized Ratio (INR) levels in such a condition. In the present report, we describe the case of a patient under management with chronic low-dose amiodarone, who was admitted to the emergency department for lingual hematoma. During the assessment for bleeding diathesis, the INR was found to be 8.59. After excluding all other possible causes for the high INR level, amiodarone was suggested to be the cause. Since there were diffuse infiltrations on chest x-ray, the patient underwent thorax tomography. Asymptomatic diffuse alveolar hemorrhage secondary to INR elevation was considered. This patient is the first case who had amiodarone-induced INR elevation, and as a consequence, developed asymptomatic diffuse alveolar hemorrhage. © 2019 OMUÖğe A very rare complication of sublingual captopril(Ondokuz Mayis Universitesi, 2019) Adar, A.; Onalan, O.; Aktas, H.; Ertugrul, S.; Cakan, F.Captopril inhibits angiotensin-converting enzyme and it is the most used sublingual drug in emergency departments to decrease blood pressure. Sublingual captopril is safe, effective and useful in treating hypertensive urgency. However, it is known that captopril has fewer systemic and dermatologic side effects such as headache, weakness and oral ulcers, oral pemphigus, consecutively. No data is available about captopril induced oral mucositis. Herein, we present a 50-year-old hypertensive woman who uses sublingual captopril frequently and suffers from recurrent, reversible and painful oral mucositis that thought to be caused by sublingual captopril. © 2019 OMU
