Postoperative Intracardiac Thrombus in a Child with Nephrotic Syndrome.

Background: Thromboembolic events are a known complication of nephrotic syndrome in children. Intracardiac thrombi are a rare location for thrombus formation but can lead to severe clinical consequences. Case Presentation: We report an intracardiac left atrial thrombus in a child with new onset steroid-resistant nephrotic syndrome and recently repaired atrial septal defect and cor triatriatum. The thrombus was successfully treated with surgical excision. Conclusion: Intracardiac thrombus is a rare but serious complication of nephrotic syndrome in children, especially in children with risk factors for potentially increased intracardiac thrombogenicity such as history of recent intervention.

Prothrombin complex concentrate in the management of major bleeding induced by oral anticoagulant therapy.

OBJECTIVES: To share clinical data on the efficacy of 4F-PCC in the treatment of major bleeding caused by warfarin, dabigatran, and rivaroxaban. METHODS: This is a retrospective study of patients admitted to King Fahad Medical City, Riyadh, Saudi Arabia with major bleeding caused by oral anticoagulants and treated with 4-factor prothrombin complex concentrate (4F-PCC). The International Society of Thrombosis and Hemostasis Scientific and Standardization Subcommittee criteria were used to evaluate the effectiveness of PCCs. RESULTS: A total of 22 patients were included in the study. Ten of the events were caused by gastrointestinal bleeding (46%). In the majority of patients, anticoagulation was prescribed for stroke prevention, atrial fibrillation, and venous thromboembolism. The median international normalized ratio was significantly lower before and after PCC administration (p<0.001). In patients treated with 4-factor PCC, the rate of thromboembolic events was 0%. The hemostatic effectiveness of PCC was effective in 19 patients. During treatment, no clinically significant bleeding complications occurred. CONCLUSION: Prothrombin complex concentrate can effectively reverse the effects of warfarin and rivaroxaban in patients with major bleeding, but only partially reverses the effect of dabigatran.

Stroke Risk Factor Awareness Among Populations in Saudi Arabia.

BACKGROUND: Stroke is considered the second leading cause of death and the third leading cause of disability in the world. The incidence of stroke in Saudi Arabia is 43.8 per 100,000, due to the lack of knowledge and awareness of the population. This study intends to determine the level of stroke risk factor awareness among the Saudi population. METHODS: A cross-sectional study was conducted in Saudi Arabia on 898 participants older than 18 years old. The validated online survey was randomly distributed and consisted of 20 questions in both English and Arabic languages to evaluate the level of awareness of stroke risk factors among the population. RESULTS: A total of 898 participants completed the survey. The results showed that the median risk factor score was 5 (IQ 3-8) out of 14. A total of 2.2% could recognize all 14 risk factors. Personal history of hypertension was chosen as a risk factor by the majority of the participants (81.7%) followed by personal history of stroke (74.1%) and personal history of dyslipidemia (57.2%). CONCLUSION: This study showed that there is an insufficient level of stroke risk factor awareness in Saudi Arabia. More than half of the participants identified the term (stroke), while only 2.2% could recognize all 14 risk factors. Hence, public education is needed to identify people with stroke risk factors.