acenocoumarol and Chronic-Disease

Currently pulmonary endarterectomy is considered the method of choice in patients with chronic thromboembolic pulmonary hypertension (CTEPH). It is not known if this option should be recommended in all suitable patients as it is highly variable with respect to prognosis. There is also doubt about selection of adequate time to refer patients with CTEPH for surgery.. To establish whether some patients with CTEPH may clinically benefit from isolated anticoagulation with drugs and if the use of anticoagulation may have any impact on the time of patient referral for pulmonary endarterectomy.. The prospective analysis involved 29 patients (9 male, 20 female) aged 37 to 82 years, with pulmonary arterial systolic pressure ranging from 39 to 133 mmHg and newly diagnosed CTEPH who had not been treated with pulmonary endarterectomy and were not receiving anticoagulation. Survival, functional status according to NYHA classification, duration of thromboembolism, exercise tolerance and echocardiographic parameters of right ventricular overload before and at one year after initiation of therapy with anticoagulants were evaluated.. During follow-up, 3 patients with PASP ranging from 120 to 133 mmHg died. In 26 patients with PASP 39-115 mmHg, who survived, improvement in echocardiographic parameters of right ventricular overload, better exercise tolerance as well as functional status according to NYHA classification was observed. In 12 survivors, pulmonary pressure returned to normal.. The results of this study suggest that favourable effects of isolated anticoagulation are likely in patients with newly detected CTEPH, mild and moderate baseline pulmonary hypertension and acceptable exercise tolerance. They also indicate the necessity of anticoagulation in these patients prior to possible referral for pulmonary endarterectomy.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anticoagulants; Chronic Disease; Endarterectomy; Female; Follow-Up Studies; Humans; Hypertension, Pulmonary; Longitudinal Studies; Male; Middle Aged; Prognosis; Pulmonary Embolism; Time Factors; Treatment Outcome

Chronic spontaneous urticaria is a common condition, with a lifetime prevalence of 0.5-1.0%. It has a significant effect on quality of life, comparable to having triple-vessel coronary artery disease. Warfarin and nicoumalone are synthetic derivatives of the plant toxin coumarin. We report the first case of successful response to both warfarin and nicoumalone in the same patient, thereby demonstrating a class action of synthetic coumarins in the disease. Complete response with both coumarins occurred once an INR above 2.0 was achieved, and was maintained during a 12-month follow-up. The mechanism of action of coumarins on urticaria is not known, but may be related to decrease in thrombin production or to interference of activation of other inflammatory proteins produced during the coagulation process. Side-effects of anticoagulation can be catastrophic, and coumarin treatment currently remains reserved for restricted severe recalcitrant cases only.

Topics: Acenocoumarol; Administration, Oral; Chronic Disease; Dermatologic Agents; Female; Humans; International Normalized Ratio; Treatment Outcome; Urticaria; Warfarin; Young Adult

Oral anticoagulation with coumarin derivatives (OAC) has been used for more than 50 years and is being prescribed to a steadily increasing number of patients as a long-term therapy. The aim of our study was to evaluate patients' knowledge about the safety of acenocumarol treatment, the therapeutic range of International Normalized Ratio (INR) and its interactions with other medications and food.. One hundred and forty patients on long-term acenocumarol treatment were included in the study. They were interviewed using a questionnaire specifically prepared by the authors. The questions concerned their understanding of the reasons for the treatment, knowledge of target INR ratio, frequency of INR examination. Additionally the questionnaire contained questions specifically designed to check the patients' knowledge about factors influencing INR values e.g. drugs, food, alcohol and the like.. One hundred and fifteen (82.1%) patients declared knowledge of target INR ratio, but only eighty eight (62.9%) answered correctly. Percentages of correct answers for the questions evaluating knowledge about acenocumarol treatment did not exceed 50%. Patients' responses suggested that advice was not always provided by doctors.. Level of patients' knowledge about the safety of OAC treatment was very low. Insufficient knowledge was observed particularly in patients with lower education levels and those over 60 years of age. Those groups require a special attention and longer education to be able to self-manage the treatment. Special anticoagulant clinics do not exist in Poland. So, it seems very appropriate to develop concise guidelines available for patients in practices of family doctors. Education should be systematic and modified according to changing recommendations.

Topics: Acenocoumarol; Anticoagulants; Chronic Disease; Drug Administration Schedule; Drug Interactions; Educational Measurement; Health Knowledge, Attitudes, Practice; Herb-Drug Interactions; Humans; International Normalized Ratio; Patient Education as Topic; Poland; Self Care; Surveys and Questionnaires; Venous Thrombosis

A SPORTIF-III substudy.. Warfarin has been considered to provide more stable anticoagulant effect than acenocoumarol due to its longer half-life.. The aim of this SPORTIF-III substudy was to compare acenocoumarol (A) with warfarin (W) in the same group of 74 patients, with chronic atrial fibrillation who started with W and then changed to A.. We compared prospectively a 3 months period on W with a 3 months period on A.. The mean number of INR measurements per patient was 5.7 +/- 1.2 and 5.4 +/- 1.6 resp (NS). The mean percentage of INR-s in the therapeutic range of 2-3 was 49 +/- 22.6% for W and 56 +/- 26.8% for A (p < 0.05), the percentage of subtherapeutic values were not different, the supratherapeutic values however occurred more frequently on W (28 +/- 20%) than on A (19 +/- 19%), p < 0,001. There was a good correlation between A and W doses (r = 0.65, p < 0.001), the mean W dose was 5.03 +/- 1.99 mg, the mean A dose was 2.5 +/- 1.3 mg, the W/A dose ratio was computed to be 2.18 +/- 0.78.. 1. anticoagulation effect stability was superior for A compared to W; 2. W/A dose ratio was 2.18.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Chronic Disease; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Humans; International Normalized Ratio; Male; Middle Aged; Prospective Studies; Treatment Outcome; Warfarin

Topics: Acenocoumarol; Administration, Oral; Aged; Anticoagulants; Antifibrinolytic Agents; Atrial Fibrillation; Blood Coagulation Factors; Chronic Disease; Female; Fibrin Fibrinogen Degradation Products; Fibrinolysis; Humans; Male; Middle Aged

Transvenous internal cardioversion of chronic AF using a right atrium (RA) coronary sinus (CS) vector requires more energy than cardioversion of paroxysmal AF. Chronic AF is not terminated in 25% of patients using biphasic shocks up to 10 J. We therefore evaluated efficacy, safety, and tolerability of internal cardioversion using a "unipolar" configuration (RA to skin patch) and biphasic shocks in patients with long-lasting AF and different heart disease. In each patient, biphasic R wave synchronous shocks were delivered between a large defibrillating surface area electrode in the RA and a skin patch in the left prepectoral position. Defibrillation protocol started with a test shock of 0.4 J. Shocks were repeated and increased until termination of AF or a maximum of 34 J. Sedation was used when the patient described the shock as painful. This study included 11 patients with a mean age of 67 +/- 8 years (range 56-83). AF duration was > or = 1 month in all patients with a mean duration of 11 +/- 11 months (range 2-36). Underlying heart disease was present in all patients and the mean left atrial dimension was 43 +/- 9 mm (range 26-57). AF was terminated in 10 of 11 patients (91%) with a mean delivered energy of the successful shocks of 18.7 +/- 8.7 J (median energy 16.9 J; range 7.3-32.5) and a mean leading edge voltage of 564 +/- 129 V. The mean shock impedance at the defibrillation threshold was 71 +/- 13 omega (range 59-103). A total of 131 shocks were delivered without any complication and proarrhythmia episodes. We conclude that low energy "unipolar" internal cardioversion is a simple, safe, and effective technique for termination of chronic AF in patients with heart disease. The procedure is often tolerated under light sedation.

Topics: Acenocoumarol; Aged; Amiodarone; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Chronic Disease; Electric Countershock; Electrocardiography; Electrodes, Implanted; Female; Humans; Male

Fibrinolysis of 19 patients who developed CVI after deep vein thrombosis was examined. Mean age of patients at the first thrombosis was 31.8 years. For testing fibrinolysis fibrinogen, plasminogen, AP, ECLT, with venous occlusion were determined. In 10 patients t-PA and PAI-1 activities were also measured and plethysmography was carried out. For screening blood coagulation abnormalities of TCT count, PT, APTT, TT, AT III, protein C were tested. The common abnormality was the decreased fibrinolysis. Patients had been on coumarin for 6.14 years before entering the study. Under coumarin treatment 6 patients had relapsed DVT, 4 had crural ulcer and CVI deteriorated in 8 patients. Therefore we added fibrinolysis increasing PPS to coumarin. PPS dose was individually determined by PPS loading test (150-500 mg). Mean observation time with the combined treatment was 2.92 years. Clinical check up and fibrinolysis test were carried out every 6 months. Clinical improvement occurred in 13 patients, (decrease of swelling, pain etc). Two out of 4 patients with stasis ulcer experienced complete healing; in 1 the ulcer territory diminished in size. Maximum venous outflow improved in 7 patients, 3 patients were non-responders. We observed an increase of fibrinolysis in 10 patients. Venous occlusion enhanced the fibrinolysis increasing effect of PPS. The activity reached its maximum by the first control. The fibrinolysis increase and the clinical improvement do not always run parallel, therefore other effects of PPS as the reason for being beneficial in CVI must be considered (antiinflammatory, ect.). Combination of coumarin and PPS seems to be an effective therapy in CVI with decreased fibrinolysis.

Topics: Acenocoumarol; Administration, Oral; Adult; Chronic Disease; Drug Therapy, Combination; Female; Humans; Male; Pentosan Sulfuric Polyester; Thrombophlebitis; Venous Insufficiency

Forty seven patients with IgA glomerulonephritis (GN) were studied. The males predominated among them--the ratio males-female--2,9:1. The first clinical manifestations were macroscopic hematuria (in 2/3 of the cases) or only urine changes--low-degree proteinuria and microscopic erythrocyturia. As early as the establishment--38,2 per cent of the patients had elevated arterial pressure, and it reached, 59,5 per cent during the follow-up period. Anemia was rare. Manifestations of nephrotic syndrome were absent. ESR was normal in 1/3 of the employees or slightly accelerated. Chronic renal insufficiency developed 6,31 per cent of the patient all of them males. Terminal renal insufficiency developed 8 patients. The elevated arterial pressure, proteinuria over 2g/24 h, accelerated ESR, high serum levels of IgA, the longer duration of the disease and higher age of the patients to a certain extent--were unfavourable prognostic criteria. The basic immune deviations of IgA GN are the high serum levels of IgA (in 53,1% of the patients) and to a lower extent of IgG (in 17% of the patients) as well as the reduced serum levels of C3 (in 31,9% of the patients). CIC are not a frequent finding. The percentage of ERF is lower than in the healthy subjects. The treatment with a combination of azathioprine (acenocoumarol, indomethacin or levamisole) has no effect on the clinical manifestations and evolution.

Topics: Acenocoumarol; Adolescent; Adult; Antigen-Antibody Complex; Azathioprine; Chronic Disease; Complement C3; Drug Therapy, Combination; Female; Glomerulonephritis, IGA; Humans; Immunoglobulins; Indomethacin; Levamisole; Male; Middle Aged; Rosette Formation; Time Factors

Topics: Acenocoumarol; Anticoagulants; Chronic Disease; Coronary Disease; Female; Humans; Male; Middle Aged; Myocardial Infarction; Thromboembolism

Topics: Acenocoumarol; Angina Pectoris; Chronic Disease; Follow-Up Studies; Humans; Myocardial Infarction