acenocoumarol and Coronary-Disease

Stent prosthesis is a high efficacious method with low complication rates. However, the ideal adjunctive therapy following stent implantation remains controversial. The authors compared the effectiveness and complication rates of aspirin-ticlopidine antiplatelet therapy vs. anticoagulant therapy with acenocoumarol within 30 days following stent prosthesis. They prospectively studied 404 patients following stent prosthesis while randomly receiving anticoagulant (Group A: 201 patients) vs. antiplatelet treatment (Group B: 203 patients). Groups A and B were similar in demographic data (age, gender), stent location, clinical presentation, indication of stenting, and type of implanted stent. Chi-square test, t test, and Wilcoxon test for two samples were used for statistical analysis of the results. Stent implantation was attempted in 434 cases. This was successful in 70/85 (82%) of the bailout, 122/135 (90%) of the suboptimal, and 212/214 (99%) of the elective cases. In 201 patients anticoagulant treatment with acenocoumarol was administered for 4 weeks (group A), while 203 received antiplatelet treatment with ticlopidine (group B). The need for reintervention was less and total cardiac events were fewer in group B than in group A: three (1.5%) and nine (4.4%) vs 18 (9%) and 29 (14.4%), p<0.0008 and p<0.006 respectively. Hemorrhagic complications and total noncardiac events were fewer in group B than in group A: six (3%) and six (3%) vs. 18 (9%) and 19 (9.5%), p<0.01 and p<0.007 respectively. The length of hospital stay was shorter in group B than in A, p<0.0001. In conclusion, in this study of intracoronary stenting the authors had a high success rate in 434 attempted cases. Antiplatelet therapy was accompanied by fewer cardiac and noncardiac 1 month events when compared with anticoagulant therapy, supporting its role as the adjunctive treatment of choice post-stenting for the time being.

Topics: Acenocoumarol; Aged; Angina Pectoris; Angioplasty, Balloon, Coronary; Anticoagulants; Aspirin; Coronary Disease; Female; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Prospective Studies; Stents; Ticlopidine

From 1987 until 1991 a large prospective randomized multicentre study was performed in The Netherlands, Germany and Switzerland entitled CABADAS (Prevention of Coronary Artery Bypass graft occlusion by Aspirin, Dipyridamole, and Acenocoumarol/Phenprocoumon Study). The aim of CABADAS was to evaluate the relative efficacy of (1) aspirin, (2) aspirin plus dipyridamole, and (3) oral anticoagulants in the prevention of vein graft occlusion during the first year after aortocoronary bypass surgery. No significant difference was observed in the incidence of graft occlusion among the three treatment groups. In a subgroup of 127 CABADAS patients, studied in the Academic Medical Centre in Amsterdam, the relationship between treatment and clinical status (i.e. symptoms of angina pectoris and exercise capacity) was assessed, and the relationship between treatment and functional status of the vein grafts was determined by means of thallium-201 exercise scintigraphy. There were no differences in symptoms among the three treatment groups in the 127 patients studied. There were no significant differences either among the treatment groups, as regards exercise capacity and the number or intensity of perfusion defects, in the 81 patients who underwent thallium-201 exercise scintigraphy. The three antithrombotic treatment regimens had a similar effect on the clinical status of patients and on the functional status of venous bypass grafts one year after coronary bypass surgery. This finding underscores the CABADAS results in that aspirin may be the preferred treatment option in patients following venous bypass surgery.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Aspirin; Coronary Artery Bypass; Coronary Circulation; Coronary Disease; Dipyridamole; Drug Therapy, Combination; Exercise Test; Female; Fibrinolytic Agents; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Phenprocoumon; Postoperative Complications; Prospective Studies; Radionuclide Imaging; Saphenous Vein; Thallium Radioisotopes; Treatment Outcome

The effects of the antiaggregant substance ticlopidine and of the anticoagulant acenocoumarol on patency rates of aorto-coronary bypass grafts were compared in a prospective randomized trial. Ticlopidine, 250 mg b.i.d. was administered orally from the first postoperative day till angiography, while anticoagulation with acenocoumarol was initiated on the second to third postoperative day. Side-effects of ticlopidine were rare and patient management with the standard dosage of this drug was easier than oral anticoagulation. From an initial group of 166 randomized patients 149 completed the trial by coronary angiography three months postoperatively. The 78 patients in the ticlopidine group showed a compliance of 85%. The average prothrombin time in the 71 patients receiving acenocoumarol was 26.9%. Detailed statistical analysis of the two study groups revealed no reason to doubt the correctness of randomization. Coronary angiography showed an average patency rate per patient of 84% with ticlopidine and of 82% with acenocoumarol. This and various other measures of graft occlusion did not reveal any substantial difference in graft patency of patients receiving ticlopidine or acenocoumarol. It is concluded that ticlopidine may well be used instead of anticoagulants for prevention of postoperative occlusion of aorto-coronary bypass grafts.

Topics: Acenocoumarol; Anticoagulants; Clinical Trials as Topic; Coronary Angiography; Coronary Artery Bypass; Coronary Disease; Graft Occlusion, Vascular; Humans; Middle Aged; Postoperative Complications; Thiophenes; Ticlopidine

Topics: Acenocoumarol; Adult; Ambulatory Care; Aspirin; Clinical Trials as Topic; Coronary Disease; Dipyridamole; Follow-Up Studies; Humans; Middle Aged; Myocardial Infarction; Recurrence

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Clinical Trials as Topic; Coronary Disease; Female; Humans; Male; Middle Aged; Prospective Studies; Time Factors

Topics: Acenocoumarol; Blood Coagulation; Blood Coagulation Tests; Coronary Disease; Coumarins; Female; Humans; Male; Middle Aged; Myocardial Infarction

Topics: Acenocoumarol; Anti-Bacterial Agents; Blood Coagulation Tests; Clinical Trials as Topic; Coronary Disease; Coumarins; Dental Service, Hospital; Humans; Phenindione; Postoperative Complications; Thrombosis; Tooth Extraction; Vitamin K 1

Topics: 4-Hydroxycoumarins; Abdomen; Acenocoumarol; Aged; Anti-Bacterial Agents; Anticoagulants; Coronary Disease; Cytochrome P-450 Enzyme System; Drug Interactions; Hematoma; Humans; Indenes; Liver; Male; Roxithromycin; Vitamin K

To compare systemic anticoagulation with antiaggregation in patients with coronary stent, with regard to subacute occlusion, mean hospital staying and haemorrhagic complications.. Seventy-five patients with coronary stent were treated with one of two different antithrombotic protocols. A group comprised of 34 patients (group A) received sodium heparin and acenocoumarin, plus acetylsalicylic acid (325 mg) and dipyridamole (225 mg). The remaining 41 patients (group B) were given antiplatelet agents, namely ticlopidine (125-250 mg) and aspirin (125 mg).. One case of group A (2.9%) showed thrombosis due to stent occlusion. No thrombotic complications were seen in the patients with antiplatelet drugs. Haemorrhagic complications were present in 11 group A patients (32.3%), and blood transfusion was necessary in 3 of them. Hemorrhage was present in 9 cases of group B (21.8%), and none of them needed blood transfusion. The mean number of days to achieve INR > 2 was 3.06 (1-11) in group and 2.02 (1-5) in group B.. Antiplatelet regimes appear as a good choice in coronary stent, in spite of the fact that the primary indication seems that of group A.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Aspirin; Coronary Disease; Dipyridamole; Drug Evaluation; Drug Therapy, Combination; Female; Fibrinolytic Agents; Hemorrhage; Heparin; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Postoperative Complications; Retrospective Studies; Stents; Thrombosis; Ticlopidine

Topics: Acenocoumarol; Coronary Artery Bypass; Coronary Disease; Fibrinolytic Agents; Heparin; Humans; Myocardial Infarction; Postoperative Care; Preoperative Care

Four cases of myocardial infarction after termination of anticoagulant therapy are presented. The controversy on the clinical relevance of the "rebound-phenomenon" is discussed: although laboratory parameters seem to suggest a rebound, the phenomenon may be of clinical importance only in certain subpopulations at risk. In these patients withdrawal of the anticoagulant therapy should be gradual.

Topics: Acenocoumarol; Aged; Coronary Disease; Drug Administration Schedule; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Recurrence; Risk

Topics: Acenocoumarol; Aged; Coronary Disease; Dose-Response Relationship, Drug; Hemorrhage; Humans; Male; Patient Education as Topic

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Blood Coagulation Tests; Coronary Disease; Coumarins; Dicumarol; Female; Humans; Long-Term Care; Male; Middle Aged; Myocardial Infarction; Recurrence

Sixty unselected survivors from ischaemic heart disease, all male service personnel, were treated, within 1 to 6 months of recovery from the acute episode, by promotion of physical activity, correction of coronary risk factors, and routine use of nicoumalone and prenylamine lactate. The results showed that this approach was conducive to more rewarding rehabilitation than was obtained in 89 patients who, in the past, were on conventional treatment based on advice regarding weight, diet, and physical and mental activity. Thus within 1 to 30 months of treatment by this approach, out of 60 patients, 12 were fit for medical category A active service duties in operational areas in any part of the world in any terrain, including altitudes between 10,000 and 18,000 feet, 30 were fit for medical category B service duties in non-operational communication zones in any part of the world including altitudes below 10,000 feet, and 17 were fit for medical category C sedentary duties in non-operational areas in India only. One patient, who initially recovered from congestive heart failure, died while in a state of temporary unfitness for service. No patient was released from service on account of ischaemic heart disease. Against this, by the conventional approach, out of 89 patients, 81 were fit for medical category C sedentary duties in non-operational areas in India only, 4 were released from service, and 4 died.

Topics: Acenocoumarol; Adult; Altitude; Blood Pressure; Cholesterol; Climate; Coronary Disease; Diet, Reducing; Electrocardiography; Glucose Tolerance Test; Humans; Male; Middle Aged; Military Medicine; Physical Fitness; Prenylamine; Smoking; Uric Acid

Topics: Acenocoumarol; Adult; Aged; Angina Pectoris; Anticoagulants; Coronary Disease; Coumarins; Female; Heart Diseases; Heart Valve Diseases; Heart Valve Prosthesis; Hemorrhage; Humans; Long-Term Care; Male; Middle Aged; Myocardial Infarction; Phenindione; Prothrombin Time; Thromboembolism

Topics: Acenocoumarol; Adult; Aged; Coronary Disease; Embolism; Female; Heart Valve Diseases; Humans; Male; Middle Aged

Topics: Acenocoumarol; Blood Coagulation; Coronary Disease; Drug Synergism; Humans; Phenothiazines; Vasodilator Agents

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

Topics: Acenocoumarol; Anticoagulants; Biomedical Research; Coronary Disease; Drug Therapy

Topics: Acenocoumarol; Anticoagulants; Coronary Disease; Coumarins; Ethyl Biscoumacetate; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Aged; Anticoagulants; Cerebrovascular Disorders; Coronary Disease; Dicumarol; Drug Therapy; Ethyl Biscoumacetate; Geriatrics; Humans; Incidence; Middle Aged; Mortality; Neoplasm Metastasis; Neoplasms; Pathology; Phenindione; Thromboembolism; Warfarin

Topics: Acenocoumarol; Coagulants; Coronary Disease; Ethyl Biscoumacetate; Geriatrics; Myocardial Infarction; Prothrombin Time; Toxicology

Topics: Acenocoumarol; Anticoagulants; Coronary Disease; Coumarins; Peripheral Vascular Diseases; Thromboembolism; Vascular Diseases

Topics: Acenocoumarol; Anticoagulants; Coronary Disease; Coumarins; Humans

Topics: Acenocoumarol; Anticoagulants; Coronary Artery Disease; Coronary Disease; Coumarins; Humans