acenocoumarol and Embolism

This trial evaluated the efficacy and safety of the combination of antiplatelet and moderate-intensity anticoagulation therapy in patients with atrial fibrillation associated with recognized risk factors or mitral stenosis.. Warfarin was more effective than aspirin in preventing stroke in these patients; combined therapy with low anticoagulant intensity was ineffective. Mitral stenosis patients were not investigated.. We performed a multicenter randomized trial in 1,209 patients at risk. The intermediate-risk group included patients with risk factors or age >60 years: 242 received the cyclooxygenase inhibitor triflusal, 237 received acenocumarol, and 235 received a combination of both. The high-risk group included patients with prior embolism or mitral stenosis: 259 received anticoagulants and 236 received the combined therapy. Median follow-up was 2.76 years. Primary outcome was a composite of vascular death and nonfatal stroke or systemic embolism.. Primary outcome was lower in the combined therapy than in the anticoagulant arm in both the intermediate- (hazard ratio [HR] 0.33 [95% confidence interval (CI)0.12 to 0.91]; p = 0.02) and the high-risk group (HR 0.51 [95% CI 0.27 to 0.96]; p = 0.03). Primary outcome plus severe bleeding was lower with combined therapy in the intermediate-risk group. Nonvalvular and mitral stenosis patients had similar embolic event rates during anticoagulant therapy.. The combined antiplatelet plus moderate-intensity anticoagulation therapy significantly decreased the vascular events compared with anticoagulation alone and proved to be safe in atrial fibrillation patients.

Topics: Acenocoumarol; Aged; Anticoagulants; Atrial Fibrillation; Cause of Death; Dose-Response Relationship, Drug; Drug Therapy, Combination; Embolism; Female; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Intracranial Embolism; Male; Middle Aged; Mitral Valve Stenosis; Platelet Aggregation Inhibitors; Proportional Hazards Models; Salicylates; Survival Analysis; Treatment Outcome

Few trials have studied platelet activity during oral anticoagulation and all show a tendency for platelet aggregation to increase. This adverse effect has also been shown in some patients treated with unfractionated heparin, the so-called white clot syndrome. We studied platelet aggregation in patients with atrial fibrillation enrolled in the NASPEAF study and receiving antiaggregant, anticoagulant and both treatments.. 15 healthy control subjects (group C) and 99 patients were enrolled, the latter receiving 4 different antithrombotic regimens for platelet aggregation: group 1, 600 mg of the antiplatelet drug triflusal; group 2, anticoagulation for an INR of 2-3; and both treatments with 2 different levels of anticoagulation, mean INR of 1.85 (group 3) and of 2.15 (group 4). The same amounts of the agonists ADP, arachidonic acid and collagen were used in all tests. For statistical analysis we used the interval in min, from the addition of the agonist to the beginning of aggregation and the % of aggregation at 5 and 8 min.. After arachidonic acid was given, the interval to the beginning of aggregation was shorter in group 2 than in group C: 0.6 +/- 0.21 and 1.1 +/- 1.2, and in both was significantly shorter than in the other three receiving antiplatelet drugs alone: group 1 = 1.58 +/- 1.4 or combined with anticoagulants: group 3 = 1.7 +/- 1.7 and group 4 = 2.4 +/- 2.1. The % of aggregation at 5 min, in groups C, 2, 1, 3 and 4 was respectively 48 +/- 24, 43.2 +/- 19, 29.6 +/- 17, 34.8 +/- 22 and 23.2 +/- 22.5. The data showed significantly increased platelet activity in groups C and 2 compared to groups 1, 3 and 4. Group 3 with a low anticoagulation level (mean INR = 1.85) showed a tendency to greater platelet activity than group 1 and 4 with p value = 0.08.. The antiplatelet drug triflusal alone or combined with a therapeutic level of anticoagulation effectively reduces platelet aggregation and is not influenced by anticoagulant treatment. A low level of anticoagulation (INR < 2) shows a tendency to increase platelet activity.

Topics: Acenocoumarol; Adenosine Diphosphate; Aged; Analysis of Variance; Anticoagulants; Arachidonic Acid; Atrial Fibrillation; Blood Platelets; Collagen; Embolism; Female; Humans; Male; Platelet Aggregation; Platelet Aggregation Inhibitors; Salicylates; Time Factors

The prevalence of atrial fibrillation (AF) has increased over the past years due to aging of the population, and healthcare costs associated with AF reflect a significant financial burden. The aim of this study was to explore predictors for the real-world AF-related in-hospital costs in patients that recently initiated anticoagulation with acenocoumarol or dabigatran.. Predictors for claimed total hospital care costs and cardiology costs in AF patients were explored by using hospital financial claims data from propensity score matched patient groups in a large Dutch community hospital. This study analyzed the total dataset (n = 766) and carried out a secondary analysis for all matched pairs of anticoagulation naïve AF patients (n = 590) by ordinal regression.. Dabigatran was a predictor for significantly lower cardiology and total hospital care costs (Odds Ratio [OR] = 0.43, 95% confidence interval (CI) = 0.33-0.57; and OR = 0.60, 95% CI = 0.46-0.79, respectively). Female gender was a predictor for lower total hospital care costs. Predictors for an increase in total hospital care costs were the occurrence of stroke or systemic embolism, major bleeding, and minor bleeding. The costs predictors were comparable when limiting the analysis to patients that were anticoagulation naïve. Age and CHA. Dabigatran treatment was as a predictor for lower cardiology costs and lower total hospital care costs in AF patients that initiated oral anticoagulation.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Cardiology; Dabigatran; Embolism; Female; Hemorrhage; Hospital Charges; Humans; Male; Middle Aged; Netherlands; Propensity Score; Retrospective Studies; Sex Factors; Stroke

The Allcarbon tilting disc valve has been used for valve replacement at the present authors' institution since 1993. Herein is reported their experience with Allcarbon valve implantation.. Between March 1993 and December 1998, Allcarbon valves were implanted in 599 patients (341 males, 258 females; mean age 36.2 years; range: 7-64 years). Among patients, 238 underwent mitral valve replacement (MVR), 217 aortic valve replacement (AVR), and 144 double valve replacement (DVR). The etiology of valve disease was rheumatic in 91% of cases. Follow up was 95.7% complete; cumulative follow up was 3,185 patient-years.. Operative mortality was 2.2% (13/599). Actuarial survival at eight years was 96.6 +/- 1.2% after MVR, 96.1 +/- 1.3% after AVR, and 97.9 +/- 1.2% after DVR. Freedom from valve thrombosis at eight years was 97.0 +/- 1.3% after MVR, 100% after AVR, and 90.0 +/- 9.5% after DVR. Freedom from major bleeding at eight years was 90.0 +/- 2.7% after MVR, 93.5 +/- 2.6% after AVR, and 79.7 +/- 7.6% after DVR. There was one embolic episode after MVR. No structural valve failure was observed. Freedom from reoperation on implanted valves at eight years was 96.1 +/- 1.4% after MVR, 97.9 +/- 1.0% after AVR, and 97.9 +/- 1.5% after DVR. On completion of follow up, 91.3% of survivors were in NYHA class I, 8.5% in class II, and 0.2% in class III.. Among a population of mostly young patients with rheumatic valve disease, the Allcarbon valve showed satisfactory clinical performance when implanted in the mitral and aortic positions.

Topics: Acenocoumarol; Adolescent; Adult; Anticoagulants; Aortic Valve; Child; Embolism; Endocarditis, Bacterial; Female; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Outcome Assessment, Health Care; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections; Reoperation; Rheumatic Heart Disease; Thrombosis

To assess age-related risks of long term anticoagulation, the records of 348 patients followed up at our university hospital outpatient anticoagulation clinic during a seven year period were reviewed. There were 129 patients, under 56 years of age, 144 from 56 to 69 and 75 over 70 years old. The total observation period was 1089 patient-years (3.3 yrs per pt). 64% of the patients had adequate anticoagulation level (prothrombin time < 35%, INR 2.2-4.5) 70 to 100% of the observation period. Prothrombin time was slightly, but significantly higher in the elderly group. During this period 21 patients developed major bleeding complications (1.84/100 pt yrs), 8 of them with fatal intracranial hemorrhages, and 20 embolic complications (1.93/100 pt yrs), 3 of them fatal. No significant differences in the incidence of both bleeding and embolic complications were observed in the three groups. The results of this retrospective follow-up study suggest that long term anticoagulation can be carried out in elderly pts with risk of hemorrhagic and embolic complications similar to those observed in the general population.

Topics: Acenocoumarol; Administration, Oral; Adult; Age Factors; Aged; Aged, 80 and over; Cerebral Hemorrhage; Embolism; Female; Hemorrhage; Humans; Incidence; Intracranial Embolism and Thrombosis; Male; Middle Aged; Prothrombin Time; Retrospective Studies; Time Factors

We report a case of embolism of the intrarenal arterial branches of a cardiac origin. The results of the urographic, ultrasound, ascending pyelography and laboratory work up prompted us to suspect the vascular nature of the condition. Its unilateral feature, involvement of the intrarenal arterial branches, and the coexisting mitral valve disease with atrial flutter advised conservative management with systemic anticoagulation.

Topics: Acenocoumarol; Atrial Flutter; Embolism; Female; Heparin; Humans; Middle Aged; Mitral Valve Stenosis; Renal Artery Obstruction

Four weeks after appendicectomy a 28-year-old man developed dragging pains in the left calf. Left popliteal, posterior tibial and dorsalis pedis arteries could not be palpated. Angiography revealed an embolic occlusion of the left superior femoral artery at the level of the adductor canal. Echocardiography demonstrated a pedunculated left ventricular thrombus, 3.5 x 2.0 cm, as a possible source of the embolus. After successful trifurcation embolectomy and saphenous vein patch-plasty acenocoumarol, 4 mg/d and heparin, 3 x 7500 IU/d were administered. Because the thrombus failed to shrink, systemic thrombolysis, initially 750,000 IU streptokinase and 3000 IU heparin i.v., was begun. After five days the thrombus diameter had decreased to 0.7 cm. But because thrombus movement had increased, streptokinase was replaced by 70 IU/d ancrod i.v. The thrombus completely disappeared within two weeks. The patient was symptom-free during the period of anticoagulation with acenocoumarol. Six months later echocardiography confirmed the absence of thrombus in the left ventricle.

Topics: Acenocoumarol; Adult; Ancrod; Appendectomy; Combined Modality Therapy; Embolism; Femoral Artery; Heart Diseases; Heart Ventricles; Heparin; Humans; Male; Postoperative Complications; Saphenous Vein; Streptokinase; Thrombolytic Therapy; Thrombosis

Topics: Acenocoumarol; Adolescent; Adult; Aged; Aortic Valve; Dipyridamole; Drug Therapy, Combination; Embolism; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Postoperative Complications; Vitamin K

Topics: Acenocoumarol; Administration, Oral; Adolescent; Adult; Aged; Anticoagulants; Arteriosclerosis; Embolism; Factor VII; Factor X; Female; Humans; Kinetics; Male; Middle Aged; Prothrombin; Prothrombin Time; Thromboembolism; Time Factors

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation Disorders; Coumarins; Embolism; Femoral Neck Fractures; Humans; Postoperative Complications; Thromboembolism; Veins

Topics: Acenocoumarol; Adult; Aged; Ambulatory Care; Embolism; Female; Hemorrhage; Humans; Hungary; Male; Middle Aged; Myocardial Infarction; Physician-Patient Relations; Socioeconomic Factors; Thrombosis

Topics: Acenocoumarol; Adult; Cardiovascular Diseases; Embolism; Female; Humans; Male; Middle Aged; Thrombosis

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

Topics: Acenocoumarol; Amputation, Surgical; Anticoagulants; Blood Vessels; Drug Therapy; Embolism; Surgeons; Vascular Diseases; Vascular Surgical Procedures

Topics: Acenocoumarol; Anticoagulants; Arrhythmias, Cardiac; Embolism; Humans; Myocardial Infarction; Pulmonary Embolism; Thrombophlebitis

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation Tests; Coumarins; Drug Therapy; Embolism; Heparin; Humans; Hungary; Myocardial Infarction; Thrombophlebitis; Thrombosis

Topics: Acenocoumarol; Adolescent; Angiography; Anticoagulants; Arteriosclerosis Obliterans; Blood Vessels; Child; Drug Therapy; Embolism; Geriatrics; Heparin; Humans; Postoperative Care; Tetralogy of Fallot; Thromboangiitis Obliterans; Thrombosis; Vascular Surgical Procedures; Warfarin

Topics: Acenocoumarol; Anticoagulants; Emaciation; Embolism; Ethyl Biscoumacetate; Humans; Thrombosis