acenocoumarol and Heart-Diseases

To evaluate the therapeutic impact of an education program on patients undergoing oral anticoagulation treatment, within the hospital of Annecy (France).. Groups of 10 patients were invited to participate to two meetings. The education was carried out by two nurses. Thanks to this prospective study, we compare the population before and after education in terms of treatment knowledge and stability.. Within 9 months 88 patients have been included, amongst which 55 have attended the two meetings. The average of correct answers to the knowledge evaluation questionnaire distributed before and after 6 months of education were, respectively, 6.63/12, 10.09/12 (P < 0.0001). Through INR controls within the 6 months preceding (424 controls) and the 6 months following the education (619 controls), we observe: an increase of the total INR average in therapeutic zone, from 45% to 61% (P < 0.0001); a decrease of the difference average per patient between the INR value observed and the one targeted: 0.54 before education, 0.40 after education (P = 0.0016); at last, the average phasing per patient under the therapeutic zone increases after education, from 49% to 65% (P < 0.001).. The education improves objectively the knowledge of patient undergoing AVK. If the size of patient sample is not large enough to prove any consequence on hemorrhagic or thrombotic complications, the education program still improves significantly the treatment stability.

Topics: Acenocoumarol; Administration, Oral; Aged; Anticoagulants; Chi-Square Distribution; Data Interpretation, Statistical; Female; Heart Diseases; Humans; Male; Middle Aged; Patient Education as Topic; Patient Satisfaction; Phenindione; Surveys and Questionnaires; Thromboembolism; Time Factors; Vitamin K

The effect of chronic cumarin treatment on bone mineral content was investigated. Bone mineral density was determined by double photon densitometry (Lunar DPXL). The density data (mean +/- SE) of 45 cardiac patients (age: 57.0 = +/- 6.3 y, body mass index: 26.7 +/- 3.8 kp/m2, cardiac stadium score, according to New York Heart Association: 2-3), had been treated by acenocumarol at least for 2 years (duration of treatment: 75.0 +/- 52 months), were compared to the values of 45 age, body mass index, cardiac status matched patients not treated by anticoagulant. The density values of L2-L4 lumbar regions were lower in the treated group (1.041 +/- 0.17 vs. controlls: 1.13 +/- 0.15 g/cm2, p < 0.05), while no differences in ultradistal ulnar and radial regions were detected. No correlation between bone mineral density and the length, or the dose of the cumarin treatment were observed. This observation suggests the importance of the regular bone densitometry control of cumarin treated patient.

Topics: Acenocoumarol; Adult; Anticoagulants; Bone Density; Dose-Response Relationship, Drug; Female; Heart Diseases; Humans; Hungary; Male; Middle Aged

This study was designed to assess, by two-dimensional echocardiography, the effects of anticoagulant therapy on left ventricular thrombosis detected after acute myocardial infarction. Thirty-eight patients with left ventricular thrombi detected by two-dimensional echocardiology within 5 weeks (mean 4) of the onset of infarction were randomly assigned to the following groups: group A consisted of 19 patients who received oral anticoagulants (acenocoumarin 1-6 mg daily regulated to keep prothrombin time within the range of 25 to 35%) and group B which consisted of 19 non-treated control patients. Seventeen patients from both groups were restudied 15 days, 3 months and one year later to evaluate the changes in size of thrombi. Echocardiographic examinations were read blindly; a significant decrease in ventricular thrombus size was taken as a greater than or equal to 5 mm reduction of thickness in the apical views. In Group A, 9 patients showed a complete resolution of thrombus at the 15 day study; at one year, thrombus had resolved in 15 and persisted unchanged in size in 2 patients. The mean dimension of thrombi in patients of group A was 18 +/- 6.6 mm at the screening examination and decreased to 6.6 mm, 3.8 mm and 2.2 mm, respectively, at 15 days, 3 months and one year follow-up studies. Among 17 patients of group B at the 15 day study, two had resolution of thrombus and 15 were unchanged; at the one year examination thrombus was resolved in 4, decreased in size in 4 and persisted unchanged in 9 patients. Analysis of variance of the dimensional changes of thrombi in the two groups of patients confirmed a significant efficacy of anticoagulant therapy (P less than 0.001). On the basis of our results we conclude that full-dose anticoagulant therapy, started early (within 5 weeks) after acute myocardial infarction, is effective in the resolution of left ventricular thrombosis.

Topics: Acenocoumarol; Adult; Aged; Clinical Trials as Topic; Echocardiography; Follow-Up Studies; Heart Diseases; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Random Allocation; Thrombosis

Behçet's disease is a vasculitis affecting both arteries and veins. Cardiac involvement is less well known. The association of an aneurysm of the pulmonary artery and intracardiac thrombosis is rare, and a therapeutic challenge. We report the case of a 26-year-old patient hospitalized for moderately abundant hemoptysis and New York Heart Association (NYHA) class III dyspnea, which illustrates the difficulty encountered when using anticoagulants in this complex situation.

Topics: Acenocoumarol; Adult; Aneurysm; Anticoagulants; Behcet Syndrome; Cyclophosphamide; Dyspnea; Heart Atria; Heart Diseases; Hemoptysis; Heparin; Humans; Male; Pulmonary Artery; Pulmonary Embolism; Recurrence; Thrombosis; Ultrasonography; Weight Loss

Patients with atrial fibrillation taking either indirect anticoagulant acenocumarol or most often prescribed antiaggregant aspirin were followed for 1 year. The results have shown that therapy with acenocumarol lowers content of D-dimer, prevents formation and promotes lysis of left auricular thrombi and lowers risk of development of ischemic stroke in patients with atrial fibrillation and high risk of thromboembolism. Therapy with aspirin in a dose providing maximal suppression of platelet function, does not lower D-dimer levels, does not promote lysis of left auricular thrombi and is inferior to acenocumarol in prevention of ischemic stroke.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Aspirin; Atrial Fibrillation; Blood Platelets; Female; Follow-Up Studies; Heart Diseases; Humans; Male; Middle Aged; Platelet Aggregation Inhibitors; Platelet Count; Thrombocytosis; Thrombosis; Treatment Outcome

Few studies have attempted to investigate the clinical course or identify factors responsible for excessive anticoagulation in patients with heart disease.. To determine the incidence of excessive anticoagulation in outpatients with heart disease treated with acenocoumarol, analyze the factors related with over-anticoagulation, and identify bleeding complications.. This 7-month prospective observational study included consecutive outpatients anticoagulated with acenocoumarol. They were seen in an anticoagulation unit. The high INR group of 55 over-anticoagulated patients had at least one test with INR > 5. The control group of 49 patients had INR results strictly within therapeutic range.. A total of 3,683 INR determinations were made in 512 patients. Seventy-seven tests had an INR > 5 (a 2% overall incidence of high-INR). In the group of 55 INR < 5 patients, 31% had more than one INR determination > 5 during follow-up. Multivariate analysis identified four variables as independent predictors of over-anticoagulation: artificial heart valve, poor treatment compliance, addition of potentially interactive new drugs, and illness in the last month. The high-INR group patients had more bleeding episodes (21.8 vs 4.08%; p = 0.008), one of which was major.. The incidence of excessive oral anticoagulation in our outpatient population was similar to that reported in other studies. Patients with INR > 5 had more total bleeding complications, mostly minor. It is recommended to proceed carefully with oral anticoagulant therapy in patients with an artificial heart valve, suspected poor treatment compliance, addition of potentially interactive new drugs, and illness in the last month.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anticoagulants; Drug Utilization; Heart Diseases; Hemorrhage; Humans; International Normalized Ratio; Middle Aged; Outpatients; Prospective Studies; Risk Factors

Topics: Acenocoumarol; Aged; Anticoagulants; Echocardiography, Transesophageal; Female; Follow-Up Studies; Heart Atria; Heart Diseases; Humans; Stroke; Thrombosis

Left atrial (LA) and/or left atrial appendage (LAA) thrombi are often found in patients with rheumatic mitral stenosis (MS). The fate of these thrombi on optimal oral anticoagulation, and the feasibility of balloon mitral valvulotomy (BMV) is not well established. The study aims were to assess the efficacy of oral anticoagulation in the resolution/organization of these thrombi, and the feasibility and safety of Inoue BMV in these patients.. All consecutive patients with severe MS and a mitral valve suitable for BMV, but found to have LA/LAA thrombus on transesophageal echocardiography (TEE) between January 1999 and January 2001 were included. Anticoagulation was carried out with oral nicoumalone; the INR was maintained at 2.5-3.5. Follow up TEE was performed at intervals of two months for a maximum of six months. BMV using the Inoue balloon technique was performed as soon as possible after resolution or organization of thrombus.. Sixty-six patients with MS (41 females, 25 males, mean age 33.1+/-10.4 years) and LA thrombus on TEE were studied. Thrombi were categorized into three groups: type I, thrombi localized to LAA (n = 36; 54.6%); type II, LAA thrombi protruding just beyond the LAA mouth (n = 22; 33.3%); and type III, LAA thrombi extending into the LA cavity (n = 8; 12.1%). Mean thrombus size was 27.6+/-9.1 mm (range: 15-35 mm). Complete resolution was seen in 22 patients (33.3%), and organization in 38 (57.6%). No significant change was observed in six patients (9.1%). Resolution was most common in the first two months, and in type I thrombi (41.7%, 27.2% and 12.5% in type I, II and III thrombi, respectively). BMV was performed in 90.9% of patients, and was uneventful in all. BMV was performed in the presence of organized thrombus in 63% of patients.. Anticoagulant therapy is effective in resolution and/or organization of LA thrombi in patients with MS. Six months' duration of anticoagulation appears optimal. BMV using the Inoue balloon technique can be performed safely after resolution or organization of thrombus, with no additional risk of complication.

Topics: Acenocoumarol; Administration, Oral; Adult; Anticoagulants; Catheterization; Dose-Response Relationship, Drug; Echocardiography, Transesophageal; Female; Follow-Up Studies; Heart Atria; Heart Diseases; Humans; Male; Middle Aged; Mitral Valve Stenosis; Probability; Prospective Studies; Sensitivity and Specificity; Severity of Illness Index; Survival Analysis; Thrombosis; Treatment Outcome; Ultrasonography, Doppler, Color

Echocardiographic demonstration of right ventricular thrombosis is relatively common in pulmonary embolism. There are also reports of right ventricular thrombi in patients affected by right myocardial infarction or dilated cardiomyopathy. In arrhythmogenic right ventricular cardiomyopathy single or multiple aneurysms are often present in the right ventricular free wall. These hypoakinetic areas represent a site for potential development of thrombi especially in advanced disease states. In the literature a single case of a patient affected by arrhythmogenic right ventricular cardiomyopathy with right heart failure and atrial and ventricular thrombi is reported. We report a case of arrhythmogenic right ventricular cardiomyopathy with a right ventricular thrombus located inside a single apical aneurysm in the presence of normal right ventricular systolic function.

Topics: Acenocoumarol; Adult; Amiodarone; Anti-Arrhythmia Agents; Anticoagulants; Arrhythmogenic Right Ventricular Dysplasia; Echocardiography; Electrocardiography; Fibrinolytic Agents; Follow-Up Studies; Heart Aneurysm; Heart Diseases; Heparin; Humans; Male; Thrombosis; Time Factors

Anticoagulation therapy in the elderly poses some doubts on the possible increase in hemorrhagic risk. The hemorrhagic complications in a population of patients over 70 years of age anticoagulated with acenocoumarol by heart disease were studied.. A study was made of seventy-two patients (43 females and 29 males; mean age: 73 years) anticoagulated for one year and controlled on an outpatient basis by means of INR (international normalized ratio) measurement with a maximal interval of four weeks. INR values above 4.5 or below 2.0 were considered out of range.. Nineteen patients had an INR above the recommended value on one occasion and eleven patients on two or more occasions. Sixteen patients had hemorrhagic complications, five were admitted on account of hemorrhages although none of them required transfusional therapy. No cases of brain hemorrhage or peripheral embolism occurred.. Most anticoagulated elderly patients were within their therapeutic range. The percentage of severe hemorrhagic complications was low. Advanced age had did not prove to be a factor against therapy with oral anticoagulants.

Topics: Acenocoumarol; Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Blood Coagulation Tests; Female; Heart Diseases; Hemorrhage; Humans; Male; Outpatients; Time Factors

We recently observed five cases of early thrombus formation in patients undergoing anticoagulation with subcutaneous heparin following open heart surgery. The reasons prompting surgery were as follows: one mitral valve replacement, one double valve replacement, one mitral valve reconstruction, one aortic valve replacement associated with coronary bypass. In all cases, intravenous heparin was begun on the day of surgery and replaced by subcutaneous (SC) heparin on postoperative day 1. Acute thrombocytopenia was observed between the 6th and 11th postoperative day. This was interpreted as denoting an idiosyncratic reaction to heparin which was replaced by low molecular weight heparin (LMWH) in two cases and by acenocoumarol in the other cases. Massive thrombosis of the aortic valve resulted in the death of one patient. Thrombosis of the left atrium occurred in three patients (two of whom had a transient ischemic attack (TIA)). One patient had aorto-iliac thrombosis. Successful reoperation was carried out in four of the five patients. Although heparin-induced thrombocytopenia and thrombosis [HITT] is a rare complication of heparin therapy, serial platelet count monitoring and in vitro platelet aggregation tests are mandatory in the diagnosis of this syndrome. Discontinuation of heparin is indicated as soon as the syndrome is recognized and the institution of aspirin is recommended if the thromboembolic complication requires reoperation and reexposure to heparin.

Topics: Acenocoumarol; Adult; Cardiac Surgical Procedures; Female; Heart Diseases; Heparin; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Platelet Aggregation; Platelet Count; Postoperative Complications; Reoperation; Thrombocytopenia; Thrombosis

Topics: Acenocoumarol; Drug Therapy, Combination; Heart Diseases; Heart Ventricles; Heparin; Humans; Thrombosis; Ultrasonography

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

During a 5-year period, 85 patients with TIAs, 65 patients with embolic brain ischemia of cardiac source and 50 patients with progressing stroke received intravenous heparin within 96 h. Twelve (6%) developed an early bleeding in the area involved by ischemia. In the 2 cases with transient ischemic attacks (TIAs) (2.3%), major functional sequelae persisted and the 2 cases with emboli from heart (3.2%) died, whereas among the 8 cases with progressing stroke (16%), only 3 worsened from anticoagulant-induced bleeding. Intracerebral bleeding was not associated with excessive anticoagulation or high blood pressure and was related to a large infarction only in the cases with emboli from the heart. Among the 108 patients who were placed on acenocoumarol during 3-12 months after heparin therapy, only one (0.9%) suffered a hemorrhagic infarct from a probable recurrent embolization. The risk of anticoagulant-induced intracerebral bleeding is quite different between the varieties of preceding ischemic events, with different subsequent impact on prognosis.

Topics: Acenocoumarol; Aged; Brain Ischemia; Cerebral Hemorrhage; Cerebrovascular Disorders; Female; Heart Diseases; Heparin; Humans; Intracranial Embolism and Thrombosis; Ischemic Attack, Transient; Male; Middle Aged

Topics: Acenocoumarol; Adult; Aged; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Drug Evaluation; Heart Diseases; Humans; Middle Aged; Time Factors

Topics: Acenocoumarol; Adult; Aged; Female; Heart Diseases; Humans; Male; Middle Aged

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; Dipyridamole; Electrocardiography; Geriatrics; Heart Defects, Congenital; Heart Diseases; Heart Failure; Humans; Hypertension; Myocardial Infarction; Niacin; Occupational Therapy; Papaverine; Psychology; Rehabilitation; Social Work; Thiamine