acenocoumarol and Heart-Valve-Diseases

Antiplatelet agents are used for prevention of thromboembolism in surgical patients and in patients with chronic atrial fibrillation. Up to date, however, results of randomized studies comparing antiplatelet agents and oral anticoagulation have not been reported. The aim of this study was to compare the efficacy and safety of triflusal (an antiplatelet agent) versus acenocoumarol for primary prevention of thromboembolism in the early postoperative period after implantation of a bioprosthesis.. In this prospective, multicentric, randomized, open pilot trial, patients were assigned to treatment with triflusal (600mg/d) or acenocoumarol (target INR 2.0-3.0). Study medication was started 24-48h after valve replacement with a bioprosthesis, and continued for 3 months. Four follow-up visits were scheduled: baseline, and at 1, 3 and 6 months thereafter. The primary end-point was a composite of the rate of thromboembolism, severe hemorrhage and valve-related mortality.. A total of 193 patients were included (97 received triflusal and 96 acenocoumarol), with a mean age of 72.5 years. Half were men. Aortic valve replacement was performed in 181 patients (93.8%), mitral valve replacement in 10 patients (5.2%) and double valve replacement in 2 (1.0%). Hospital mortality was 11 (5.7%). Primary outcome was recorded in 9 patients with triflusal (9.4%) and in 10 patients with acenocoumarol (11%). There were nine episodes (4.7%) of thromboembolism, six in the triflusal group and three in the acenocoumarol group, and three episodes of permanent neurological deficits, one in the triflusal group and two in the acenocoumarol group. Severe hemorrhage: nine episodes, six in the acenocoumarol group and three in the triflusal group. None of the observed differences in efficacy were statistically significant. Regarding safety, three patients in triflusal group reported at least one hemorrhage, compared to 10 in acenocoumarol group (P=0.048).. There were no significant differences in efficacy between both groups, however, triflusal showed a significantly lower incidence of bleeding episodes.

Topics: Acenocoumarol; Aged; Anticoagulants; Bioprosthesis; Epidemiologic Methods; Female; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male; Platelet Aggregation Inhibitors; Postoperative Complications; Postoperative Hemorrhage; Salicylates; Thromboembolism

This study assessed the risk associated with several schedules of perioperative treatment with coumadin in anticoagulated patients who underwent oral surgery.. A prospective, randomized study compared bleeding complications with six perioperative schedules in 92 patients chronically treated with acenocoumarol. In three of the perioperative schedules, the dose was reduced before surgery and calcium heparin was added. In the other three, oral anticoagulation was not modified and heparin was not used. The groups also differed regarding the antifibrinolytic agents used and the postoperative measures applied.. Those schedules in which the oral anticoagulation was not modified preoperatively and an antifibrinolytic agent was applied locally both during and after surgery were not associated with a significantly higher odds ratio of bleeding complications than those in whom oral anticoagulation was reduced and calcium heparin was added preoperatively.. In orally anticoagulated patients who undergo oral surgery, schedules that maintain the oral anticoagulant regimen and use local tranexamic acid as an antifibrinolytic agent postoperatively for 2 days are safe, simple, and less troublesome.

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Antifibrinolytic Agents; Chi-Square Distribution; Dental Care for Chronically Ill; Female; Heart Valve Diseases; Heart Valve Prosthesis; Heparin; Humans; Logistic Models; Male; Mouthwashes; Odds Ratio; Prospective Studies; Thromboembolism; Tooth Extraction; Tranexamic Acid

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Aortic Valve; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Germany; Heart Valve Diseases; Heart Valve Prosthesis; Hemorrhage; Humans; Male; Middle Aged; Mitral Valve; Phenprocoumon; Postoperative Complications; Prospective Studies; Survival Rate; Thromboembolism; Warfarin

Vitamin K antagonists are indicated for the thromboprophylaxis in patients with mechanical prosthetic heart valves (MPHV). However, it is unclear whether some differences between acenocoumarol and warfarin in terms of anticoagulation quality do exist. We included 2111 MPHV patients included in the nationwide PLECTRUM registry. We evaluated anticoagulation quality by the time in therapeutic range (TiTR). Factors associated with acenocoumarol use and with low TiTR were investigated by multivariable logistic regression analysis. Mean age was 56.8 ± 12.3 years; 44.6% of patients were women and 395 patients were on acenocoumarol. A multivariable logistic regression analysis showed that patients on acenocoumarol had more comorbidities (i.e., ≥3, odds ratio (OR) 1.443, 95% confidence interval (CI) 1.081-1.927,

Topics: Acenocoumarol; Aged; Anticoagulants; Blood Coagulation; Female; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Retrospective Studies; Venous Thromboembolism; Warfarin

This study was undertaken to analyze the maternal and perinatal outcome in women with prosthetic heart valves on different anticoagulant regimens.. A retrospective chart review of pregnancies in 40 women with mechanical valve prostheses at a tertiary referral centre from 1997 to 2010. The main outcome measures were major maternal complications and perinatal outcome.. The valves replaced were mitral (67.5%), aortic (15.0%), or both (17.5%). Forty-nine pregnancies (72.1%) resulted in live births, 3(4.4%) had stillbirths, and 13(19.1%) had spontaneous abortions and 1(1.4%) underwent therapeutic abortions. The live birth rate was higher in women on heparin (78.3%) compared with those on warfarin (66.9%). There were 2 maternal deaths due to acute mitral valvular thrombosis while on acenocoumarol in the second trimester. Hemorrhagic complications occurred in 3 patients on heparin in the postpartum period, 2 of whom required transfusion. In addition one patient who was on acenocoumarol developed secondary hemorrhage.. No anticoagulant regimen can be said to be entirely safe for use during pregnancy as there is a degree of risk with each regimen. Further larger studies are needed to come up with sufficient evidence-based recommendations for the best possible management of such patients to reduce the maternal risks after mechanical heart valve replacement without compromising fetal outcome.

Topics: Abortion, Spontaneous; Academic Medical Centers; Acenocoumarol; Adult; Anticoagulants; Female; Heart Valve Diseases; Heart Valve Prosthesis; Heparin; Humans; Incidence; India; Medical Records; Mitral Valve; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Hematologic; Pregnancy Outcome; Retrospective Studies; Thrombosis; Warfarin; Young Adult

Patients with mechanical heart valve prostheses are obligated to receive lifelong oral anticoagulant therapy to prevent thromboembolic complications; however, this treatment is associated with an increased risk of bleeding. The aim of this study was to evaluate the frequency of major hemorrhagic and thromboembolic complications in patients with mechanical heart valves who received oral anticoagulant therapy.. The analysis involved 225 patients who underwent successful surgery in 2000; the mean (+/-SD) follow-up period was 43.3 +/- 9.2 months. Aortic, mitral, and double valve replacement was performed in 128 (56.7%), 70 (31.1%), and 27 (12.1%) of the patients, respectively. There were 128 men (57.3%), and the mean patient age was 57.9 +/- 18.8 years. The following data were assessed: rate of major hemorrhagic and thromboembolic complications, frequency of international normalized ratio (INR) rate measurements, and percentage of results within the therapeutic range.. Major hemorrhagic and thromboembolic complications occurred in 25 patients (11.1%). Seventeen patients (7.5%) survived, and 8 (3.6%) died of the complications. Major hemorrhagic and thromboembolic complications occurred in 17 patients (7.6%) and 8 patients (3.6%), respectively. The mean time between sequential measurements was 4.3 +/- 3.0 weeks, and of all the INR values collected, 42.4% were within, 31.3% were below, and 26.3% were above the target ranges.. Patients with a mechanical heart valve prosthesis receiving acenocoumarol are susceptible to major hemorrhagic and thromboembolic complications, some of which lead to death. Despite the danger related to these complications, patients receiving anticoagulant therapy still have difficulty achieving INR values within the therapeutic range.

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Female; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis; Hemorrhage; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Risk Factors; Survival Rate; Thromboembolism

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

Topics: Acenocoumarol; Administration, Oral; Aged; Anticoagulants; Blood Proteins; Drug Administration Schedule; Drug Synergism; Erectile Dysfunction; Gingival Hemorrhage; Half-Life; Heart Valve Diseases; Humans; International Normalized Ratio; Male; Piperazines; Postoperative Complications; Protein Binding; Purines; Ranitidine; Sildenafil Citrate; Sulfones; Thrombosis; Warfarin

Although the indications for oral anticoagulation (AO) in the treatment of cerebral vascular disease (CVD) are well established, their potential side effects continue to give cause for worry.. To describe the complications and ischemic relapses in patients treated with AO for secondary prevention of CVD of cardiac embolic origin.. We included 169 patients with embologenic cardiopathy who, following an CVD, were treated with AO and followed-up at our medical centre for at least three months. We recorded their past clinical history and risk factors, occurrence of vascular relapses (VR), complications involving hemorrhage (CH), and data regarding course and follow-up.. During an average follow-up of 50.3 months of a total of 707.9 patient/years, 20 VR (2.8% per year) were recorded; 15 of these were cerebro-vascular and mainly mild. We recorded 59 CH in 41 patients (8.3% per year) of which 6 were considered to be major. There was a 30% drop-out rate from follow-up at our centre, mainly due to death from other causes or to change of referral centre.. There is a low incidence of relapse and of complications (usually mild) following AO for the secondary prevention of CVD of cardio-embolic origin. Efficacy and security are maintained in the long term.

Topics: Acenocoumarol; Administration, Oral; Alcoholism; Anticoagulants; Arteriosclerosis; Atrial Fibrillation; Cardiomyopathy, Dilated; Cohort Studies; Comorbidity; Diabetes Mellitus; Disease-Free Survival; Follow-Up Studies; Heart Valve Diseases; Hemorrhage; Humans; Hyperlipidemias; Hypertension; Intracranial Embolism and Thrombosis; Life Tables; Myocardial Infarction; Recurrence; Risk Factors; Smoking; Spain; Treatment Outcome

A selected group of patients who underwent valve replacement were analyzed to evaluate the feasibility, effectiveness and safety of combined treatment with moderate intensity anticoagulation plus aspirin. One hundred ninety-six patients who received a total of 204 mechanical valve prostheses between 1985 and 1991 were selected according to rigid criteria. The prostheses included 124 valves of caged ball design, 62 St. Jude valves and 18 others. The follow up of the whole population was 581.8 patient years, with an average of 2.97 patient years, and was complete by the definition criteria. All patients received moderate intensity anticoagulation with acenocoumarol (target International Normalized Ratio 2.5 to 3.5) and daily aspirin (100 mg or 325 mg). The incidence of thromboembolic events for the whole group was 3.26% per patient year, but only 1.6% in patients "compliant" with treatment. Preoperative embolism and non-compliance with treatment had a strong correlation with postoperative thromboembolism. The INR values had a strong correlation with both thromboembolic and hemorrhagic events. The incidence of serious hemorrhagic events was 4.12% patient years although only two cases (0.34%/pty) were fatal (cerebral hemorrhages). There was no difference in hemorrhagic incidence between patients receiving either 325 mg or 100 mg daily. A low incidence of thromboembolic complications was attained with the use of combined antithrombotic and antiplatelet therapy, even in the first generation caged ball type prostheses. However, the combination of moderate intensity anticoagulation with either 325 mg or 100 mg aspirin was associated with a risk of bleeding similar to high intensity anticoagulation alone. The risk of bleeding appeared to be greater in the presence of gastric pathology, and the combination of anticoagulants and aspirin should be avoided in patients with these conditions.

Topics: Acenocoumarol; Adult; Aged; Aspirin; Blood Coagulation Tests; Dose-Response Relationship, Drug; Drug Therapy, Combination; Feasibility Studies; Female; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis; Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications; Prosthesis Design; Retrospective Studies; Survival Rate; Thromboembolism; Treatment Outcome

Pregnancy after valve replacement has been considered hazardous because of maternal and fetal complications secondary to anticoagulant medication, in addition to basic myocardial problems. Of 229 females aged 15-45 years with prosthetic valve replacement, 37 (including 34 with Björk-Shiley valve and anticoagulants) subsequently had a total of 47 pregnancies. Fullterm delivery of a normal infant was achieved in 40 cases. There were three premature births, two spontaneous abortions, one stillbirth and one ectopic pregnancy. The fetal mortality was 8.5%. Valve thrombosis developed in two cases, but surgical treatment was successful. Oral anticoagulants (acenocoumarin and dipyridamole) were continued throughout pregnancy. Heparin was substituted before labour began, but discontinued after delivery, when effective oral anticoagulation was resumed. Our experience showed that pregnancy in women with mechanical heart valve prosthesis and continued oral intake of anticoagulants is safe and successful in most cases.

Topics: Acenocoumarol; Adolescent; Adult; Aortic Valve; Female; Fetal Death; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Mitral Valve; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Thrombosis

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Acenocoumarol; Female; Heart Valve Diseases; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Risk

To assess the effects of oral contraceptives on anticoagulant treatment the prothrombin times of 12 patients were measured while they were taking both drugs simultaneously and while they were taking only anticoagulants. The mean prothrombin time ratio was significantly higher when patients were taking both drugs than when they were taking only anticoagulants and their doses of anticoagulant were significantly lower. During both periods most of the prothrombin values remained in the therapeutic range. These findings suggest that, contrary to the common belief that oral contraceptives diminish the effects of anticoagulants, contraceptives in fact potentiate the action of the anticoagulants.. Of 197 patients with heart disease on oral anticoagulant treatment (nicoumalone) 12 were simultaneously taking an estroprogestogenic oral contraceptive. The patients were aged 27-44 years old and anticoagulation control was maintained by measuring prothrombin activity. For 230 months the women took anticoagulant only. The mean prothrombin time ratio was significantly higher when the women were taking both the anticoagulant and the pill than taking only the anticoagulant, but the prothrombin values were in the therapeutic range during both periods. The oral contraceptive seems to potentiate anticoagulation activity not diminish their effect. It is suggested that the estrogen in the pill may produce enzymatic inhibition in microsomes of hepatic cells which potentiate anticoagulant activity through retarded metabolic degradation.

Topics: Acenocoumarol; Adult; Contraceptives, Oral; Drug Synergism; Female; Heart Valve Diseases; Heart Valve Prosthesis; Humans

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