acenocoumarol and Hemophilia-B

A 25-year-old man with factor IX deficiency had an aortic and mitral valve replacement using a 2M Starr Edwards valve in the mitral position and a 22 Medtronic valve in the aortic position under cover of factor IX concentrate. The surgical procedure and the immediate postoperative period were uneventful except for a pericardial effusion which required a pericardiostomy. He was anticoagulated with heparin in the immediate postoperative period while the factor IX concentrate was being administered. Oral anticoagulation with acenocoumarol (Acitrom) was started, maintaining the international normalized ratio between 1.5 and 2. He was doing well at follow-up 9 months later.

Topics: Acenocoumarol; Adult; Anticoagulants; Aortic Valve; Coagulants; Factor IX; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemophilia B; Heparin; Humans; Male; Mitral Valve; Prosthesis Design; Rheumatic Heart Disease; Treatment Outcome

The authors present two cases of haematoma accompanying coagulopathies, treated successfully in the Department of Neurosurgery, Medical Academy in Gdańsk. In the first case, haematoma occurred after trauma in a patient with haemophilia B, and in the other case in a patient treated with Syncumar for mitral valve implantation. The authors apply the strategy of treatment of patients with coagulopathies which should involve achieving of stable haemostasis, indispensable for positive result of the treatment.

Topics: Acenocoumarol; Aged; Anticoagulants; Child; Female; Heart Valve Prosthesis Implantation; Hematoma, Epidural, Cranial; Hemophilia B; Humans; Male; Mitral Valve; Tomography, X-Ray Computed

Thrombotest clotting times of mixtures of coumarin plasmas and normal plasma yielded a patterm similar to that observed in mixtures of plasma with congenital coagulation disorders and normal plasma. The presence of 10 or 20% of test plasma in the mixture failed to affect the clotting times which resulted in normal limits. The only exception to this rule was the hemophilia BM plasma. In this case even the presence of 10-20% of patient plasma in the mixture caused a prolongation of the clotting time. This indicates that no inhibitor is present in coumarin plasmas and in the plasma of congenital coagulation disorders of the prothrombin complex save for hemophilia BM plasma which does contain an inhibitor.

Topics: Acenocoumarol; Blood Coagulation; Blood Coagulation Disorders; Blood Coagulation Tests; Female; Hemophilia B; Humans; Male; Prothrombin; Thromboplastin; Warfarin