acenocoumarol and Postoperative-Complications

Deep vein thrombosis (DVT) has an incidence of 1 case per 1000 inhabitants in the general population and it is very rare after arthroscopy of the shoulder. Therefore, the current guidelines do not advise the administration of DVT prophylaxis in shoulder arthroscopy procedures.. We describe two cases of thrombosis of the arm after shoulder arthroscopy on a total of 10.452 shoulder arthroscopies performed during a period of ten years. One of two patients was further complicated by a bilateral pulmonary microembolism. In these two clinical cases the complication developed despite the absence of risk factors such as a concomitant neoplasm, thrombophilia, smoking habit, or a long duration of the procedure.. The DVT after shoulder arthroscopy procedure remain a very rare complication. However, in view of the growing number of patients undergoing this procedure, this figure is expected to rise. The clinician surgeon should take in mind this possible complication that normally appears in the first 3 weeks after surgery, so to perform anti-coagulant treatment. Further clinical studies are therefore warranted to assess the true risk of VTE. In fact, the presence of "minor" predisposing factors that are not routinely studied, as well as the postoperative immobilization period, are potential risk factors that, associated with the invasiveness of the arthroscopy procedure, could trigger a thromboembolism.

Topics: Acenocoumarol; Anticoagulants; Arm; Arthroscopy; Axillary Vein; Dyspnea; Edema; Heparin, Low-Molecular-Weight; Humans; Hyperbaric Oxygenation; Male; Middle Aged; Perfusion Imaging; Postoperative Care; Postoperative Complications; Pulmonary Embolism; Risk Factors; Shoulder Joint; Thrombophilia; Ultrasonography, Doppler, Color; Venous Thrombosis; Young Adult

Currently, pharmacological thromboprophylaxis is frequently required in patients undergoing surgery, due to the high risk of deep venous thrombosis in the perioperative period. The administration of these anticoagulant agents (in Spain, usually low molecular weight heparins or fondaparinux, and in future, probably also the new oral anticoagulants dabigatran and rivaroxaban) may conflict with regional anesthetic techniques, in which maintaining hemostatic integrity is essential. Therefore, safety protocols have been designed that allow thromboprophylaxis to be administered with optimal effectiveness and anesthetic techniques to be performed with maximal safety; these protocols are based on the drug used, as well as on the dose and time of administration. The present chapter reviews the details related to these issues.

Topics: Acenocoumarol; Administration, Oral; Anesthesia, Conduction; Anticoagulants; Benzimidazoles; Clinical Protocols; Dabigatran; Early Ambulation; Fibrinolytic Agents; Fondaparinux; Heparin; Heparin, Low-Molecular-Weight; Humans; Morpholines; Polysaccharides; Postoperative Complications; Pyridines; Risk Factors; Rivaroxaban; Safety; Surgical Procedures, Operative; Thiophenes; Venous Thromboembolism; Venous Thrombosis

Topics: Acenocoumarol; Adult; Aspirin; Clinical Trials as Topic; Dextrans; Dipyridamole; Heparin; Hip; Humans; Injections, Subcutaneous; Middle Aged; Postoperative Complications; Thrombophlebitis; United Kingdom

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

Oral anticoagulant therapy is initiated in most hospitals in The Netherlands by clinicians who routinely dose oral anticoagulants (without using an algorithm). This may explain the low proportion of patients leaving the hospital stabilized. To test this hypothesis this study compared the dosing of acenocoumarol in orthopedic and surgical patients using an algorithm with routine dosing. Because of the routine administration of low molecular weight heparin for at least the first 5 days of acenocoumarol therapy, the study focused on supratherapeutic INR-values during this period. The study included 103 patients and was performed on orthopedic surgery and general surgery wards of a Dutch hospital over 5 months. The patients received acenocoumarol as an oral anticoagulant to prevent venous thromboembolism after general of orthopedic surgery. Patients were randomized into a group routinely dosed by physicians (n=54) and a group dosed using a dosing algorithm (n=49). A patient was defined as stable if he had two consecutive INR values within the range of 2-3 during hospitalization with the first (of the two consecutive INR values within range) having been measured on day 5 or later. The groups did not differ significantly in proportion of patients stabilized, time to stabilization, or length of hospitalization. In the first period (days 1-5) the routine dosing group had significantly more INR values above therapeutic range than the algorithm group, while the algorithm group had more INR values below the therapeutic range. There were two bleeding episodes in the routine dosing group and none in the algorithm group. Despite the lack of differences in stabilization between the two groups, this study suggests an advantage of dosing acenocoumarol using an algorithm in a study population consisting of prophylactically treated, mostly elderly orthopedic patients. The algorithm provides a safe dosing schedule for elderly postoperative patients who use low molecular weight heparin and NSAIDs concomitantly and are thus at high risk for bleeding complications.

Topics: Acenocoumarol; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Algorithms; Anticoagulants; Comorbidity; Female; Humans; International Normalized Ratio; Male; Middle Aged; Netherlands; Postoperative Complications; Venous Thrombosis

Gynecologic malignancies are often associated with deep vein thrombosis and pulmonary embolism, even before treatment is begun. But such complications also happen during treatment, also if thromboembolism prophylaxis is performed. The incidence of pulmonary embolism before treatment was investigated using scintigraphy. In a retrospective and in a prospective randomized trial, various methods of thromboembolism prophylaxis were evaluated during primary or postoperative radiation therapy. Pulmonary embolism was present in 11.9% of the patients admitted with uterine malignancy. Retrospectively, there were deep vein thromboses in 6.8%, pulmonary embolisms in 3.8% and bleeding complications in 5.3% of the patients receiving thromboembolism prophylaxis with acenocoumarol during radiation therapy of cervical and endometrial cancer. In the prospective study, deep vein thromboses occurred in 1.5%, pulmonary embolisms in 5.9% and bleedings in 2.2%, with both the LMW heparin and the acenocoumarol groups presenting similar results. Thromboembolism is a frequent paraneoplasia of uterine malignancies. The prevention of thromboembolic complications during radiation therapy of uterine malignancies is efficacious and safe using either LMW heparin or acenocoumarol.

Topics: Acenocoumarol; Anticoagulants; Combined Modality Therapy; Female; Genital Neoplasms, Female; Heparin, Low-Molecular-Weight; Humans; Postoperative Complications; Prospective Studies; Pulmonary Embolism; Radiotherapy, Adjuvant; Retrospective Studies; Thrombophlebitis; Treatment Outcome; Uterine Neoplasms

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

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

The antithromboembolic efficacy of once a day low molecular weight heparin in fixed combination with dihydroergotamine (LMWH-DHE) was compared with conventional heparin-DHE in combination with Acenocoumarol (heparin-DHE/A) in 191 patients undergoing gynaecological surgery. LMWH-DHE proved equally effective in preventing thromboembolic complications, with a similar incidence of postoperative bleeding and side effects. Deep vein thrombosis occurred once in each group and one non-fatal pulmonary embolism occurred in the LMWH-DHE group. The main advantage of LMWH-DHE was significantly better patient acceptance of the single daily subcutaneous injection as compared with the two injections of conventional heparin-DHE (P = 0.02). On the other hand, LMWH-DHE was associated with significantly increased incidence of intraoperative bleeding (P less than 0.02). The bleeding did not, however, cause any clinical problems. Discontinuation of therapy due to bleeding or pain at the site of injection occurred three times in each group. We consider the use of LMWH-DHE to be an attractive, economic and safe method of thromboembolic prophylaxis.

Topics: Acenocoumarol; Clinical Trials as Topic; Dihydroergotamine; Drug Combinations; Female; Genital Diseases, Female; Hemorrhage; Heparin; Heparin, Low-Molecular-Weight; Humans; Hysterectomy; Postoperative Complications; Premedication; Prospective Studies; Pulmonary Embolism; Random Allocation; Thrombophlebitis

A prospective randomized study involving 101 patients undergoing total hip replacement was performed to find out whether prophylactic anticoagulation starting 4 days before the operation was more effective than starting on the eve of the operation. The postoperative level of anticoagulation was set at an INR of 2.1. There was no difference between the two groups in the incidence of proximal localized deep venous thrombosis. Blood loss did not depend on the level of peroperative anticoagulation. There were no postoperative hemorrhagic complications. No fatal pulmonary embolism occurred during the study. After discontinuation of the oral anticoagulants because of a negative venogram, nonfatal pulmonary embolism occurred in 3 out of 55 patients. A plea is made for low-dose anticoagulation for 3 months after total hip arthroplasty.

Topics: Acenocoumarol; Administration, Oral; Aged; Female; Hip Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Pulmonary Embolism; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Thrombosis; Time Factors

202 patients undergoing surgery involving the lower limbs were given antithrombotic treatment for at least 21 days, or until they had regained full mobility. Following subcutaneous prophylaxis with a combination of heparin and dihydroergotamine, two oral regimens were compared in a controlled and randomized prospective study. The first treatment consisted of a combination of acetylsalicylic acid (ASA) and dihydroergotamine (DHE), and the second of acenocoumarol. The radiofibrinogen uptake test was carried out in high-risk patients (i.e. those undergoing hip surgery) to detect deep-vein thrombosis. No statistically significant difference was found between the two groups. However, the ASA/DHE combination enjoyed better patient acceptance and was much easier to use.

Topics: Acenocoumarol; Adult; Aged; Aspirin; Dihydroergotamine; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Leg; Male; Middle Aged; Postoperative Complications; Prospective Studies; Random Allocation; Thromboembolism

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

Low-dose heparin (L.D.H.) prophylaxis gives good protection against deep venous thrombosis (D.V.T.). In the case of subjects presenting for herniorrhaphy the literature is less unanimous regarding the chance of wound hematoma. In this prospective randomised, matched trial in 86 patients, a wound hematoma incidence of 36 percent was noted in the treatment group as against 7% in the control group. This is statistically significant at the P less than 0.001 level.

Topics: Acenocoumarol; Clinical Trials as Topic; Hematoma; Heparin; Hernia, Inguinal; Humans; Male; Postoperative Complications; Thrombophlebitis

Topics: Acenocoumarol; Adult; Aspirin; Clinical Trials as Topic; Dextrans; Dipyridamole; Heparin; Hip; Humans; Injections, Subcutaneous; Middle Aged; Postoperative Complications; Thrombophlebitis; United Kingdom

Topics: Acenocoumarol; Administration, Oral; Adult; Aged; Blood Coagulation Tests; Clinical Trials as Topic; Drug Evaluation; Fibrinogen; Heparin; Humans; Injections, Subcutaneous; Iodine Radioisotopes; Middle Aged; Postoperative Complications; Pulmonary Embolism; Surgical Procedures, Operative; Thrombophlebitis

Topics: Acenocoumarol; Cesarean Section; Clinical Trials as Topic; Dextrans; Female; Genital Diseases, Female; Humans; Leg; Obstetric Labor Complications; Oxyphenbutazone; Phlebitis; Postoperative Complications; Pregnancy; Pulmonary Embolism; Thromboembolism; Thrombophlebitis

Topics: Acenocoumarol; Adult; Aged; Female; Fracture Fixation; Fractures, Bone; Hip Injuries; Humans; Male; Middle Aged; Postoperative Complications; Thromboembolism

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

After elective aortic valve replacement, patients are at risk of developing valve thrombosis and systemic arterial thromboembolism. Current guidelines recommend antithrombotic therapy with aspirin or vitamin K antagonists (VKAs) during the first 3 months after the procedure, but have level 2 or 3 evidence. As a consequence, the most appropriate antithrombotic therapy is still a matter of debate. This retrospective study analysed all thromboembolic and bleeding complications in patients with either antiplatelet or anticoagulation therapy 1 year after bioprosthetic aortic valve replacement.. A total of 402 patients undergoing bioprosthetic aortic valve implantation at the VU University Medical Centre and subsequently treated at three regional hospitals were included. The individual duration of either VKAs (acenocoumarol) or aspirin was determined and related to thrombotic and bleeding events. Patients were followed and censored at 1 year postoperatively for survival, cerebral ischaemia, myocardial infarction, peripheral arterial embolism, and minor and major haemorrhages.. A total of 24 thromboembolic complications and 31 bleeding episodes occurred. Multivariable analyses revealed that acenocoumarol caused more bleeding episodes (risk ratio [RR]: 8.41, 95% CI: 3.58-19.79) and a similar amount of thromboembolic events (RR: 1.2, 95% CI: 0.47-3.02) compared with aspirin. Prior use of acenocoumarol was found to be a risk factor for thromboembolic events (RR: 3.1, 95% CI: 1.31-7.19). Gender, dyslipidaemia, prior percutaneous coronary intervention, prior use of acenocoumarol and concomitant coronary artery bypass grafting were found to be predictors for bleeding events.. In patients 1 year following bioprosthetic aortic valve replacement, acenocoumarol therapy was associated with a significant increased risk of bleeding events and no reduction in thromboembolic events compared with antiplatelet therapy. These findings support the recommendations of aspirin over VKAs as postoperative thromboprophylaxis.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Aortic Valve; Aspirin; Bioprosthesis; Electrocardiography; Female; Fibrinolytic Agents; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemorrhage; Humans; Kaplan-Meier Estimate; Male; Postoperative Complications; Practice Guidelines as Topic; Retrospective Studies; Thromboembolism

Strategies are needed to reduce health care costs and improve patient care. The objective of our study was to analyze the safety of outpatient implantation of cardioverter-defibrillators.. A retrospective study was conducted in 401 consecutive patients who received an implantable cardioverter-defibrillator between 2007 and 2012. The rate of intervention-related complications was compared between 232 patients (58%) whose implantation was performed in the outpatient setting and 169 patients (42%) whose intervention was performed in the inpatient setting.. The mean age (standard deviation) of the patients was 62 (14) years; 336 (84%) were male. Outpatients had lower left ventricular ejection fraction and a higher percentage had an indication for primary prevention of sudden death, compared to inpatients. Only 21 outpatients (9%) required subsequent hospitalization. The rate of complications until the third month postimplantation was similar for outpatients (6.0%) and inpatients (5.3%); P = .763. In multivariate analysis, only previous anticoagulant therapy was related to the presence of complications (odds ratio = 3.2; 95% confidence interval, 1.4-7.4; P < .01), mainly due to an increased rate of pocket hematomas. Each outpatient implantation saved approximately €735.. Outpatient implantation of implantable cardioverter-defibrillators is safe and reduces costs. Close observation is recommended for patients receiving chronic anticoagulation therapy due to an increased risk of complications.

Topics: Acenocoumarol; Ambulatory Care; Ambulatory Surgical Procedures; Anticoagulants; Costs and Cost Analysis; Defibrillators, Implantable; Drug Administration Schedule; Enoxaparin; Female; Humans; Male; Middle Aged; Patient Safety; Postoperative Complications; Prosthesis Implantation; Retrospective Studies; Tachycardia, Ventricular

The aim of the study is to present our own perioperative bridging therapy with low molecular weight heparin (LMWH) for surgical patients with thrombophilia on long-term acenokumarol therapy [oral anticoagulant (OAC)]. In some European countries, the drug used in secondary antithrombotic prophylaxis is acenokumarol. Forty-two patients with inherited thrombophilia and 21 with antiphospholipid syndrome underwent surgery. All patients were on long-term OAC. This OAC was interrupted 2 days before elective surgery and since that day half of the individual therapeutic dose of LMWH was administered. On day of surgery, the LMWH therapeutic dose was divided into two parts. Starting with day 2 after surgery, the patient was again given half of the individual dose of LMWH every 24 h. On day 4, OAC was additionally included. Both drugs were administered until stabilization of international normalized ratio (INR) values within the therapeutic target for 2 consecutive days. LMWH was then interrupted, whereas OAC continued. No symptoms or episodes of venous thromboembolism were observed. No intraoperative or postoperative hemorrhagic complications were reported. The results suggest that our perioperative bridging therapy is safe and effective for prevention of thromboembolic and hemorrhagic complications.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Antiphospholipid Syndrome; Female; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Postoperative Complications; Thromboembolism

Topics: Acenocoumarol; Edema; Heparin; Heparin, Low-Molecular-Weight; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Polycystic Kidney, Autosomal Dominant; Polycythemia; Postoperative Complications; Recurrence; Renal Dialysis; Renal Veins; Thrombectomy; Thrombolytic Therapy; Thrombophilia; Thrombophlebitis; Time Factors; Treatment Outcome; Venous Thrombosis

Vitamin K antagonists (VKAs) are widely used in thromboembolic diseases. We report five cases of necrotic leg ulcers having a particularly severe course and in which withdrawal of VKA treatment alone enabled healing.. Five patients presented with necrotic leg ulcers clinically evocative of necrotic angiodermatitis or vasculitis. Histological features were variable, including inconstantly inflammatory lesions (leukocytoclastic vasculitis) and microthrombosis. None of the patients had laboratory signs of autoimmune disease. Healing occurred in all patients only after withdrawal of VKA therapy (fluindione or acenocoumarol). Associated vascular diseases included superficial venous, distal arterial insufficiency and postphlebitic disease. In three cases, thrombotic factors were observed: hyperhomocysteinaemia or heterozygous Factor V Leiden mutation.. Although the causative role of VKAs is based solely on chronological criteria, this potential side effect deserves publication because of its practical therapeutic consequences. The physiopathological mechanisms accounting for the role of VKAs, including immunoallergic phenomena and, above all, microcirculatory thrombotic processes, are hypothetical and not universally accepted.

Topics: Acenocoumarol; Activated Protein C Resistance; Aged; Aged, 80 and over; Anticoagulants; Diabetic Angiopathies; Factor V; Female; Humans; Hyperhomocysteinemia; Leg Ulcer; Male; Necrosis; Phenindione; Polyarteritis Nodosa; Postoperative Complications; Purpura; Thrombophilia; Varicose Ulcer; Vasculitis, Leukocytoclastic, Cutaneous; Vitamin K

Cardiovascular disease is the main cause of death after renal transplantation. There are few trials evaluating the efficacy of prevention strategies in renal transplant patients on major adverse cardiac events (MACE) and cardiovascular mortality. However, there is general agreement that active prevention strategies can significantly decrease cardiovascular mortality after renal transplantation. Here, we present the case of a 52-year-old male patient who received a first kidney transplant in 1993. He showed a small fixed perfusion defect on thallium scintigraphy before transplant. He was admitted at 13 months due to an antero-lateral myocardial infarction that was complicated with ventricular fibrillation. Despite anti-coagulation with acenocumarol, treatment with statins and angiotensin II receptor blocking agents and an excellent preservation of renal function, the patient presented with a second episode of myocardial infarction at 9 years post-transplant. This case report is discussed in order to highlight the way in which attitudes have been modified in the past decade in order to systematically pursue an early diagnosis of pre-existing coronary artery disease, aggressively treat MACE and actively decrease cardiovascular risk in transplant patients, using all available efficacious treatments as well as individualizing immunosuppression to prolong not only graft but also patient survival.

Topics: Acenocoumarol; Amiodarone; Angioplasty; Calcineurin Inhibitors; Carbazoles; Carvedilol; Cyclosporine; Drug Therapy, Combination; Fatty Acids, Monounsaturated; Fluvastatin; Humans; Immunosuppressive Agents; Indoles; Kidney Transplantation; Male; Middle Aged; Myocardial Infarction; Nitroglycerin; Postoperative Complications; Pravastatin; Prednisone; Propanolamines; Risk Factors; Tacrolimus; Treatment Outcome

Seven consecutive cases of late cardiac tamponade after valvular surgery are reported; all were postoperatively treated with acenocoumarol and 6 had an international normalized ratio peak greater than 6.0 within 3 days preceding tamponade. It is suggested that during this excessive anticoagulation state a hemorrhagic event within the pericardial space precipitates the tamponade. In addition, it is proposed that all valve patients with a postoperative international normalized ratio peak greater than 5.0 within 6 weeks postoperatively should be considered for a transthoracic echocardiogram.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Cardiac Tamponade; Drainage; Female; Heart Valve Prosthesis Implantation; Humans; International Normalized Ratio; Male; Middle Aged; Pericardial Effusion; Postoperative Complications; Retrospective Studies; Time Factors; Ultrasonography

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

Splenic rupture associated with anticoagulant therapy is a rare entity. We report a case of spontaneous splenic rupture in a 62-year-old man who was treated by acenocoumarol orally after an aortic-valve replacement. Unrecognised, minor trauma may lead to splenic haemorrhage in patients receiving anticoagulant therapy. The symptoms and signs may mimic those of acute myocardial infarction and cardiogenic shock. Early diagnosis is essential. Reversal of the anticoagulant and emergent splenectomy are the treatments of choice.

Topics: Acenocoumarol; Adult; Anticoagulants; Aortic Valve; Humans; Male; Middle Aged; Postoperative Complications; Radiography; Splenic Rupture

Percutaneous vertebroplasty is increasingly used for the treatment of vertebral compression fractures. Local leakage of polymethylmethacrylate cement into the perivertebral space is a common complication, but important systemic effects have rarely been reported. The authors describe the case of a 52-year-old patient with central pulmonary embolism after percutaneous vertebroplasty of the eleventh thoracic vertebral body. The large cement embolus was removed from the right pulmonary artery with a hybrid technique combining an interventional catheter procedure with an open heart operation. The patient made an uneventful recovery. The authors review how appropriate arthroplasty techniques might minimize the risk of this dreadful complication.

Topics: Acenocoumarol; Anticoagulants; Bone Cements; Dyspnea; Female; Humans; Middle Aged; Polymethyl Methacrylate; Postoperative Complications; Pulmonary Embolism; Spinal Fractures; Surgical Procedures, Operative; Thoracic Vertebrae; Treatment Outcome

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

Between 1997 and 2001, 150 children (one month to 16 years of age) were treated with oral anticoagulants after cardiac surgery (Fontan's operations and congenital heart diseases without valvulopathy: 62%, valvular prosthesis: 20%, arrhythmia: 4.6%, thrombosis: 4%, other: 9.4%). They were first treated by either unfractionated heparin (49%) or nadroparin (51%), then by acenocoumarol (n1 = 114) or fluindione (n2 = 36) until steady state.. The retrospective analysis of data (age, body weight, international normalized ratio, loading and maintenance doses, time to achieve the steady state) led to the building of a dosage nomogram usable in pediatrics.. We demonstrated that the mean maintenance dose depended on age and weight. After three years, that dose (mg/kg) was getting close to adult values; it was higher before three years of age, especially before 12 months (p < 0.01), and very variable from a child to another. The recommended loading dose should be as close as possible to the effective maintenance dose: within that cohort, about 0.14 and 0.05 (acenocoumarol) or 1.1 and 0.40 mg kg-1 day-1 (fluindione), before 12 months and after three years respectively.

Topics: Acenocoumarol; Administration, Oral; Adolescent; Anticoagulants; Cardiovascular Surgical Procedures; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Phenindione; Postoperative Care; Postoperative Complications; Retrospective Studies

Our objective was to evaluate the effect about half stay at hospital, in patients treated with Sintrom, which required different urological surgery.. We evaluated 55 patients in treatment with Sintrom which required different urological surgery. We analysed a cohort control group with similar characteristic without anticoagulation therapy. The patients was at hospital 3 days before surgery to realize the change Sintrom/Heparina. We used the haematology service's protocol at the Hospital del Mar. We analysed in each patient the half stay at hospital and the morbidity referred to bleeding complications. The decrease of haemoglobin higher than 2 g/dl was considered significant.. About half stay, all patients required more days of hospitalization. The additional morbidity was obvious in the transurethral resection of the prostate and in great not endoscopical surgery. In the rest of surgery the complications referred to bleeding have repercussion about stay at hospital.. We found a significant increased half stay at hospital and the morbidity referred to bleeding complications and its consequence (transfusion, second surgery,...).

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Cohort Studies; Female; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Urologic Diseases

Authors study the risk diseases in dental practice. They analyze the possible complications and the methods of their prevention in each risk group. They take deal with the importance of antibiotic prophylaxis, the problems of local anaesthesia and the management of patients who suffer from coagulation disturbances. They present the management of risk patients in two cases. They emphasize the importance of anamnestic history in every case before dental treatment.

Topics: Acenocoumarol; Adult; Anti-Bacterial Agents; Anticoagulants; Blood Coagulation Disorders; Blood Loss, Surgical; Dental Care; Female; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Nadroparin; Postoperative Complications; Risk Factors; Tooth Extraction; Venous Thrombosis; Vestibuloplasty

Topics: Acenocoumarol; Anticoagulants; Aortic Valve; Coronary Artery Bypass; Drug Interactions; Female; Humans; Mercaptopurine; Middle Aged; Postoperative Complications; Thrombosis

Deep vein thrombosis (DVT) seems to be related to a hypercoagulation and definite hemorheological alterations, but the importance of these alterations in the development of thrombotic events in the deep vein system has not been established. The present study examines both aspects in a group of 55 patients with DVT; the presence of a hypercoagulable state was assessed by quantifying the prothrombin fragment 1+2 (F1+2) and the thrombin-antithrombin III complex (T-AT), and the main hemorheological parameters were evaluated in the acute state and 6 and 12 months later. The results show marked hemorheological, F1+2, and TAT alterations in the acute phase. After 12 months the pattern shows a modest improvement, but erythrocyte aggregation, fibrinogen, F1+2 and T-AT remain increased with respect to the control group (8.51 +/- 1.43; 331 +/- 81 mg/dl; 1.33 +/- 0.60 nmol/l; 3.54 +/- 1.71 ng/ml vs. 8.10 +/- 1.40; 230 +/- 38; 0.94 +/- 0.40; 1.56 +/- 0.59, respectively). These data suggest that the thrombotic event could be influenced by the previous rheological situation and hypercoagulable state.

Topics: Acenocoumarol; Acute Disease; Adult; Aged; Anticoagulants; Antithrombin III; Blood Coagulation; Blood Viscosity; Convalescence; Erythrocyte Aggregation; Female; Fibrinogen; Follow-Up Studies; Hemorheology; Heparin; Humans; Male; Middle Aged; Peptide Fragments; Peptide Hydrolases; Postoperative Complications; Prothrombin; Thrombophilia; Thrombophlebitis; Wounds and Injuries

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

The authors describe the combined occurrence of heparin-induced thrombocytopenia and cumarin-induced skin necrosis, a rare condition that has not yet been reported in Hungary. The 69-year-old woman had received prophylactic heparin treatment prior to total hip arthroplasty. The first complication that the anticoagulant therapy brought about was serious thrombocytopenia paradoxically associated not with bleeding but with deep vein thrombosis. The latter necessitated coumarin therapy which resulted in severe skin necrosis.

Topics: Acenocoumarol; Aged; Female; Heparin; Hip Prosthesis; Humans; Necrosis; Postoperative Complications; Preoperative Care; Skin; Thrombocytopenia; Thrombophlebitis

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

We present the case of a woman undergoing treatment with acenocoumarol for deep vein thrombosis, who maintained an international normalized ratio (INR) of between 2.5 and 4 for 2 months. Seven days after the introduction of amoxycillin (500 mg/8 h) for a probable respiratory infection, the patient developed spontaneous bruising, with an INR of 7.1. Treatment with amoxycillin was discontinued, and 3 weeks later the INR had returned to previous values. In this case, the increase in the INR value with associated bruising after the addition of amoxycillin suggests a drug interaction between acenocoumarol and amoxycillin, other possible causes having been eliminated.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Amoxicillin; Drug Interactions; Drug Therapy, Combination; Female; Humans; Postoperative Complications; Respiratory Tract Infections; Thrombophlebitis; Time Factors

The aim of this study was to investigate the factors related to the presence of left atrial spontaneous echo contrast in mitral valve disease, and to ascertain whether it is a predictor of thromboembolism. One hundred and one patients (47 men, 54 women) with a mean age of 57.04 +/- 10.6 years who underwent transthoracic and transesophageal echocardiography were included in the study. Forty-five (44.5%) had isolated or predominant mitral valve stenosis, 12 (11.9%) predominant mitral insufficiency and 44 (43.6%) had had previous mitral valve replacement. Left atrial spontaneous echo contrast was detected by transesophageal echocardiography in 58 patients, while the transthoracic approach detected it in only 15 (14.9%) (P < 0.0001). An atrial thrombus was found in six cases, with a history of recent systemic embolism in three of them. There was no thrombus in the left atria of a further nine patients, despite definitive histories of recent systemic embolism. The finding of left atrial spontaneous echo contrast was related to the presence of atrial fibrillation or enlarged left atrium, the severity of mitral stenosis and the absence of significant mitral insufficiency. Anticoagulant therapy was not significantly associated with spontaneous left atrial echo contrast, but a stepwise linear regression analysis showed that its presence was the only independent predictor of thromboembolism (p < 0.0001). We conclude that left atrial spontaneous echo contrast in mitral valve disease can be discovered mainly by transesophageal echocardiography, and is correlated with factors which are associated with low left atrial blood flow velocity such as atrial fibrillation, enlarged left atrium, mitral stenosis of increased severity and the absence of significant mitral insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acenocoumarol; Adult; Aged; Atrial Fibrillation; Echocardiography; Echocardiography, Doppler; Echocardiography, Transesophageal; Female; Heart Atria; Heart Valve Prosthesis; Hemodynamics; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Postoperative Complications; Prosthesis Design; Regression Analysis; Risk Factors; Thromboembolism

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

A case of a arachnoidal cyst with intracystic bleeding and subdural haematoma is reported. The association of an arachnoidal cyst in the middle cranial fossa with a subdural haematoma or intracystic bleeding is emphasised. The diagnosis of such lesions, the nature of the pathology and therapy are discussed.

Topics: Acenocoumarol; Adult; Arachnoid Cysts; Female; Hematoma, Subdural; Humans; Magnetic Resonance Imaging; Postoperative Complications; Recurrence; Thrombophlebitis; Tomography, X-Ray Computed

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

A male patient had been treated with acenocoumarol for 9 years. Raised white cell count returned to normal, when acenocoumarol was substituted by heparin, but rose again after reexposure. An analysis of variance showed that this effect is mediated by neutrophils only. The rise is quick and may therefore be caused by a redistribution of white cells rather than by increased cell production.

Topics: Acenocoumarol; Adult; Aorta, Thoracic; Aortic Aneurysm; Aortic Dissection; Blood Vessel Prosthesis; Graft Occlusion, Vascular; Granulocytes; Heparin; Humans; Leukocyte Count; Leukocytosis; Male; Postoperative Complications

This report documents our experience with long term antithrombotic therapy (acenocoumarol plus aspirin) in 31 children and adolescents, from 5 months to 16 years of age. The valves replaced were mitral in 20 patients, aortic in 4, mitral-aortic in 4 and tricuspid in 3; the overall follow-up time was of 1336 months. Anticoagulant requirement in each children was not in correlation with age, but a significant increase (p less than 0.01) was found in association with sexual development. Our total incidence of embolic episodes was 1.49/1000 patient-months. The embolic incidence on adequate anticoagulated patients was 0.74/1000 patient-months and 93.7% of all patients were free of thrombo-embolic accidents up to 96 months of follow-up. Minor haemorrhage in relation to an excess of anticoagulant was 1.49/1000 patient-months. There has been only one major bleeding episode associated with severe sepsis, with an incidence of 0.74/1000 patient-months. No major difficulties were found in the management of anticoagulant treatment and its association with antiplatelet drugs in children.

Topics: Acenocoumarol; Adolescent; Age Factors; Aspirin; Child; Child, Preschool; Drug Therapy, Combination; Fibrinolytic Agents; Heart Valve Prosthesis; Hemorrhage; Humans; Postoperative Complications; Sex Factors; Sexual Maturation; Thromboembolism

The Omniscience prosthetic heart valve has been clinically evaluated in 44 patients operated on between January and July, 1981. There were 23 aortic valve replacements (AVR), 18 mitral valve replacements (MVR) and 3 double valve replacements (DVR). Mean age was 48 +/- 11 years. Preoperatively, 61% patients were in New York Heart Association (NYHA) functional class IV, 36% in class III and 2% in class II. The hospital mortality rate was 4.5%. Actuarial freedom from thromboembolic events was 97.4 +/- 2.6% (3 1/2 years of follow-up). Postoperatively, 93% of the patients were in NYHA class I and 7% in class II. There were 7 cases of periprosthetic leak requiring reoperation (6 AVR, 1 MVR) for an overall incidence of 6.3% per patient year. In all these cases the causative factor was considered to be the Dacron sewing ring. All patients survived the reoperation. The actuarial survival rate was 93.9 +/- 5.9% for AVR and 93.7 +/- 6.1% for MVR. These data would suggest that the Omniscience prosthesis represents an acceptable device for heart valve replacement, except for the high incidence of periprosthetic leakage, related to the Dacron sewing ring. Recent modification of the valve-construction including a Teflon sewing ring may avoid the relatively high rates of periprosthetic leakage following implantation of this mechanical valve.

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Cardiovascular Diseases; Equipment Design; Equipment Failure; Evaluation Studies as Topic; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Reoperation; Thromboembolism

Topics: Acenocoumarol; Administration, Oral; Adult; Aged; Arteriosclerosis Obliterans; Blood Vessel Prosthesis; Female; Humans; Leg; Male; Middle Aged; Postoperative Complications; Thrombosis; Time Factors

Topics: Acenocoumarol; Adult; Aged; Arteriosclerosis Obliterans; Blood Vessel Prosthesis; Female; Follow-Up Studies; Humans; Leg; Male; Middle Aged; Postoperative Complications; Smoking Prevention; Thrombosis; Time Factors

A hundred and fifty-two patients who were to undergo major orthopaedic surgery were divided into two groups in order to study the value of dextrans administered as adjuvants to oral anticoagulants in the prevention of deep venous thrombosis. The control group had oral anticoagulants only from the evening before the day of operation, aimed at the 15 per cent thrombotest level. The dextran group had peroperative and postoperative dextran infusions as well. Radionuclide venography was used for thrombosis detection. The dextran group had a lower incidence of thrombosis, but more haemorrhagic problems. The incidence of thrombosis was high in both groups.

Topics: Acenocoumarol; Anticoagulants; Dextrans; Female; Hemorrhage; Humans; Intraoperative Care; Male; Orthopedics; Postoperative Care; Postoperative Complications; Premedication; Thrombophlebitis

Topics: Acenocoumarol; Adult; Aged; Cardiovascular Diseases; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Prothrombin

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

Haemorrhagic infarction of the breast induced by anticoagulant therapy is rare and has been infrequently reported in the literature. The following report illustrates such a case in which there was development of massive haemorrhagic infarction of the breast during treatment with nicoumalone for deep venous thrombosis after an operation for carcinoma of the colon.

Topics: Acenocoumarol; Adenocarcinoma; Aged; Breast; Colonic Neoplasms; Female; Heparin; Humans; Infarction; Postoperative Complications

Topics: Acenocoumarol; Heart Valve Prosthesis; Humans; Postoperative Complications; Thromboembolism

Anticoagulation therapy with acenocoumarin or with anticoagulants plus aspirin was given to 65 and 57 patients, respectively, with cardiac valve replacement. The follow-up was 1,462 months (22.5 months per patient) for the first group and 1,411 months (24.7 months per patient) for the second group. The frequency of embolic accidents was significantly lower in the group taking aspirin: Thirteen thromboembolic accidents were detected in patients receiving the anticoagulant and 3 in the group receiving the anticoagulant plus aspirin. These figures represent a 20.3 per cent incidence (one each 9.3 years of treatment) for the anticoagulant group and a 5.2 per cent incidence (one accident each 39.1 years of treatment) for the other group. The statistical significance between groups is p less than 0.005. There was no difference in the hemorrhagic risk between the two groups. We conclude that the use of an anticoagulant plus aspirin is a good and safe therapy for the prevention of thromboembolism in these patients.

Topics: Acenocoumarol; Anticoagulants; Aspirin; Blindness; Drug Therapy, Combination; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Humans; Intracranial Embolism and Thrombosis; Male; Myocardial Infarction; Postoperative Complications; Thromboembolism

Topics: Acenocoumarol; Anticoagulants; Dextrans; Heparin; Humans; Postoperative Complications; Thrombosis

Topics: Acenocoumarol; Adolescent; Adult; Age Factors; Aged; Ambulatory Care; Cerebrovascular Disorders; Child; Child, Preschool; Female; Humans; Infant; Male; Middle Aged; Myocardial Infarction; Netherlands; Phenprocoumon; Postoperative Complications; Thrombosis

Topics: Acenocoumarol; Female; Humans; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Postoperative Complications; Thrombosis

Topics: Acenocoumarol; Aged; Anticoagulants; Aspirin; Blood Coagulation Disorders; Dextrans; Drug Therapy, Combination; Female; Germany, West; Hemorrhage; Heparin; Humans; Middle Aged; Postoperative Care; Postoperative Complications; Preoperative Care; Pulmonary Embolism; Thromboembolism; Time Factors

Topics: Acenocoumarol; Animals; Anticoagulants; Femoral Artery; Microsurgery; Postoperative Complications; Rabbits; Suture Techniques; Thrombosis; Vascular Resistance; Vascular Surgical Procedures

Topics: Acenocoumarol; Adolescent; Adult; Aged; Humans; Middle Aged; Postoperative Complications; Pulmonary Embolism; Surgical Procedures, Operative

Topics: Acenocoumarol; Adult; Aged; Humans; Male; Middle Aged; Postoperative Complications; Thrombosis; Vascular Surgical Procedures

Topics: Acenocoumarol; Adult; Blood Coagulation Tests; Cesarean Section; Female; Genital Diseases, Female; Genital Neoplasms, Female; Heparin; Humans; Hysterectomy; Middle Aged; Postoperative Care; Postoperative Complications; Pregnancy; Thromboembolism; Thrombosis

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

Topics: Acenocoumarol; Adult; Cholecystectomy; Cholelithiasis; Contraceptives, Oral; Coumarins; Cyanosis; Ethynodiol Diacetate; Female; Heparin; Humans; Hypotension; Mestranol; Postoperative Complications; Pulmonary Embolism; Streptokinase; Tachycardia

Topics: Acenocoumarol; Aged; Anticoagulants; Ethyl Biscoumacetate; Female; Humans; Male; Middle Aged; Postoperative Complications; Prothrombin; Thromboembolism; Warfarin

Topics: Acenocoumarol; Female; Germany, West; Humans; Postoperative Complications; Thromboembolism

Topics: Acenocoumarol; Adult; Aged; Female; Humans; Male; Middle Aged; Postoperative Complications; Thromboembolism

Topics: Acenocoumarol; Aged; Female; Humans; Male; Middle Aged; Postoperative Complications; Thromboembolism

Topics: Acenocoumarol; Aged; Anticoagulants; Ethyl Biscoumacetate; Female; Hemorrhage; Humans; Hypoprothrombinemias; Male; Postoperative Complications

Topics: Acenocoumarol; Blood Coagulation Tests; Drug Therapy; Humans; Postoperative Care; Postoperative Complications; Prothrombin Time; Thromboembolism

Topics: Acenocoumarol; Anticoagulants; Dicumarol; Drug Therapy; Heparin; Phenindione; Postoperative Complications; Preventive Medicine; Pulmonary Embolism; Thrombophlebitis; Toxicology; Venous Thrombosis; Vitamin K 1; Warfarin