acenocoumarol and Thrombosis

The periprocedural management of patients receiving chronic therapy with oral anticoagulants (OACs), including vitamin K antagonists (VKAs) such as warfarin and direct OACs (DOACs), is a common clinical problem. The optimal perioperative management of patients receiving chronic OAC therapy is anchored on four key principles: (i) risk stratification of patient-related and procedure-related risks of thrombosis and bleeding; (ii) the clinical consequences of a thrombotic or bleeding event; (iii) discontinuation and reinitiation of OAC therapy on the basis of the pharmacokinetic properties of each agent; and (iv) whether aggressive management such as the use of periprocedural heparin bridging has advantages for the prevention of postoperative thromboembolism at the cost of a possible increase in bleeding risk. Recent data from randomized trials in patients receiving VKAs undergoing pacemaker/defibrillator implantation or using heparin bridging therapy for elective procedures or surgeries can now inform best practice. There are also emerging data on periprocedural outcomes in the DOAC trials for patients with non-valvular atrial fibrillation. This review summarizes the evidence for the periprocedural management of patients receiving chronic OAC therapy, focusing on recent randomized trials and large outcome studies, to address three key clinical scenarios: (i) can OAC therapy be safely continued for minor procedures or surgeries; (ii) if therapy with VKAs (especially warfarin) needs to be temporarily interrupted for an elective procedure/surgery, is heparin bridging necessary; and (iii) what is the optimal periprocedural management of the DOACs? In answering these questions, we aim to provide updated clinical guidance for the periprocedural management of patients receiving VKA or DOAC therapy, including the use of heparin bridging.

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Aortic Valve; Atrial Fibrillation; Elective Surgical Procedures; Fibrinolytic Agents; Hemorrhage; Heparin; Humans; Perioperative Care; Phenprocoumon; Prothrombin; Randomized Controlled Trials as Topic; Societies, Medical; Thromboembolism; Thrombosis; United States; Vitamin K; Warfarin

The antiphospholipid syndrome is an antibody mediated hypercoagulable state characterized by recurrent venous and arterial thromboembolic events. Several studies have determined that the frequency of antiphospholipid syndrome in patients presenting with a venous thromboembolic event is between 4% and 14%. Classical criteria include the presence of anticardiolipin antibody or lupus anticoagulant with typical complications of thrombosis or pregnancy loss. Other common associated manifestations include livedo reticularis, thrombocytopenia, valvular heart disease, and nephropathy with renal insufficiency, hypertension and proteinuria. Because of the high risk for recurrent thromboembolism in these patients, current recommendations suggest a longer, potentially lifelong, course of antithrombotic therapy following an initial event. For an initial venous thromboembolic event, a target INR of 2.0 to 3.0 is supported by two prospective, randomized clinical trials. In contrast, relatively limited data exist for an initial arterial thromboembolic event in patients who have the antiphospholipid syndrome, and therapeutic recommendations range from aspirin to warfarin with a high target INR. Recurrent thromboembolic events can be extremely difficult to treat, and some patients may benefit from the addition of immunosuppressive therapies. It is very important to evaluate in this setting additional, coincident prothrombotic risk factors.

Topics: Abortion, Spontaneous; Acenocoumarol; Adult; Antibodies, Anticardiolipin; Anticoagulants; Antiphospholipid Syndrome; Aspirin; Enzyme-Linked Immunosorbent Assay; Female; Fibrinolytic Agents; Heparin; Humans; Lupus Coagulation Inhibitor; Male; Platelet Aggregation Inhibitors; Pregnancy; Prospective Studies; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Thrombophilia; Thrombosis; Warfarin

Vitamin K antagonists (VKA) decrease the synthesis of the active forms of four coagulation factors (factors II, VII, IX, X) and three inhibitors (proteins C, S, Z). There are VKA having a short half life (Sintrom, Pindione) and VKA having a long half life (Apegmone, Previscan, Coumadine). The treatment is monitored by the INR which in the majority of the indications must range between two and three. The first INR is usually performed 36 to 72 h after starting the treatment. There are a number of drug interactions. The rate of major bleedings range from 1.1 to 4.9 for 100 patient-year according to the published studies. Since around 600,000 patients are treated by VKA in our country, the absolute number of serious bleeding is high (> or = 17,000 per year). Anticoagulant clinics are structures aimed to instruct the patient and to advise the general practitioner to monitor the treatment, using computer assisted methods. It has been reported that these structures reduce the incidence of bleeding and of thrombotic events by 3 to 4 times.

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Drug Interactions; Family Practice; Food; Hemorrhage; Humans; Patient Education as Topic; Phenindione; Thrombosis; Time Factors; Vitamin K; Warfarin

The plasma concentration of heparin cofactor II was measured by "rocket" immunoelectrophoresis in healthy volunteers, patients taking Syncumar and thrombophiliacs. The values in healthy volunteers averaged 99% (+/- 16.5). In the group of Syncumar treated patients 100% (+/- 10.5) was measured. This did not differ from the control group. The average of heparin cofactor II level in thrombophiliacs was 92.5% (+/- 23). In this group three patients had low heparin cofactor II levels. In one case this was due to intestinal protein loss. In the two other cases the role of heparin cofactor II is uncertain in the pathogenesis of thrombophilia.

Topics: Acenocoumarol; Adult; Antithrombin III; Blood Coagulation Disorders; Evaluation Studies as Topic; Female; Humans; Immunoelectrophoresis; Male; Thrombophlebitis; Thrombosis

The effect of either (randomized) Heparin/Dihydroergotamine (HDHE) or heparin-acenocoumarin (Hep/S) on the incidence of deep-vein thrombosis in the legs was studied in 212 women of more than 60 years of age with hip fractures. All patients were screened with the 125-I-fibrinogen uptake test (FUT) confirmed by a bilateral ascending venogram upon positive FUT. This revealed good sensitivity and specificity (85/84%) for the FUT. Deep vein thrombosis developed in 37.6% of the HDHE group and in 59.1% of the Hep/S group which was significantly different (p less than 0.005). The calculated thrombosis risk was significantly diminished (by 38% - p less than 0.005) in the HDHE group. Therefore we conclude that in traumatology Heparin/Dihydroergotamine seems to be the prophylaxis of choice.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Bone Nails; Dihydroergotamine; Drug Therapy, Combination; Female; Heparin; Hip Fractures; Humans; Middle Aged; Thrombosis

Unfavorable fibrin clot features have been observed in patients with venous thromboembolism (VTE). We investigated whether rivaroxaban, a direct factor Xa inhibitor, and vitamin K antagonists (VKAs) can improve plasma clot viscoelastic properties. We studied four age- and sex-matched groups: 25 healthy controls, 15 VTE patients taking rivaroxaban 20 mg/day (blood concentration, 145 (67 - 217) ng/ml), 15 VTE patients taking VKA (INR: 2 - 3), and 15 VTE patients who stopped oral anticoagulant therapy (OAT). Using a hybrid rheometier the storage (G') and loss (G") moduli were evaluated in citrated plasma after addition of 5 pmol/l tissue factor. Fiber thickness within clots was assessed using scanning electron microscopy. Higher G' but not G" was observed for VTE patients taking rivaroxaban (+34%; post hoc, P = 0.029) compared to controls. As reflected by lower G' and G", patients taking rivaroxaban (-19% and -30%; post hoc, P = 0.0013 and P < 0.0001, respectively) formed less stiff and viscous clots compared to VTE patients after OAT withdrawal, also after adjustment for fibrinogen. VTE patients treated with rivaroxaban and VKA had similar clot viscoelastic properties (post hoc, P = 0.85 for G' and P = 0.29 for G"). G' and G" correlated with plasma rivaroxaban concentrations (r = -0.67, P = 0.005 and r = -0.59, P = 0.021, respectively), and the time from the last dose of rivaroxaban intake (r = 0.59, P = 0.02 and r = 0.58, P = 0.022, respectively). G' and G" showed no association with INR in patients on VKAs. G' or G" were not associated with fibrin diameter on scanning electron microscopy images in either group. Our preliminary study shows that both rivaroxaban and VKA improve clot viscoelastic properties in VTE patients, which might contribute to their antithrombotic effects. G' and G" may reflect specific clot physical features, beyond key plasma clot characteristics, which highlights benefits from comprehensive plasma clot analysis in patients with thrombotic diseases.

Topics: Acenocoumarol; Adult; Anticoagulants; Elasticity; Factor Xa Inhibitors; Female; Fibrin; Humans; Male; Middle Aged; Rivaroxaban; Thrombosis; Venous Thromboembolism; Viscosity; Vitamin K; Warfarin

We evaluated efficacy and safety of early and short-term prophylaxis with acenocumarine or dalteparin in the prevention of non-occlusive or occlusive central vein catheter-related thrombosis (CVCrT).. Consecutive cancer patients scheduled for chemotherapy randomly received: acenocumarine 1 mg/day for 3 days before and 8 days after central vein catheter (CVC) insertion; dalteparin 5000 IU 2 h before and daily for 8 days after CVC insertion; no anticoagulant treatment (NT). All patients underwent venography on days 8 and 30, some of them on days 90, 150 and 210 after CVC.. A total of 450 patients were randomized, 348 underwent at least two venography. Both acenocumarine and dalteparin reduced venography-detected CVCrT rate [21.9% acenocumarine versus 52.6% NT, odds ratio (OR) 0.3, P < 0.01; 40% dalteparin versus 52.6% NT, OR 0.6, P = 0.05]. Acenocumarine was more effective than dalteparin (OR 0.4, P = 0.01). The rate of occlusive CVCrT was not different in the three groups (0.9% acenocumarine, 3.3% dalteparin, 1.8% NT; P = 0.40). Most CVCrTs (95.6%) were observed on day 8 after CVC insertion and were non-occlusive.. In this study of early and short-term prophylaxis, acenocumarine was more effective than dalteparin on non-occlusive and asymptomatic CVCrT events. The first days following CVC insertion represent the highest risk for CVCrT.

Topics: Acenocoumarol; Aged; Anticoagulants; Catheterization, Central Venous; Dalteparin; Female; Humans; Male; Middle Aged; Neoplasms; Phlebography; Thrombosis

To investigate the presence of thromboembolic risk factors and the effect of low-dose acenocoumarol therapy on migraine in patients who spontaneously reported a reduction of their migraine attacks during previous therapeutic use of anticoagulants.. The positive effect of anticoagulants on migraine has been described in case reports and observational studies. It remains unclear whether this concerns only a select group of migraineurs with certain common characteristics.. In 4 migraineurs with a self-reported reduction of attack frequency during previous use of anticoagulants (international normalization ratio [INR], 2.5:4.0), the presence of thromboembolic risk factors and the effect of low-dose acenocoumarol therapy (INR, 1.5:2.0) on migraine attacks were prospectively investigated in an open study.. All patients had one or more thromboembolic risk factors. Two patients, both with factor V Leiden heterozygosity, experienced a clear improvement of migraine during low-dose acenocoumarol therapy.. Our findings support the hypothesis that migraine, as a phenotype, has different underlying mechanisms, amongst which a thromboembolic tendency. In this group of patients, oral anticoagulants may be a suitable form of migraine prophylaxis, but this needs further clinical investigation.

Topics: Acenocoumarol; Adult; Anticoagulants; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Migraine Disorders; Prospective Studies; Risk Factors; Thrombosis; Treatment Outcome

Topics: Acenocoumarol; Adult; Cholestasis; Chromogenic Compounds; Cohort Studies; Desmin; Factor Xa; Humans; Liver Diseases; Middle Aged; Partial Thromboplastin Time; Peptic Ulcer; Prothrombin; Thrombin Time; Thrombosis

To compare two initial doses of oral anticoagulant (acenocoumarin) studying the haemorrhagic and thromboembolic episodes occurred during the first month of treatment, the mean time and necessary controls until achievement of the desired level of anticoagulation.. From january 1992 to december 1993; a comparative study of two groups of patients was performed: group 1, compiling 129 patients chosen at random and retrospectively, who begun oral anticoagulant treatment with 4 daily mg of acenocoumarin; and group 2, compiling 129 patients chosen prospectively, who begun with 2 mg daily. In both groups the mean time and the number of controls performed until achieving the desired level of anticoagulation were analyzed, as well as the haemorrhagic episodes occurred during the first month of treatment, their severity (classified into major and minor ones), the level of anticoagulation when they occurred and their possible causes. In the same way the thromboembolic processes occurred during that period in both groups were studied.. The mean time necessary to achieve the desired level of anticoagulation was 3.8 days in group 1 and 6.3 in group 2; the mean number of controls performed in group 1 was 1.2 and in group 2 it was 1.8. We have observed 19 haemorrhagic episodes, 15 in group 1 (4 minor and 11 major); and 4 in group 2 (2 minor and 2 major). We have found significant differences with respect to the mean time (p < 0.01), number of controls (p < 0.01) and incidence of hemorrhages (p = 0.017) between groups 1 and 2. One thromboembolic episode was registered in each group: in group 1 a deep venous thrombosis and in group 2 a stroke.. The initial daily doses of acenocoumarin of 2 mg is as effective as the 4 mg one in the prevention of thromboembolic episodes, with a significant reduction in the number of haemorrhages observed during the first month of treatment. However this produces a prolongation in the necessary mean time and more number of controls performed until the achievement of the desired level of anticoagulation.

Topics: Acenocoumarol; Administration, Oral; Adult; Aged; Aged, 80 and over; Female; Hemorrhage; Humans; Incidence; Male; Middle Aged; Retrospective Studies; Thrombosis

The effect of either (randomized) Heparin/Dihydroergotamine (HDHE) or heparin-acenocoumarin (Hep/S) on the incidence of deep-vein thrombosis in the legs was studied in 212 women of more than 60 years of age with hip fractures. All patients were screened with the 125-I-fibrinogen uptake test (FUT) confirmed by a bilateral ascending venogram upon positive FUT. This revealed good sensitivity and specificity (85/84%) for the FUT. Deep vein thrombosis developed in 37.6% of the HDHE group and in 59.1% of the Hep/S group which was significantly different (p less than 0.005). The calculated thrombosis risk was significantly diminished (by 38% - p less than 0.005) in the HDHE group. Therefore we conclude that in traumatology Heparin/Dihydroergotamine seems to be the prophylaxis of choice.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Bone Nails; Dihydroergotamine; Drug Therapy, Combination; Female; Heparin; Hip Fractures; Humans; Middle Aged; Thrombosis

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

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

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

Topics: Acenocoumarol; Adult; Clinical Trials as Topic; Female; Genital Diseases, Female; Humans; Pregnancy; Pregnancy Complications; Puerperal Disorders; Thrombosis

Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug reaction associated with thrombosis. Clinical scoring systems and the presence of anti-platelet factor 4 (anti-PF4)/heparin antibodies determine the diagnosis.. The clinical presentation of intraventricular and multiple arterial thrombi is remarkable. SARS-CoV-2 infection likely contributed to a hypercoagulable state. The management of patients with HIT undergoing cardiac surgery is challenging. If surgery cannot be delayed, then treatment with bivalirudin is recommended. Additionally, this drug is recommended for PCI. Bivalirudin is safe and well-tolerated in both procedures.

Topics: Acenocoumarol; Anticoagulants; Arginine; COVID-19; COVID-19 Drug Treatment; Heparin; Hirudins; Humans; Male; Middle Aged; Peptide Fragments; Percutaneous Coronary Intervention; Pipecolic Acids; Recombinant Proteins; SARS-CoV-2; Sulfonamides; Thrombocytopenia; Thrombosis

Myocardial infarction is a life-threatening emergency with a high mortality rate. A high plasma level of factor VIII is an established risk for both arterial and venous thrombotic events. In this mini-review, we report the case of a 41-year-old woman without cardiovascular risk factors or a previous history of thrombotic events, admitted for ST-elevation myocardial infarction, in whom coronary angiography showed a thrombotic occlusion in the left anterior descending artery. The patient underwent primary percutaneous coronary intervention (PCI), with GPIIB-IIIA antagonist, then, a pre-dilation with a semi-compliant balloon-catheter, followed by implantation of 2 stents. The etiological assessment revealed a high level of coagulation factor VIII (FVIII). She underwent anticoagulation therapy (with acenocoumarol) with well-controlled international normalised ratio (INR).

Topics: Acenocoumarol; Adult; Anticoagulants; Coronary Angiography; Factor VIII; Female; Humans; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Platelet Glycoprotein GPIIb-IIIa Complex; ST Elevation Myocardial Infarction; Stents; Thrombosis

The aim of this study was to compare the efficacy of dabigatran 110 mg twice daily and acenocoumarol in patients with atrial fibrillation discharged after ischemic stroke. We prospectively studied 436 consecutive patients who were discharged after acute ischemic stroke (39.2% males, age 78.6 ± 6.7 years). Approximately 1 year after discharge, the functional status was assessed with the modified Rankin scale (mRS). Adverse outcome was defined as mRS between 2 and 6. The occurrence of ischemic stroke, myocardial infarction (MI) and death during the 1-year follow-up was also recorded. At discharge, 142 patients had atrial fibrillation. Acenocoumarol and dabigatran 110 mg twice daily were prescribed to 52.1 and 6.3% of these patients, respectively. At 1 year after discharge, there was a trend for patients treated with acenocoumarol to have lower mRS than patients prescribed dabigatran (2.3 ± 2.4 and 4.1 ± 2.2, respectively; P = 0.060). Adverse outcome rates and the incidence of stroke during follow-up did not differ between the two groups. The incidence of MI was almost three times higher in patients prescribed dabigatran than in those prescribed acenocoumarol, but this difference did not reach significance (11.1 and 4.0%, respectively; P = 0.254). The incidence of cardiovascular death was also almost three times higher in the former, but again this difference was not significant (33.3 and 12.2%, respectively; P = 0.237). In real-world patients with acute ischemic stroke, dabigatran 110 mg twice daily is as effective as acenocoumarol in preventing stroke but appears to be associated with worse long-term functional outcome and higher incidence of MI.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Antithrombins; Atrial Fibrillation; Brain Ischemia; Dabigatran; Drug Administration Schedule; Female; Humans; Male; Myocardial Infarction; Patient Discharge; Prospective Studies; Stroke; Survival Analysis; Thrombosis

Topics: Acenocoumarol; Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Middle Aged; Polycythemia Vera; Proportional Hazards Models; Risk Factors; Smoking; Thrombophilia; Thrombosis; Warfarin

Atrial fibrillation (AF) is a prothrombotic condition, involving increased thrombin generation and fibrinogen concentrations. Vitamin K antagonists (VKAs) prevent arterial thromboembolism if optimal anticoagulation is achieved by individualised drug doses, assessed by determining the Prothrombin time-related International Normalized Ratio (Pt-INR). There is evidence that formation of tight-laced fibrin networks is pathogenic in prothrombotic diseases. This study was performed among AF patients, to test whether long-term treatment with VKAs affects the structure of fibrin networks, and whether the effect is altered by employing different coagulation triggers: exogenous thrombin (1 IU/ml), 10 pM tissue factor (TF) or a commercial Pt-INR reagent (containing 400-fold more TF). In the thrombin-based method, fibrin network porosity (scanning electron microscopy) and liquid permeability (flow measurements) correlated inversely to fibrinogen concentrations, while positive correlations to the degree of anticoagulation were shown with the Pt-INR reagent. In the method with 10 pM TF, the two above relationships were detected, though the influence of Pt-INR was more profound than that of fibrinogen concentrations. Moreover, greater shortening of clot lysis time (CLT) arose from more permeable clots. As a coagulation trigger, 10 pM TF vs exogenous thrombin or the Pt-INR reagent is more informative in reflecting the in vivo process from thrombin generation to fibrin formation. Since fibrin network permeability rose in parallel to elevations of INR and shortening of CLT in AF patients, antithrombotic effects on prevention of thrombotic complications may be achieved from impairment of thrombin generation, resulting in formation of permeable clots susceptible to fibrinolysis.

Topics: Acenocoumarol; Aged; Anticoagulants; Atrial Fibrillation; Blood Coagulation; Case-Control Studies; Fibrin; Fibrin Clot Lysis Time; Humans; International Normalized Ratio; Microscopy, Electron, Scanning; Poland; Porosity; Protein Conformation; Sweden; Thrombin; Thrombosis; Vitamin K; Warfarin

Topics: Acenocoumarol; Adult; Angiolipoma; Anticoagulants; Female; Humans; Neoplasms, Adipose Tissue; Thrombosis

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Consensus; Humans; Terminology as Topic; Thrombosis; Vitamin K

To identify, in a case-control study, the risk factors associated with a thrombotic or bleeding event in patients treated with vitamin K antagonists.. We performed a single-centre observational study during a three-month period where we consecutively included patients admitted to the emergency department of a secondary-level hospital and treated with vitamin K antagonists, regardless the reason for admission. Patients admitted for a thrombotic or bleeding event were included as cases and the other patients served as controls. Main thrombotic or bleeding risk factors during vitamin K antagonist therapy were a priori identified in literature and tested in conditional logistic regression.. Two hundred and forty subjects were identified, 40 of which (17%) were admitted for a bleeding event, 19 (8%) for a thrombotic event and 181 (75%) for another reason. Over 85% of patients were treated with fluindione. No risk factor was significantly associated with bleeding or thrombotic event in patients treated with vitamin K antagonist. Patients presenting a thrombotic event were however more likely to have a chronic respiratory disease.. In this study, no risk factor significantly associated with a bleeding or thrombotic event in patients treated with vitamin K antagonist were identified. The occurrence of these events supposes other risk factors, including potential genetic polymorphisms that should be considered in future studies.

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Case-Control Studies; Drug Interactions; Emergency Service, Hospital; Female; Genetic Predisposition to Disease; Hemorrhage; Humans; International Normalized Ratio; Male; Phenindione; Respiration Disorders; Risk Factors; Secondary Care Centers; Thrombosis; Vitamin K; Warfarin

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

We present a case of a 67-year-old male with pulmonary embolism. Transesophageal echocardiography (TEE) showed the presence of a mobile thrombus straddling the patent foramen ovale (PFO) and prolapsing into both atria. Treatment with heparin was started. Five days after admission, repeat TEE revealed a reduction in thrombus dimensions, so anticoagulation therapy was continued. Eleven days after admission, TEE showed complete disappearance of the thrombus.

Topics: Acenocoumarol; Aged; Anticoagulants; Drug Therapy, Combination; Echocardiography, Transesophageal; Follow-Up Studies; Foramen Ovale, Patent; Heart Atria; Heparin; Humans; Male; Pulmonary Embolism; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome

Topics: Acenocoumarol; Angiography; Anticoagulants; Aorta, Thoracic; Female; Humans; Leriche Syndrome; Middle Aged; Thrombosis; Tomography, X-Ray Computed

Topics: Acenocoumarol; Anticoagulants; Benzamides; Benzimidazoles; beta-Alanine; Dabigatran; Heparin; Humans; Morpholines; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Stroke; Thiazoles; Thiophenes; Thromboembolism; Thrombosis; Warfarin

To investigate whether the phenprocoumon and acenocoumarol maintenance doses are influenced by genetic variations in GATA-4, a transcription factor of CYP2C9.. The influence of seven GATA-4 SNPs on the coumarin maintenance dose was investigated by performing an analysis of variance trend analysis, stratified for CYP2C9 genotypes. Results of the best-explaining SNP were validated in the Rotterdam Study cohort.. The largest dose differences were found for rs3735814 in patients using acenocoumarol and having the common allele for CYP2C9. The mean dosages decreased from 2.92 mg/day for the patients having the GATA-4 common alleles to 2.65 mg/day for the patients carrying one GATA-4 variant allele and to 2.37 mg/day for patients carrying two GATA-4 variant alleles (p = 0.004). Results could not be replicated in the validation cohort. For phenprocoumon, no significant effects were observed.. Genetic variation in GATA-4 does not seem relevant for clinical implementation.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Alleles; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Cytochrome P-450 CYP2C9; Female; GATA4 Transcription Factor; Genotype; Humans; Male; Middle Aged; Pharmacogenetics; Phenprocoumon; Polymorphism, Single Nucleotide; Thrombosis

The authors assessed the impact of CYP2C9*2, CYP2C9*3, and/or VKORC1-1639G>A/1173C>T single-nucleotide polymorphisms on oral anticoagulants in a Lebanese population. This study recruited 231 Lebanese participants on long-term warfarin or acenocoumarol maintenance therapy with an international normalized ratio (INR) monitored at the American University of Beirut Medical Center. CYP2C9 and VKORC1 variant alleles were screened by real-time PCR. Plasma R- and S-warfarin and R- and S-acenocoumarol levels were assayed using high-performance liquid chromatography. The variant allele frequencies of CYP2C9*2, CYP2C9*3, and VKORC1 -1639G>A/1173C>T were 15.4%, 7.8%, and 52.4%, respectively. Fifty-five participants were excluded from analysis because of nontherapeutic INR values at recruitment, leaving 43 participants taking warfarin and 133 taking acenocoumarol. There was a significant decrease in the weekly maintenance dose of both drugs with CYP2C9 and VKORC1 variants when compared with wild-type patients. CYP2C9*2 had the least impact on the response to both drugs. The concentrations of R- and S-warfarin in plasma were significantly correlated with CYP2C9 genotypes. For acenocoumarol, time to reach target INR was more prolonged in patients carrying any CYP2C9 variant allele but failed to reach statistical significance because of low numbers of patients. There was no association between allelic variants and bleeding events. This is the first pharmacogenetic study of oral anticoagulants in Arabs. The authors showed that both CYP2C9 and VKORC1 polymorphisms are common in Lebanon and influence warfarin and acenocoumarol dose requirements, with the CYP2C9*2 polymorphism having less effect on acenocoumarol, the most commonly used oral anticoagulant in Lebanon.

Topics: Acenocoumarol; Adult; Aged; Aged, 80 and over; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Cytochrome P-450 CYP2C9; Female; Genotype; Humans; International Normalized Ratio; Lebanon; Male; Middle Aged; Mixed Function Oxygenases; Polymorphism, Genetic; Retrospective Studies; Thrombosis; Vitamin K Epoxide Reductases; 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

Bioprosthetic valve thrombosis is an unexpected complication which has no guidelines for its management. A 70-year-old female presented 10 days after a stroke, three years after having undergone mitral bioprosthetic valve implantation. Both, transthoracic echocardiography and transesophageal echocardiography (TEE) revealed a large mobile, non-obstructive mass attached to the atrial side of the sewing ring of the bioprosthesis. The administration of low-molecular-weight heparin and aspirin resulted only in a reduction of thrombus size, whereas a slow streptokinase infusion resulted in complete disappearance of the thrombus after 16 h. A review of the literature shows that late non-obstructive bioprosthetic valve thrombosis, as diagnosed with TEE, is a rare condition that can be successfully treated either by anticoagulant or thrombolytic therapy. Late bioprosthetic valve thrombosis should be considered as a cause of prosthetic valve dysfunction, and long-term preventive anticoagulant treatment of high-risk patients is warranted. Slow thrombolytic therapy is safe and successful, even for large non-obstructive bioprosthetic thrombi, if there are no contraindications.

Topics: Acenocoumarol; Aged; Bioprosthesis; Echocardiography, Transesophageal; Female; Fibrinolytic Agents; Heart Valve Prosthesis; Humans; Mitral Valve; Nadroparin; Streptokinase; Thrombolytic Therapy; Thrombosis; Time Factors

The movement of thrombi migrating from the veins of the lower limbs can give rise to pulmonary emboli within 24 hours. This is manifested as massive pulmonary embolism in 30% of cases, with a mortality rate of around 50%. Free-floating thrombi within the right cardiac cavities are rare, and the diagnosis is made mainly by transthoracic and transoesophageal echocardiography. Treatment includes surgery, invasive percutaneous embolectomy, thrombolysis and heparin administration. Here we report the case of an 80-years-old patient with massive pulmonary embolism caused by a free floating thrombus within the right atrium. Tenecteplase was administered with excellent results.

Topics: Acenocoumarol; Aged, 80 and over; Echocardiography; Fibrinolytic Agents; Heart; Heart Atria; Heart Ventricles; Humans; Male; Pulmonary Embolism; Severity of Illness Index; Thrombosis

We report a case of a 53-year-old male who presented with thoracodynia three months after right pneumonectomy. Chest CT-scan demonstrated thrombus at the pulmonary artery stump without any other abnormal finding. He was treated successfully with acenocoumarol. We present this case analyzing the possible causes and discussing the treatment.

Topics: Acenocoumarol; Anticoagulants; Carcinoma, Non-Small-Cell Lung; Humans; Ligation; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Pulmonary Artery; Pulmonary Embolism; Thrombosis; Tomography, X-Ray Computed

Topics: Acenocoumarol; Aged; Aged, 80 and over; Anticoagulants; Drug Monitoring; Enoxaparin; Factor VII Deficiency; Hemorrhage; Humans; International Normalized Ratio; Male; Risk Assessment; Thrombosis; Time Factors; Treatment Outcome

To analyse incidence of hemorrhagic and thrombotic events in a series of ambulatory patients receiving acenocoumarol in a rural area of Spain (1997-2007).. Out of 1,544 patients, 1,086 are receiving acenocoumarol at present (2% of our region's population). The total follow-up was 5,462 patients-years. Median age was 74 years. INR therapeutic range was 2.0-3.0 in 82.5%. Atrial fibrillation (AF) was the most frequent indication (73%). Incidence of hemorrhagic and thrombotic events was 2.27 and 0.2/100 patients-year, respectively. Gastrointestinal tract was the most frequent site of bleeding. In multivariate analysis, patients with AF and prosthetic heart valves (PHV) had increased risk of bleeding (OR 2.1 and 4.8, respectively). Age and therapeutic ranges of INR were not associated with increased risk of bleeding.. 2% of our population is receiving acenocoumarol. Incidence of hemorrhagic and thrombotic events was low. Patients with AF and PHV had increased risk of bleeding.

Topics: Acenocoumarol; Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Cohort Studies; Female; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Male; Middle Aged; Outpatient Clinics, Hospital; Prospective Studies; Risk Factors; Spain; Thrombosis; Treatment Outcome; Young Adult

Prosthetic valve thrombosis (PVT) represents a serious and potentially lethal complication. It can be attributed more frequently to inadequate anticoagulant therapy. We present a case of acute aortic mechanical valve thrombosis six months after implantation. The patient discontinued oral anticoagulation after being discharged following the primary operation. Two days after reinitiating warfarin as an outpatient, he developed acute valve thrombosis presenting with symptoms and signs of cardiac failure. He was managed with intravenous thrombolysis with a recombinant plasminogen activator which resulted in immediate resolution of thrombus and clinical improvement. A paradox procoagulant effect of warfarin is evident on the first one or two days after initiation of therapy. A 'bridging' protocol with unfractionated or low molecular weight heparin (LMWH) should be considered, according to recently published guidelines, until warfarin reaches therapeutic levels and exerts an antithrombotic effect.

Topics: Acenocoumarol; Acute Disease; Adult; Anticoagulants; Aortic Valve Insufficiency; Endocarditis; Fibrinolytic Agents; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heparin; Humans; Male; Medication Adherence; Tenecteplase; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator; Treatment Outcome; Warfarin

Within each patient treated with vitamin K antagonist (VKA), variation of the international normalised ratio (INR) occurs over the treatment period. The purpose of the present study was to assess INR variation in selected patients on long-term treatment in whom the dose of VKA was not changed. This type of variation is considered as "biological variation" which is caused by many factors but not VKA dose changes or other medication. Four groups of long-term patients were examined: each group with a different VKA (acenocoumarol or phenprocoumon) or a different target intensity (INR 2.0-3.5 or 2.5-4.0). All patients were monitored with the same PT system (Hepato Quick, STA-R Evolution coagulation instrument) by one laboratory. The variation of the INR within each patient was expressed as coefficient of variation (CV, in %). The CV was corrected for the average imprecision of the INR measurement (CV, 2.4%). The mean corrected CV values for the four groups were: 10.9% (acenocoumarol, target INR 2.0-3.5); 10.5% (acenocoumarol, target INR 2.5-4.0); 10.4% (phenprocoumon, target INR 2.0-3.5); 9.1% (phenprocoumon, target INR 2.5-4.0). The analytical performance goal for the INR measurement (imprecision) can be derived from the within-subject biological variation. Desirable INR imprecision goals are <4.9% and <5.3% CV for monitoring of phenprocoumon and acenocoumarol, respectively. These goals were achieved using the aforesaid PT system.

Topics: Acenocoumarol; Aged; Anticoagulants; Chemistry, Clinical; Female; Humans; International Normalized Ratio; Male; Middle Aged; Phenprocoumon; Quality Assurance, Health Care; Quality Control; Reproducibility of Results; Retrospective Studies; Thrombosis; Treatment Outcome

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

Topics: Abdominal Pain; Acenocoumarol; Aged; Aged, 80 and over; Emergency Treatment; Factor VII; Factor VIIa; Female; Humans; International Normalized Ratio; Laparotomy; Recombinant Proteins; Risk Assessment; Shock, Septic; Thrombosis

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

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

To obtain an impression of the extent and quality of the anti-coagulation treatment with coumarin derivatives carried out by the Thrombosis Services in the Netherlands.. Descriptive.. Data were drawn from the medical annual reports of 62 of the 63 Thrombosis Services in the Netherlands over the period 1998-2002. In 2002 the Thrombosis Services treated 325,072 patients and performed 4,469,730 INR laboratory tests. The half-yearly figures produced by the Thrombosis Services were calculated as an average percentage per year per thrombosis service and then recalculated as a percentage per year.. Seventy-three per cent of the patients were treated for an arterial and 27% for a venous indication. Depending on the required intensity of anticoagulation a mean of 74-78% of the long-term treated patients fell within the therapeutic range and a mean of 6-10% below. The mean number of major bleedings per 100 treatment years was 1.0. A mean of 79% of the patients was treated with acenocoumarol and 21% with phenprocoumon. When acenocoumarol was used, a mean of 72-77% fell within the therapeutic range and in the case of phenprocoumon 79-82%. In the last few years the number of patients had increased due to a growing number of patients treated for atrial fibrillation. The percentages of INR within the therapeutic range were unchanged or showed a slight increase.. The quality of the anticoagulation therapy with coumarin derivatives was good or acceptable.

Topics: Acenocoumarol; Anticoagulants; Atrial Fibrillation; Coumarins; Hemorrhage; Humans; International Normalized Ratio; Netherlands; Phenprocoumon; Quality of Health Care; Thrombosis; Treatment Outcome

To assess frequency of left auricular thrombosis and effect of long-term therapy with acenocoumarol on auricular hemodynamics and system of hemostasis and to elucidate predictors of effective therapy with acenocoumarol in patients with nonvalvular atrial fibrillation.. Patients (n=100) with nonvalvular atrial fibrillation and at least 1 risk factor of thromboembolic complications.. Transesophageal echocardiography and measurement of blood D-dimer levels were carried out before and after 1 year of acenocoumarol therapy.. Initial prevalence of left auricular thrombosis was 75%. The use of acenocoumarol for 12 months resulted in significant reduction of frequency of left auricular thrombosis. This was associated with improvement of parameters of intraatrial hemodynamics and lowering of elevated blood D-dimer levels. Clinical-instrumental predictors of presence of left auricular thrombosis and its dynamics during therapy with acenocoumarol were also elucidated.

Topics: Acenocoumarol; Anticoagulants; Atrial Fibrillation; Follow-Up Studies; Hemodynamics; Humans; Prospective Studies; Thrombosis

Over past years, there has been a world-wide increase in oral anticoagulant treatment (OAT). This study was aimed at evaluating the efficacy and safety of OAT managing in a real-practice situation. Nine hundred and three consecutive unselected patients referred for the control of OAT to the Anticoagulation Clinic of the University of Florence were studied. The total follow-up period was 1679 patient-years. The rate of total, major and fatal bleeding events was 5.0, 1.1 and 0.06 per 100 patient-years, respectively. In patients with a target International Normalized Ratio (INR) > or = 3, a significantly higher rate of bleeding (P = 0.02) with respect to patients with a target INR < 3 was observed. The rate of all thrombotic events was 3.8 per 100 patient-years. The rate of major and fatal thrombotic events were 2.4 and 0.4 per 100 patient-years, respectively. At INR >/= 4.5 the rate of bleeding was significantly higher (P = 0.005) than at lower INR. At INR < 2 the rate of all thrombotic events was significantly higher (P = 0.00001) with respect to more elevated intensities of anticoagulation. A low incidence of complications may be obtained even in elderly outpatients on OAT followed at an anticoagulation clinic.

Topics: Acenocoumarol; Age Factors; Aged; Anticoagulants; Data Interpretation, Statistical; Female; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Male; Middle Aged; Prospective Studies; Software; Thrombosis; Warfarin

Topics: Acenocoumarol; Administration, Oral; Adult; Anticoagulants; Antiphospholipid Syndrome; Biological Availability; Cyclooxygenase Inhibitors; Drug Synergism; Female; Humans; International Normalized Ratio; Lactones; Sulfones; Thrombosis

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

We report the case of a young healthy woman who presented an early overanticoagulation when receiving acenocoumarol for a first thromboembolic episode. The patient had none of the risk factors known to influence the response to the coumarinic derivative except that she carried the rare *3 allelic variant of the cytochrome P450 CYP2C9 in a homozygous status. This case illustrates the role of the *3 polymorphism of the cytochrome P450 CYP2C9 as an independent risk factor modulating the sensitivity of patients to the anticoagulant effect of acenocoumarol. The usefulness of CYP2C9 genotyping before starting coumarinic treatments is discussed.

Topics: Acenocoumarol; Adult; Anticoagulants; Aryl Hydrocarbon Hydroxylases; Blood Coagulation Disorders; Cytochrome P-450 CYP2C9; Female; Genotype; Humans; Polymorphism, Genetic; Risk Factors; 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

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

Topics: Acenocoumarol; Acute Kidney Injury; Aged; Anticoagulants; Aorta, Abdominal; Arterial Occlusive Diseases; Bed Rest; Combined Modality Therapy; Female; Femoral Artery; Heparin, Low-Molecular-Weight; Humans; Iliac Vein; Lumbar Vertebrae; Pulmonary Embolism; Remission Induction; Renal Artery; Renal Dialysis; Spinal Fractures; Thrombectomy; Thrombosis; Venous Insufficiency

Topics: Acenocoumarol; Anticoagulants; Humans; International Normalized Ratio; Patient Acceptance of Health Care; Patient Education as Topic; Reagent Kits, Diagnostic; Self Care; Thrombosis

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Aortic Aneurysm; Brain Ischemia; Cyanosis; Heparin; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Myocardial Infarction; Risk Factors; Thromboembolism; Thrombosis; Toes; Urinary Bladder Neoplasms

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

Thromboses represent a rare event in children and may be due to a deficiency of antithrombin.. A 10-year-old boy developed thrombosis due to a congenital quantitative deficiency in antithrombin, confirmed by molecular biology. His father was diagnosed with the same deficiency. The child was first treated with heparin and is now on antivitamin K. He is well 26 months after diagnosis.. When a young patient presents with a thrombotic event, a congenital deficiency in one of the inhibitors of coagulation, one of which is antithrombin, should be looked for and the condition treated as soon as possible.

Topics: Acenocoumarol; Anticoagulants; Antithrombins; Child; Heparin; Humans; Male; Pedigree; Protein C Deficiency; Protein S Deficiency; Thrombosis

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

Topics: Acenocoumarol; Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Child; Child, Preschool; Hemorrhage; Humans; International Normalized Ratio; Middle Aged; Retrospective Studies; Risk Factors; Thrombosis

Prosthetic heart valve thrombosis occurring during pregnancy is a life-threatening complication. Surgical treatment requires clot removal under cardiopulmonary bypass (CPB) and carries a high mortality. We describe the successful use of thrombolytic therapy for recurrent thrombosed valve prosthesis in a pregnant patient.. A 32-yr-old patient whose pregnancy was complicated by two episodes of a thrombosed St Jude mitral prosthesis is reported. The first episode occurred at 20 wk of pregnancy during the change of oral anticoagulant therapy (acenocoumarol 4 mg a day) to sc heparin. As the patient was in cardiogenic shock, the valve thrombus was treated by clot removal under CPB., with a cross clamp time of 32 min, a perfusion pressure above 70 mmHG. There was no fetal cardiac rhythm during CPB which lasted < 45 min. The second episode occurred at the 28th gestational week in a patient in cardiogenic shock and because reoperation was thought to carry too high a risk, the thrombus was successfully treated with 50 mg recombinant tissue plasminogen activators (rtPA) i.v. Following this, the course of pregnancy was uneventful and carried to term and the patient delivered vaginally. Pain relief was achieved with intravenous patient-controlled analgesia with alfentanil (bolus 100 mug; lock out = five minutes). Although rtPA has been used before, this is the first report in which pregnancy was carried to term and standard vaginal delivery performed.. This case provides evidence for the efficacy and relative safety of rtPA as thrombolytic therapy in the treatment of haemodynamically compromised valve heart thrombosis in pregnancy.

Topics: Acenocoumarol; Adult; Anticoagulants; Female; Heart Valve Prosthesis; Heparin; Humans; Mitral Valve; Mitral Valve Insufficiency; Plasminogen Activators; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Recombinant Proteins; Thrombolytic Therapy; Thrombosis; Tissue Plasminogen Activator

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

Topics: Acenocoumarol; Aged; Anticholesteremic Agents; Anticoagulants; Drug Synergism; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Lovastatin; Male; Simvastatin; Thrombosis

Disappearance of migraine during the use of warfarin and of phenprocoumon has been described in sporadic case reports. Treatment with heparin has also been associated with a reduction of migranous headaches. Recently, the Netherlands Pharmacovigilance Foundation LAREB received a case report concerning the diminution of migrainous headaches associated with the use of the vitamin K antagonist, acenocoumarol.

Topics: Acenocoumarol; Aged; Anticoagulants; Female; Humans; Migraine Disorders; Thrombosis

Abdominal trauma is a rare and poorly documented cause of portal vein thrombosis. We report here the case of a patient in whom portal vein thrombosis was diagnosed one month after an abdominal blunt trauma. Post-traumatic origin of thrombosis was confirmed by the negativity of an exhaustive aetiological investigation. Thrombosis involved portal bifurcation and right and left portal veins, but remained asymptomatic. A particularity of this case was that a total regression of the thrombosis was observed under anticoagulation therapy.

Topics: Abdominal Injuries; Accidents, Traffic; Acenocoumarol; Aged; Heparin; Humans; Male; Portal Vein; Thrombosis; Ultrasonography; Wounds, Nonpenetrating

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; Heparin; Humans; Thrombosis

Own material of 7 patients is presented pathology: venous thrombosis involving both hepatic veins and portal system, resulting in severe impairment of liver function and portal circulation, leading up to a fatal end (if not treated). Neither surgical decompression nor liver transplantation is feasible from the technical point of view. Patients were treated with activators of fibrinolysis. In four cases the treatment was effective and resulted in recanalisation of the previously occluded veins. Early re-thrombosis was the reason of death in one case. One patient died 4 years later because of cerebral vascular thrombosis. Two others live over 5 years, symptom-free. The authors consider thrombolytic treatment as a life saving procedure in cases of hepatic and portal venous thrombosis.

Topics: Acenocoumarol; Adolescent; Adult; Budd-Chiari Syndrome; Female; Heparin; Humans; Portal Vein; Streptokinase; Thrombolytic Therapy; Thrombosis

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

Topics: Acenocoumarol; Aged; Female; Heart Atria; Heparin; Humans; Mitral Valve Stenosis; Thrombosis; Ultrasonography

Acute splenoportal and superior mesenteric venous thrombosis were diagnosed on sonography and computed tomography (CT) in six patients. Sonography demonstrated the presence of echoic material filling the involved vessels in all patients. Precontrast CT scans demonstrated an increased, intra luminal density of the clots in four patients with splenoportal thrombosis. However, in two cases of superior mesenteric venous thrombosis, no hyperdensity was observed within the lumens. Nevertheless, the clots were always visualized as low-density regions in the vessel lumens after bolus injection. Intravenous anticoagulant therapy was started immediately after the diagnosis. All patients were evaluated twice a week with sonography and/or CT until recanalization occurred. The patency of the previously involved vessels was assessed from 6 days to 4 weeks after the acute episode (average time of recanalization: 17 days) without development of collateral pathways. It is concluded that, in the absence of clinical signs of a life-threatening process, a conservative management of acute splanchnic thrombosis can be successfully achieved by (1) early diagnosis, (2) efficacious intravenous anticoagulant therapy, (3) careful imaging follow-up of these patients by sonography and/or CT during the acute phase and, finally, (4) by an extensive search for a hypercoagulable state.

Topics: Acenocoumarol; Adult; Female; Heparin; Humans; Male; Mesenteric Vascular Occlusion; Mesenteric Veins; Middle Aged; Portal Vein; Splenic Vein; Thrombosis; Tomography, X-Ray Computed; 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

This case report concerns a child admitted to the County Hospital of Zalaegerszeg with the symptoms of ataxia, focal convulsions and hemiparesis. Anticonvulsive therapy abolished the epileptic manifestations, but hemiparesis remained unchanged. At the age of six and half years progressive venous thrombosis developed first on the left and some days later on the right lower limb. Phlebography revealed on both sides thrombosis of the vena iliaca which led to stenosis of the right femoral vein and dilated venous collaterals on the abdomen and right thigh. Coeliacography showed an enlarged spleen and varicosity around the portal vein. Later thrombosis of the arteria dorsalis pedis developed indicated by the gangrene the fifth toe. At this stage the child was transfered to the Pediatric Department of the University of Pécs for further evaluation. Examination of the hemostasis showed hypercoagulability due to antithrombin III deficiency pointing towards a common cause, namely thromboembolism of the earlier and recent clinical manifestations. A reduced activity of the antithrombin III was also observed in the mother and two sisters of the child. The response to Syncumar therapy was beneficial, arterial thrombosis regressed and no further thromboembolic complications developed.

Topics: Acenocoumarol; Antithrombin III Deficiency; Ataxia; Blood Coagulation Disorders; Child; Epilepsies, Partial; Female; Hemiplegia; Humans; Radiography; Roma; Thrombophlebitis; Thrombosis

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

Oral anticoagulation is sometimes unjustly referred to as a particularly difficult form of antithrombotic therapy. Apparent failures of this treatment may be caused by insufficient information on the part of either the physician or the patient himself, poor standardization of laboratory tests and/or inadequate dosage of vitamin K antagonists. Specialized centers for treatment of thrombosis have done pioneer work in standardizing and evaluating oral anticoagulant treatment with respect to various indications. Based on this experience, optimum long-term anticoagulant therapy is today possible even in a small hospital or in general medical practice, provided that the pharmacological peculiarities of vitamin K antagonists and international developments concerning standardization of the prothrombin time (Quick test) and its modifications (International Normalized Ratio, INR) are taken into consideration. Regular internal and external quality control of laboratory tests for monitoring of oral anticoagulation is of the utmost importance.

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation; Humans; Phenprocoumon; Quality Assurance, Health Care; Switzerland; Thrombosis; Time Factors; Vitamin K

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

Topics: Acenocoumarol; Anticoagulants; Female; Heparin; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Risk; Thromboembolism; Thrombosis

A significant decrease of plasma antithrombin III (AT III) levels, measured with four different biological and immunological methods, was found in 8 of 11 members of a Sicilian family (family DM) and in 3 of 14 members of a northern Italian family (family A). Different behaviour after oral anticoagulant treatment with acenocoumarin was seen in 2 long-term treated subjects. The propositus of family DM, who had had a long history of recurrent thrombosis, did not show any increase of AT III levels. A significant increase was, on the contrary, observed in the propositus of family A, who had suffered a recent thrombosis in a branch of the inferior mesenteric vein.

Topics: Acenocoumarol; Adult; Antithrombin III Deficiency; Female; Genes, Dominant; Humans; Italy; Male; Middle Aged; Pedigree; Thrombosis

Topics: Acenocoumarol; Aspirin; Drug Therapy, Combination; Hemorrhage; Humans; Platelet Aggregation; Prothrombin Time; Thrombosis

Topics: Acenocoumarol; Anti-Inflammatory Agents; Anticoagulants; Drug Evaluation; Humans; Phenprocoumon; Platelet Aggregation; Thrombosis; Vitamin K; Warfarin

Topics: Acenocoumarol; Anticoagulants; Humans; Male; Middle Aged; Myocardial Infarction; Retinal Vessels; Thrombosis

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

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; Adult; Aged; Cesarean Section; Female; Genital Diseases, Female; Humans; Hysterectomy; Middle Aged; Pregnancy; Preoperative Care; Thromboembolism; Thrombosis

Topics: Acenocoumarol; Adenine Nucleotides; Aniline Compounds; Animals; Anticoagulants; Blood Coagulation; Blood Platelets; Drug Synergism; Endotoxins; Hyperlipidemias; Oxyphenbutazone; Phenylacetates; Phenylbutazone; Platelet Adhesiveness; Rats; Sulfinpyrazone; Thrombin; Thrombosis

Topics: Acenocoumarol; Adult; Aged; Alopecia; Anticoagulants; Blood Coagulation; Blood Coagulation Tests; Coumarins; Dosage Forms; Drug Synergism; Female; Hemorrhage; Heparin; Heparinoids; Humans; Liver; Male; Middle Aged; Myocardial Infarction; Protamines; Thrombophlebitis; Thrombosis; Time Factors

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

Topics: Acenocoumarol; Adult; Aged; Anticoagulants; Breast Diseases; Coumarins; Diabetes Complications; Female; Foot Diseases; Hemorrhage; Humans; Intracranial Embolism and Thrombosis; Middle Aged; Necrosis; Obesity; Pulmonary Embolism; Thromboembolism; Thrombophlebitis; Thrombosis

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

Topics: Acenocoumarol; Animals; Blood Cell Count; Blood Coagulation Tests; Blood Platelets; Blood Proteins; Cholesterol; Dietary Fats; Endotoxins; Hemorrhage; Hemorrhagic Disorders; Rats; Salmonella typhi; Shock, Septic; Shock, Surgical; Thrombosis; Triamcinolone

Topics: Acenocoumarol; Blood Coagulation; Blood Coagulation Tests; Dicumarol; Ethyl Biscoumacetate; Humans; Metabolic Clearance Rate; Methods; Prothrombin Time; Spectrum Analysis; Thrombosis; Vitamin K

Topics: Acenocoumarol; Anticoagulants; Heparin; Humans; Postoperative Care; Preoperative Care; Thrombelastography; Thrombosis; Vascular Diseases

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

Topics: Acenocoumarol; Anticoagulants; Blood Coagulation; Blood Coagulation Factors; Factor V; Factor VII; Factor X; Humans; Postoperative Care; Prothrombin Time; Thrombelastography; Thrombin; Thrombosis

Topics: Acenocoumarol; Carotid Artery Thrombosis; Cerebral Arterial Diseases; Cerebrovascular Circulation; Cerebrovascular Disorders; Ethyl Biscoumacetate; Hemiplegia; Heparin; Hibernation; Humans; Hypothermia, Induced; Intracranial Embolism; Intracranial Embolism and Thrombosis; Promazine; Stroke; Therapeutics; Thrombosis; Toxicology

Topics: Acenocoumarol; Aminopyrine; Anticoagulants; Blood Pressure Determination; Heparin; Intracranial Embolism; Intracranial Embolism and Thrombosis; Liver Function Tests; Myocardial Infarction; Phenylbutazone; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis; Thrombosis; Toxicology

Topics: Acenocoumarol; Anticoagulants; Coronary Disease; Coumarins; Ethyl Biscoumacetate; Prothrombin Time; Pulmonary Embolism; Thrombophlebitis; Thrombosis

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

Topics: Acenocoumarol; Aphasia; Blood Coagulation Tests; Female; Heparin; Humans; Intracranial Embolism; Intracranial Embolism and Thrombosis; Leg; Leg Ulcer; Pregnancy; Pregnancy Complications; Pregnancy Complications, Cardiovascular; Thrombophlebitis; Thrombosis

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

Topics: Acenocoumarol; Hematoma; Humans; Necrosis; Thrombosis

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

Topics: Acenocoumarol; Anticoagulants; Cardiovascular System; Coumarins; Pyrogens; Retina; Retinal Vein Occlusion; Thrombosis

Topics: Acenocoumarol; Anticoagulants; Cesarean Section; Coumarins; Diagnosis, Differential; Female; Hematoma; Humans; Pregnancy; Thrombosis

Topics: Acenocoumarol; Anticoagulants; Coumarins; Myocardial Infarction; Thrombosis