dicumarol and Atrial-Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia occurring in clinical practice. It is the most frequent cause of hospitalization in cardiac rhythm disturbance. Despite comprehensive progress in the research into electrophysiological mechanisms leading to this loss of normal rhythm and new procedures dealing with it, the main problem being the conversion to and maintaining the normal sinus rhythm (SR) has not been solved. The polish study "Hot Cafe" is trying to evaluate the advantages and risks of the two procedures widely used in clinical practice in patients (pts) with chronic AF, i.e. conversion and maintaining SR vs leaving pts with the arrhythmia. Pts with non-valvular chronic AF fulfilling the criteria for including them into the sample are randomly assigned to two procedures: conversion to SR by means of direct current cardioversion and maintaining it or leaving pts with AF. Pts left with AF are treated by rate control and antithrombotic treatment. The project is of prospective kind and it will be carried out by many medical institutions. It is planned to include 200 pts. The observation period will last at least 12 months. Preliminary results after inclusion of the first 121 pts are shown.

Topics: Aged; Amiodarone; Anti-Arrhythmia Agents; Anticoagulants; Atrial Fibrillation; Chronic Disease; Dicumarol; Electric Countershock; Female; Humans; Male; Middle Aged; Premedication; Prospective Studies

Topics: Adult; Atrial Fibrillation; Cerebral Hemorrhage; Dicumarol; Ecchymosis; Embolism; Evaluation Studies as Topic; Female; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Kidney; Long-Term Care; Male; Middle Aged; Mitral Valve Insufficiency; Mitral Valve Stenosis; Oral Hemorrhage; Uterine Hemorrhage

Limited data are available on the clinical course of patients with history of atrial fibrillation (AF) when admitted in an intensive care environment. We aimed to describe the occurrence of major adverse events in AF patients admitted to a stepdown care unit (SDU) and to analyse clinical factors associated with outcomes, impact of dicumarolic oral anticoagulant (OAC) therapy impact and performance of clinical risk scores in this setting.. Single-centre, observational retrospective analysis on a population of subjects with AF history admitted to a SDU. Therapeutic failure (composite of transfer to ICU or death) was considered the main study outcome. Occurrence of stroke and major bleeding (MH) was considered as secondary outcomes. The performance of clinical risk scores was evaluated.. A total of 1430 consecutive patients were enrolled. 194 (13.6%) reported the main outcome. Using multivariate logistic regression, age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01-1.05), acute coronary syndrome (OR:3.10, 95% CI: 1.88-5.12), cardiogenic shock (OR:10.06, 95% CI: 5.37-18.84), septic shock (OR:5.19,95%CI:3.29-18.84), acute respiratory failure (OR:2.49, 95% CI: 1.67-3.64) and OAC use (OR: 1.61, 95% CI: 1.02-2.55) were independently associated with main outcome. OAC prescription was associated with stroke risk reduction and to both MH and main outcome risk increase. CHA. In critically ill AF patients admitted to a SDU, adverse outcomes are highly prevalent. OAC use is associated to an increased risk of therapeutic failure, clinical scores seem unhelpful in predicting stroke and MH, suggesting a highly individualized approach in AF management in this setting.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Comorbidity; Critical Illness; Dicumarol; Female; Hemorrhage; Hospital Mortality; Hospital Units; Humans; Intensive Care Units; Logistic Models; Male; Multivariate Analysis; Patient Transfer; Respiratory Insufficiency; Retrospective Studies; Shock, Cardiogenic; Shock, Septic; Stroke

The safety of direct oral anticoagulants (DOACs) in oldest old patients with nonvalvular atrial fibrillation (NVAF) in daily clinical practice has not been systematically assessed. This study examined the safety of DOACs and dicumarol (a vitamin K antagonist) in NVAF geriatric patients.. Prospective study from January 2010 through June 2015, with follow-up through January 2016.. Geriatric medicine department at a tertiary hospital.. A total of 554 outpatients, 75 years or older, diagnosed of NVAF and starting oral anticoagulation.. The main outcome was bleeding, which was classified into major (including those life-threatening) and nonmajor episodes. Statistical analyses were performed with Cox regression.. A total of 351 patients received DOACs and 193 dicumarol. Patients on DOACs were older, with more frequent comorbidities, mobility limitation and disability in activities of daily living, as well as higher mortality, than those treated with dicumarol. The incidence of any bleeding was 19.2/100 person-years among patients on DOACs and 13.7/100 person-years on dicumarol; corresponding figures for major bleeding were 5.2 for those on DOACs, and 3.3 for those on dicumarol. In crude analyses, hazard ratios (95% confidence intervals) for any bleeding, and for mayor bleeding in patients on DOACs vs dicumarol were 1.60 (1.04-2.44) and 2.22 (0.88-5.59), respectively. Excess risk of bleeding associated with DOACs vs dicumarol disappeared after adjustment for clinical characteristics, so that corresponding figures were 1.19 (0.68-2.08) and 1.01 (0.35-2.93). Results did not vary across subgroups of high-risk patients.. In very old patients with NVAF, the higher risk of bleeding associated with DOACs vs dicumarol could be mostly explained by the worse clinical profile of patients receiving DOACs. Risk of bleeding was rather high, and warrants close clinical monitoring.

Topics: Administration, Oral; Age Factors; Aged; Aged, 80 and over; Anticoagulants; Atrial Fibrillation; Chronic Disease; Comorbidity; Dabigatran; Dementia; Dicumarol; Disabled Persons; Follow-Up Studies; Hemorrhage; Humans; Mobility Limitation; Prospective Studies; Pyrazoles; Pyridones; Rivaroxaban; Vitamin K

Recent studies have demonstrated the efficacy and safety of new oral anticoagulant drugs for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. Our aim was to evaluate the factors that can influence physicians in their choice between a classic and a new anticoagulant in these patients.. Several variables of interest were discussed and analysed using a Workmat. Six regional meetings were held in Spain (East, Catalonia, Andalusia-Extremadura, Madrid, North-east, and North of Spain).. Meetings were attended by 39 specialists (cardiologists, neurologists, haematologists, internists, and emergency and Primary Care physicians).. Each participant graded their level of agreement, with a score from 1 to 10, on every analysed variable.. A new anticoagulant drug was preferred in patients with previous failure of dicoumarin therapy (9.7±0.5), high haemorrhagic risk (8.7±1), prior bleeding (7.8±1.5), and high thrombotic risk (7.7±1.2). Dicoumarins were preferred in cases of severe (1.2±0.4) or moderate (4.2±2.5) kidney failure, good control with dicoumarins (2.3±1.5), cognitive impairment (3.2±3), and low haemorrhagic risk (4.3±3). Age, sex, weight, cost of drug, polymedication, and low thrombotic risk achieved intermediate scores. There were no differences between the different specialists or Spanish regions.. The presence of a high thrombotic or haemorrhagic risk and the failure of previous dicoumarin therapy lead to choosing a new oral anticoagulant in patients with non-valvular atrial fibrillation, while kidney failure, cognitive impairment, good control with dicoumarins, and a low bleeding risk predispose to selecting a classic dicoumarin anticoagulant.

Topics: Anticoagulants; Atrial Fibrillation; Dicumarol; Humans; Practice Patterns, Physicians'; Spain; Stroke; Thromboembolism

Oral anticoagulation treatment with dicumarol preparations (warfarin sodium) is the standard in patients with atrial fibrillation. The effect of treatment depends on many factors, especially in elderly patients. In the study, we assessed the effect of treatment in patients with atrial fibrillation hospitalized in our cardiology ward from 2004 to 2005, in the form of a telephone survey (who controlled the treatment--general practitioner or internist?, the last 2 INR results, complications). INR 2.0-3.5 is considered an efficient therapeutic range. The proportion of permanently correctly anticoagulated patients is approximately 47% across the whole age range, the hypothesis of lower efficiency of treatment in elderly patients does not apply (48% of efficiently anticoagulated patients younger than 75 years vs. 46% of older patients--however, the study does not include polymorbid patients who could not take warfarin at all!) The fact whether a patient is monitored by a general practitioner or an outpatient specialist does not make any difference (49% of anticoagulated patients monitored by a general practitioner vs. 52% of patients monitored by an internist). The percentage of severe complications is relatively low (3.4%).

Topics: Age Factors; Aged; Anticoagulants; Atrial Fibrillation; Cerebrovascular Disorders; Dicumarol; Drug Monitoring; Female; Humans; International Normalized Ratio; Male; Warfarin

Topics: Aged; Anticoagulants; Atrial Fibrillation; Chronic Disease; Dicumarol; Female; Humans; Male; Platelet Aggregation Inhibitors; Risk Factors; Thromboembolism; Thrombolytic Therapy

Topics: Adult; Atrial Fibrillation; Bioprosthesis; Calcinosis; Cardiac Output, Low; Dicumarol; Female; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Postoperative Complications; Prosthesis Design; Risk; Thromboembolism; Thrombosis

Topics: Aged; Atrial Fibrillation; Dicumarol; Digitalis Glycosides; Diuretics; Female; Humans; Mitral Valve Insufficiency; Mitral Valve Stenosis

Topics: Adult; Atrial Fibrillation; Blood Coagulation; Blood Flow Velocity; Blood Pressure; Blood Volume; Cardiac Output; Dicumarol; Female; Follow-Up Studies; Heart Rate; Heart Valve Prosthesis; Humans; Male; Methods; Middle Aged; Mitral Valve; Oxygen Consumption; Postoperative Complications; Rheology

Topics: Action Potentials; Adult; Aged; Atrial Fibrillation; Dicumarol; Digitalis Glycosides; Electrocardiography; Female; Heart Atria; Heart Diseases; Heart Rate; Humans; Male; Middle Aged; Prognosis

Topics: Adolescent; Adult; Aged; Anticoagulants; Atrial Fibrillation; Child; Dicumarol; Electric Countershock; Embolism; Female; Humans; Male; Middle Aged; Phenindione; Quinidine; Time Factors

Topics: Adult; Aged; Ammonium Chloride; Atrial Fibrillation; Dicumarol; Digitoxin; Humans; Middle Aged; Organomercury Compounds; Quinidine

Topics: Analgesics; Analgesics, Non-Narcotic; Anticoagulants; Antipyretics; Atrial Fibrillation; Blood Coagulation Tests; Dicumarol; Drug Synergism; Drug Therapy; Geriatrics; Hemorrhagic Disorders; Muscle Relaxants, Central; Myocardial Infarction; Phenindione; Pyridines; Toxicology; Warfarin

Topics: Arteriosclerosis; Atrial Fibrillation; Cerebrovascular Disorders; Coronary Disease; Dicumarol; Diet; Diet Therapy; Family Practice; General Practice; Humans; Intracranial Embolism; Intracranial Embolism and Thrombosis; Myocardial Infarction; Prothrombin Time; Thrombosis; Vitamin K; Warfarin

Topics: 4-Hydroxycoumarins; Anticoagulants; Arteriosclerosis Obliterans; Atrial Fibrillation; Biomedical Research; Coronary Disease; Coumarins; Dicumarol; Hypertension; Thrombosis; Toxicology

Topics: 4-Hydroxycoumarins; Anticoagulants; Arteriosclerosis Obliterans; Atrial Fibrillation; Biomedical Research; Coronary Disease; Dicumarol; Hypertension; Hypertension, Pulmonary; Thrombophlebitis; Toxicology

Topics: Anticoagulants; Atrial Fibrillation; Cardiovascular Diseases; Dicumarol; Humans; Quinidine

Topics: Anticoagulants; Atrial Fibrillation; Dicumarol; Hemorrhage; Humans; Lung; Mitral Valve Stenosis; Pathology; Pharmacology; Toxicology

Considerable experience by many independent workers with the use of anticoagulants in the treatment of certain types of heart disease has shown that such therapy reduces significantly the incidence of thromboembolic complications and, largely through this effect, the morbidity and mortality rate from heart disease of these types. This is certainly established in acute coronary occlusion with myocardial infarction and in those instances of rheumatic heart disease with auricular fibrillation in which repeated embolic phenomena have occurred. The case for the administration of the anticoagulants in congestive heart failure is less secure, although there is no doubt that the number of thromboembolic complications is reduced by use of them. The administration of the anticoagulants requires considerably more exacting attention than does the administration of the majority of therapeutic agents in use commonly today. Hence, it is suggested that the use of anticoagulants in heart disease be restricted to those instances in which the indications are clear and facilities are compatible with the efficient and safe use of the drug, whether Dicumarol or heparin.

Topics: Anticoagulants; Atrial Fibrillation; Cardiovascular Diseases; Dicumarol; Heart Diseases; Heart Failure; Heparin; Humans; Myocardial Infarction; Rheumatic Heart Disease

Thirty-three patients with chronic auricular fibrillation were treated with digitalis and quinidine and in addition were given Dicumarol(R) to reduce the risk of embolism. In 21 of the patients the fibrillation was caused by rheumatic heart disease, and in 12 by arteriosclerosis or hypertension. Normal sinus rhythm was restored in 55 per cent of the 33 patients, in 67 per cent of those with arteriosclerosis or hypertension, and in 45 per cent of those with rheumatic heart disease. Embolism did not occur.

Topics: Arrhythmias, Cardiac; Atrial Fibrillation; Brugada Syndrome; Cardiac Conduction System Disease; Dicumarol; Digitalis Glycosides; Embolism; Heart Conduction System; Quinidine; Rheumatic Heart Disease

Topics: Atrial Fibrillation; Dicumarol; Quinidine