dicumarol and Rheumatic-Heart-Disease

Topics: Acenocoumarol; Angina Pectoris; Anticoagulants; Cerebrovascular Disorders; Dicumarol; Heparin; Humans; Myocardial Infarction; Phlebitis; Rheumatic Heart Disease; Thromboembolism; Thrombophlebitis; Warfarin

The immediate clinical course of 42 patients with cerebral embolism secondary to rheumatic heart disease (RHD) was analyzed retrospectively. All the cases included cranial computed tomographic (CT) findings. Twenty-five patients received early anticoagulant therapy (AT) and 17 did not. Recurrent embolic events occurred in only one case. Seven instances of hemorrhagic infarction (HI) were found. In five cases, the development of HI correlated with a recurrent stroke, which occurred in each case within 48 hours after the initial cerebral embolism. Three of the patients with HI died (all of them were receiving AT). We believe that HI is a frequent cause of recurrent stroke after a cerebral embolic event, that it generally occurs in the first 48 hours, and that its outcome is possibly worsened by AT. Anticoagulant therapy should be delayed for three days after a cerebral embolic event secondary to RHD.

Topics: Adult; Aged; Cerebral Hemorrhage; Cerebral Infarction; Dicumarol; Female; Heparin; Humans; Intracranial Embolism and Thrombosis; Male; Middle Aged; Recurrence; Retrospective Studies; Rheumatic Heart Disease

Topics: Blood Coagulation; Cardiovascular Diseases; Coagulants; Coumarins; Dicumarol; Humans; Myocardial Infarction; Rheumatic Heart Disease

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: Dicumarol; Embolism; Heart; Humans; Rheumatic Heart Disease; Rheumatology