exudates and Thromboembolism

A study was conducted on a total of 100 women attending the Family Planning Clinic in Kuala Lumpur. 50 took combined low-dose estrogen and progesterone pills for a year or more and the other 50 used different methods of birth control. Platelet aggregation, ATP release, Thromboxane B2, and 6-keto-prostaglandin F1alpha estimations were made to evaluate the effect of oral contraceptives (OCs) on platelet function and prostanoid production. The results showed no significant differences in the parameters measured in the 2 groups investigated. These findings are comparable to those reported by other studies, suggesting relatively low risk, if any, of thrombosis in OC users.

Topics: Asia; Asia, Southeastern; Biology; Blood; Clinical Laboratory Techniques; Contraception; Contraceptives, Oral; Cross-Sectional Studies; Developing Countries; Diagnosis; Disease; Embolism; Family Planning Services; Malaysia; Physiology; Platelet Aggregation; Research; Research Design; Risk Factors; Thromboembolism; Vascular Diseases

Direct oral anticoagulants (DOACs) especially dabigatran, have gain popularity for their efficacy, fixed dosing and favourable safety profile. A dabigatran prescribing checklist has been prepared by the Ministry of Health, Malaysia (MOH) to ensure rational and safe prescribing of dabigatran. This study therefore aimed to audit the utilization and documentation of this checklist and use of dabigatran in the government healthcare facilities.. This is a nationwide retrospective audit on the documentation of Dabigatran Prescribing and Dispensing Checklist for a period of two years from January 2013 till December 2014. Data from these Dabigatran Checklists (indication, dose, duration, renal function and adverse drug reactions encountered) were extracted by the pharmacist at MOH healthcare facilities.. A total of 52 out of 56 (92.9%) of MOH facilities complied to usage of checklist at their centres involving a total of 582 patients of which 569 (97.7%) patients were initiated on dabigatran for the approved indications. The recommended dose of dabigatran was used correctly in 501 (99.6%) of patients. Reason for switching to DOACs use was only documented in 76.7% (131/171) of patients. The most common reason for switching from warfarin was poor INR control (n=39), history of bleeding/overwarfarinisation (n=22) and unable to attend regular INR clinic (n=21). There were 75 cases of adverse events reported. The most common adverse event reported were abdominal discomfort (n=10) followed by gum bleeding (n=9) and dizziness (n=5).. Compliance to the dabigatran check list was high with 70% of patients prescribed the appropriate dosing.

Topics: Administration, Oral; Aged; Antithrombins; Checklist; Dabigatran; Drug Prescriptions; Drug Utilization; Female; Humans; Malaysia; Male; Medical Audit; Retrospective Studies; Thromboembolism

Evidence is emerging that rates of adverse events in patients taking warfarin may vary with ethnicity. This study investigated the rates of bleeds and thromboembolic events, the international normalised ratio (INR) status and the relationship between INR and bleeding events in Malaysia. Patients attending INR clinic at the Heart Centre, Sarawak General Hospital were enrolled on an ad hoc basis from May 2010 and followed up for 1 year. At each routine visit, INR was recorded and screening for bleeding or thromboembolism occurred. Variables relating to INR control were used as predictors of bleeds in logistic regression models. 125 patients contributed to 140 person-years of follow-up. The rates of major bleed, thromboembolic event and minor bleed per 100 person-years of follow-up were 1.4, 0.75 and 34.3. The median time at target range calculated using the Rosendaal method was 61.6% (IQR 44.6–74.1%). Of the out-of-range readings, 30.0% were below range and 15.4% were above. INR variability, (standard deviation of individuals’ mean INR), was the best predictor of bleeding events, with an odds ratio of 3.21 (95% CI 1.10–9.38). Low rates of both major bleeds and thromboembolic events were recorded, in addition to a substantial number of INR readings under the recommended target range. This may suggest that the recommended INR ranges may not represent the optimal warfarin intensity for this population and that a lower intensity of therapy, as observed in this cohort, could be beneficial in preventing adverse events.

Topics: Anticoagulants; Female; Follow-Up Studies; Hemorrhage; Humans; International Normalized Ratio; Malaysia; Male; Middle Aged; Retrospective Studies; Risk Factors; Thromboembolism; Warfarin

Limited evidence is available regarding pharmacist managed anticoagulation clinic in the Southeast Asian region where there is marked difference in terms of care model, genetic composition and patient demographics.. This study aimed at comparing the anticoagulation clinic managed by the pharmacist with physician advisory and the usual medical care provided in Kuala Lumpur Hospital (KLH) in terms of anticoagulation control and adverse outcomes.. A 2,302 bedded government tertiary referral hospital in Malaysia.. A 6-month retrospective cohort study of the effectiveness of two models of anticoagulation care, the pharmacist managed anticoagulation clinic which is known as warfarin medication therapy adherence clinic (WMTAC) and usual medical clinic (UMC) in KLH was conducted, where a random number generator was used to recruit patients. The UMC patients received standard medical care where they are managed by rotational medical officers in the physicians' clinic. As for the WMTAC with physician advisory, the pharmacist will counsel and review the patients internationalised normalization ratio at each clinic visit and also adjust the patients' warfarin dose accordingly. Patients are referred to physicians if immediate attention is required.. The main therapeutic outcome is time in therapeutic range (TTR) both actual and expanded TTR and thromboembolic and bleeding complications.. Each of the WMTAC and usual medical care recruited 92 patients, which totals to 184 patients. The patient demographics in terms of age, race and indication of treatment were comparable. At the end of the 6 months follow-up, patients in the WMTAC group had significantly higher actual-TTR (65.1 vs. 48.3 %; p < 0.05) compared to those in usual medical care group. Rates of admission were 6.5 versus 28.2 events per 100 person-years for the WMTAC and UMC groups, respectively. Though the bleeding incidences were not significantly different, it was reduced.. These findings will impact local warfarin patient management services and policies because there was no available evidence supporting the role of pharmacists in the management of warfarin patients prior to this study.

Topics: Aged; Anticoagulants; Cohort Studies; Drug Monitoring; Female; Follow-Up Studies; Hemorrhage; Humans; Malaysia; Male; Medication Adherence; Middle Aged; Models, Biological; Outpatient Clinics, Hospital; Pharmacists; Pharmacy Service, Hospital; Point-of-Care Systems; Referral and Consultation; Retrospective Studies; Risk; Tertiary Care Centers; Thromboembolism; Warfarin; Workforce

The aim of this study was to analyse the current practice of venous thromboembolism (VTE) prophylaxis among general surgeons in Malaysia.. A questionnaire survey was conducted among general surgeons attending the annual Malaysian College of Surgeons meeting in 2002. A total of 110 questionnaires were distributed to specialist-grade general surgeons with varying subspecialty interests.. Seventy-seven (70%) surgeons returned the questionnaire. Of these, 43% were of the opinion that VTE was as common in Asian patients as in the West. Selective VTE prophylaxis was used by 99% in their practice. The indications for use, in order of frequency, were: previous VTE disease, risk grading, prolonged surgery, obesity, malignancy and age. Low molecular weight heparin was the most common type of prophylaxis used. VTE-related morbidity was reported by 44 surgeons (57%) over the past year, and 39% of these cases were fatal.. The high incidence of VTE-related complications indicates that the use of thromboprophylaxis is either insufficient or not matched to the level of risk. Updated guidelines on VTE prophylaxis should be used so that a standardized approach can ensure that patients receive adequate prophylaxis where indicated.

Topics: Anticoagulants; Bandages; Humans; Malaysia; Postoperative Complications; Practice Patterns, Physicians'; Thromboembolism; Venous Thrombosis

Warfarin is a drug commonly used in the prevention of thromboembolic events. There have been reports suggesting that racial background may influence warfarin dose requirements. Malaysia is a multiracial country in which there are 3 major races, Malay, Chinese, and Indian. We examined 100 patients from our hospital on stable maintenance doses of warfarin, with international normalized ratio (INR) of 2.0 to 3.5. We found that the mean warfarin dose for Indian patients (n = 19) was 6.9 mg, for Chinese patients (n = 55) was 3.6 mg, and for Malay patients (n = 26) was 3.2 mg. The results showed that the Indian patients required a statistically significantly higher warfarin dose than did patients of the other 2 races (P < .0005). Age was also found to affect the daily warfarin maintenance dose.

Topics: Adult; Age Factors; Dose-Response Relationship, Drug; Female; Humans; International Normalized Ratio; Malaysia; Male; Middle Aged; Racial Groups; Regression Analysis; Thromboembolism; Warfarin

To survey Malaysian orthopaedic surgeons' attitudes to and use of venous thromboembolic disease prophylaxis.. A total of 144 orthopaedic surgeons from various governmental and private institutions responded to a questionnaire.. Only slightly more than half of these surgeons considered venous thromboembolic disease as common a problem in Malaysia as in western countries. The majority of surgeons (91.0%) reported using prophylaxis selectively for patients based on various indicators such as risk grading of surgery, obesity, and malignancy etc. Bleeding tendencies were cited as the greatest fear against the use of pharmacological prophylaxis. Low-molecular-weight heparin appeared to be the most commonly used pharmacological prophylaxis, used either singly or in combination with other forms of prophylaxis. The majority of surgeons employed prophylaxis until their patients were mobile.. There should be greater awareness among surgeons in Malaysia of the need for protection against venous thromboembolic disease. Current practice needs to be reviewed and further recommendations made for existing protocols.

Topics: Anticoagulants; Attitude of Health Personnel; Bandages; Health Care Surveys; Humans; Malaysia; Orthopedics; Platelet Aggregation Inhibitors; Thromboembolism

Resistance to activated protein C (APC-R) is the commonest inherited cause of thrombosis among Caucasians. Few studies have been carried out on its prevalence in Asians. We conducted a prospective study on 60 patients with thromboembolism to determine its prevalence in our local population. The Factor V Leiden (VaQ506) mutation associated with this condition was detected by amplification of the Factor V gene by polymerase chain reaction (PCR) and digestion of the fragment with Mnl I. Three patients were found to be heterozygous for this mutation. None of the 3 patients had other concomitant hypercoagulable states. In addition, we studied the prevalence of this condition in Malays which was found to be 0.5%. Our study suggests that the incidence of APC-R is much lower here compared to the West.

Topics: Activated Protein C Resistance; Adult; Aged; Aged, 80 and over; Asian People; China; Cohort Studies; Deoxyribonucleases, Type II Site-Specific; Factor V; Female; Heterozygote; Humans; Incidence; India; Malaysia; Male; Middle Aged; Point Mutation; Polymerase Chain Reaction; Prevalence; Prospective Studies; Singapore; Thromboembolism; White People

Long term use of low doses of combination oral contraceptives appears to increase plasminogen level, thereby increasing fibrinolytic activity and reducing the risk of thromboembolism. Blood levels of plasminogen, tissue plasminogen activator (tPA), and plasminogen activator inhibitor (PAI), were measured before and after stress (5 minutes of stair climbing) in a group of 30 women, 23-40 years old, who had taken 30 mcg of ethinyl estradiol with 150 mcg of desogestrel or levonorgestrel for at least 1 year. Similar measurements were taken from a control group of 30 women matched for age, height, and weight. Plasminogen and tPA levels in both groups increased significantly after exercise. The level of PAI did not change significantly with stress in either group. The level of plasminogen was significantly higher in the group taking contraceptives, whether before or after exercise, when compared to the control group. Levels of tPA and PAI, although slightly increased in the oral contraceptive group, were not significantly different between the two groups. The increase in plasminogen may be due to the estrogen component of the contraceptives. Stress seems to increase fibrinolytic response.

Topics: Asia; Asia, Southeastern; Biology; Blood; Blood Coagulation; Clinical Laboratory Techniques; Clinical Trials as Topic; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Developing Countries; Diagnosis; Disease; Embolism; Family Planning Services; Fibrinolysis; Hematologic Tests; Levonorgestrel; Malaysia; Physiology; Research; Thromboembolism; Thrombosis; Vascular Diseases

Researchers compared the results of hematocrit and blood viscosity tests of 16 women using a combined oral contraceptive (COC) with 30 mcg ethinyl estradiol/150 mcg desogestrel (group 1), 11 women using a COC with 30 mcg ethinyl estradiol/150 mcg levonorgestrel (group 2), and 16 women who did not use any OCs (control group), all who attended the National Population and Family Development Clinic at the General Hospital in Kuala Lumpur, Malaysia. They wanted to examine the effects of COCs on blood viscosity, which is inversely related to blood flow, and hematocrit. The women were matched for age. The hematocrit level of women who took the ethinyl estradiol/desogestrel COC was significantly higher than that of the control group (41.5% vs. 37.4%; p.001). On the other hand, the hematocrit level of women who took the ethinyl estradiol/levonorgestrel COC was close to that of the control group (38.5% vs. 37.4%). Even though the mean whole blood viscosity for group 2 was higher than that of group 1 and the control group (6.6 cps vs. 5.5 cps), the difference was insignificant. Yet whole blood viscosity of group 2 at the higher shear rates (46, 115, and 230 per second) was significantly higher than the control group (p.05). The whole blood viscosities of group 1 and the control group did not differ considerably. This supported the theory that hematocrit contributes to blood viscosity. Further these results agreed with those of another study which also showed increased blood viscosity and hematocrit in healthy women taking OCs. Thus thromboembolic events in women taking OCs could be a result of a drop in rate of blood flow which at the lower shear rates could increase red cell aggregation and clotting. In conclusion, health providers could use these indicators to monitor women who have used OCs over a considerable period for thrombotic risks to determine if OC use should continue.

Topics: Asia; Asia, Southeastern; Biology; Blood; Blood Coagulation; Case-Control Studies; Clinical Laboratory Techniques; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Cross-Sectional Studies; Desogestrel; Developing Countries; Diagnosis; Disease; Embolism; Ethinyl Estradiol; Family Planning Services; Hematocrit; Hematologic Tests; Levonorgestrel; Malaysia; Methods; Physiology; Research; Research Design; Thromboembolism; Thrombosis; Vascular Diseases

The effect of low-dose oral contraceptives (OCs) on hemorheology and fibrinolytic response was investigated in 107 women attending the Malaysia Maternity Hospital in Kuala Lumpur. The OC contained 0.03 mg estrogen and 0.15 mg progestagen. Study subjects were divided into 3 groups. The 30 women in Group 1 took the low-dose OC for 3-6 months, while the 27 subjects in Group 2 took the pill for a duration of 1-2 years. Group 3 was comprised of 49 controls. The 3 groups were comparable in terms of age, weight, height, and parity and included Malays, Chinese, and Indians. No significant differences were noted between the 3 groups in any of the parameters analyzed (platelet aggregate ratio, fibrinogen levels, red blood cell deformability index, euglobulin clot lysis time, and full blood count). Since the level of estrogen in the OC analyzed in this study did not cause significant alterations in any of these blood parameters, it is concluded that low-dose OCs do not confer a risk of thrombosis in their users.

Topics: Asia; Asia, Southeastern; Biology; Blood; Blood Coagulation; Cardiovascular System; Cerebrovascular Circulation; Contraception; Contraceptive Agents; Contraceptive Agents, Female; Contraceptives, Oral; Developing Countries; Disease; Embolism; Family Planning Services; Fibrinolysis; Malaysia; Physiology; Platelet Aggregation; Research; Risk Factors; Thromboembolism; Thrombosis; Vascular Diseases

Topics: Animals; Blood Coagulation; Blood Coagulation Factors; Blood Viscosity; Dogs; Enzyme Therapy; Enzymes; Fibrinogen; Fibrinolysis; Hemolysin Proteins; Humans; Injections, Intravenous; Malaysia; Snakes; Species Specificity; Thrombelastography; Thromboembolism; Venoms

Topics: Afibrinogenemia; Biotransformation; Blood Coagulation; Blood Coagulation Factors; Blood Viscosity; Factor VIII; Fibrinogen; Fibrinolysis; Humans; Lipids; Malaysia; Thromboembolism; Venoms