phenprocoumon and Arterial-Occlusive-Diseases

Type II of heparin-associated thrombocytopenia (HAT) is well known, but the cardinal symptom, thrombocytopenia, is rarely adequately considered. Serious and potential lethal complications such as pulmonary embolism, cerebral stroke, or limb gangrene are often falsely regarded as insufficient anticoagulation. Guided diagnosis and therapy are of vital importance for the patient's outcome. Based on the experience of patients with HAT Type II treated in the intensive care unit, a diagnostic and therapeutic approach to the cardinal symptom thrombocytopenia is presented. A recently developed heparin-induced platelet activation assay (HIPAA) seems to be a highly sensitive laboratory test. The first therapeutic principle in case of presumed and diagnosed HAT is the cessation of unfractioned or low-molecular-weight heparins. ORG 10172 (Orgaran), a low-sulfated heparinoid with a low cross-reactivity (10%) to heparins, can be regarded as the most effective anticoagulant in patients with HAT Type II.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Arterial Occlusive Diseases; Chondroitin Sulfates; Dermatan Sulfate; Diagnosis, Differential; Female; Gangrene; Heparin; Heparitin Sulfate; Humans; Middle Aged; Phenprocoumon; Platelet Activation; Platelet Aggregation; Platelet Count; Pulmonary Embolism; Recurrence; Systemic Inflammatory Response Syndrome; Thrombocytopenia; Thromboembolism; Thrombophlebitis

In 167 patients with complete occlusion (greater than 3 cm) of the femoropopliteal artery, percutaneous transluminal laser angioplasty (PTLA) was performed after an unsuccessful attempt at crossing with a guide wire and was immediately followed by balloon dilatation. An Nd-YAG laser and an optical fiber delivery system with a sapphire tip serving as a contact probe were used for PTLA. In 132 of 167 (79%) patients, the occluded segment was successfully reopened. Clinical symptoms improved in 126 of 167 (75%) patients. PTLA was unsuccessful in 35 patients, and in 15 of these, injury of the vessel wall occurred. In one patient, surgical drainage of a large hematoma became necessary. All patients in whom recanalization had been achieved were randomized to receive long-term treatment with either phenprocumarol or acetylsalicylic acid (ASA) plus dipyridamole to prevent rethrombosis. At 36 months of follow-up, the cumulative patency rate (CPR) was 63%. A complete reobstruction in 32 patients (24%) and a partial reobstruction in 15 patients (11%) were found angiographically. The CPR after 36 months was significantly lower (p less than 0.05) in patients younger than 60 years of age (54%) than in patients older than 60 (68%); it was also significantly lower (p less than 0.05) in patients with reduced peripheral runoff (55%) due to obstructed arteries of the lower leg than in patients with unaffected runoff (73%). The CPR was 65% in recanalized segments shorter than 7 cm and was 62% in recanalized segments longer than 7 cm.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Angioplasty, Balloon; Angioplasty, Laser; Arterial Occlusive Diseases; Aspirin; Dipyridamole; Female; Femoral Artery; Follow-Up Studies; Humans; Male; Phenprocoumon; Popliteal Artery; Recurrence; Time Factors

Topics: Aortic Diseases; Arterial Occlusive Diseases; Aspirin; Blood Vessel Prosthesis; Combined Modality Therapy; Female; Humans; Iliac Artery; Male; Middle Aged; Phenprocoumon; Polytetrafluoroethylene; Postoperative Complications; Prosthesis Design; Survival Rate

To examine whether anticoagulants given after autologous saphenous bypass surgery influenced patient survival 119 patients who received such a graft for obliterative arterial disease were recruited for a controlled clinical trial. Patients were randomly assigned to start, in the second postoperative week, phenprocoumon (60 patients) or no treatment (59 patients). The median duration of survival for all patients was greater than 60 months, and the 75%-quartile was 39.0 (SE of the median 3.9) months. 10 patients died in the treated group and 20 in the control group. The treated group had a greater probability of survival (p less than 0.023, Breslow; p less than 0.043, Mantel). Graft occlusions occurred in 11 patients in the treatment group and in 17 controls. When these patients were excluded from the analysis, the difference in probability of survival between the two groups remained significant (p less than 0.009, Breslow; p less than 0.013, Mantel).

Topics: Aged; Anticoagulants; Arterial Occlusive Diseases; Austria; Clinical Trials as Topic; Female; Femoral Artery; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Phenprocoumon; Popliteal Artery; Postoperative Care; Prognosis; Random Allocation; Reoperation; Saphenous Vein; Time Factors

Topics: Anticoagulants; Arterial Occlusive Diseases; Blood Vessel Prosthesis; Humans; Leg; Phenprocoumon; Postoperative Period; Recurrence; Thrombosis

The effect of Arwin on peripheral arterial occlusive disease has been studied in two multicentre trials. In the first, in cases of severe peripheral arterial circulatory disorders of the lower extremities with permanent rest pain (stages III and III + IV according to Fontaine) Arwin had a better intravenous therapeutic effect than anticoagulant treatment. A further trial was done to investigate whether subcutaneous administration of Arwin would have an effect superior to classical conservative therapy with vasodilator drugs in this type of disease. The results were assessed by sequential analysis. Arwin was again shown to be a much better treatment. Problems of medical documentation and statistics are discussed in relation to the value of sequential analysis.

Topics: Ancrod; Arterial Occlusive Diseases; Blood Viscosity; Clinical Trials as Topic; Depression, Chemical; Drug Evaluation; Endopeptidases; Female; Fibrinogen; Heparin; Humans; Infusions, Parenteral; Injections, Subcutaneous; Male; Nicotinyl Alcohol; Pain; Phenprocoumon

A male with atrial fibrillation for 30 years underwent embolectomy in his right leg at age 78 years. Postoperatively, he received enoxaparin 60 mg/twice a day (bid), and on day 5, phenprocoumon was started. The patient's son, a general practitioner, changed phenprocoumon to dabigatran 110 mg/bid on day 8. Pain in his left calf induced readmission after 5 days. International normalized ratio was 2.5 and D-dimer was 20 μg/mL. Dabigatran was stopped and dalteparin 5000 International Units/bid and 40 μg alprostadil infusions were started. After 8 hours, he became comatose due to basilar artery occlusion and eventually died. This tragic case raises the issue of postoperative use of dabigatran, a recently introduced thrombin inhibitor.

Topics: Aged; Anticoagulants; Antithrombins; Arterial Occlusive Diseases; Atrial Fibrillation; Benzimidazoles; beta-Alanine; Cerebral Angiography; Dabigatran; Drug Monitoring; Drug Therapy, Combination; Embolectomy; Embolism; Enoxaparin; Fatal Outcome; Femoral Artery; Humans; International Normalized Ratio; Male; Phenprocoumon; Vertebrobasilar Insufficiency

Topics: Administration, Oral; Anticoagulants; Arterial Occlusive Diseases; Contrast Media; Diagnosis, Differential; Follow-Up Studies; Hematoma; Humans; Image Processing, Computer-Assisted; Liver Diseases; Male; Middle Aged; Phenprocoumon; Tomography, X-Ray Computed

Topics: Anticoagulants; Arterial Occlusive Diseases; Aspirin; Clopidogrel; Drug Resistance; Drug Therapy, Combination; Factitious Disorders; Female; Graft Occlusion, Vascular; Heparin, Low-Molecular-Weight; Hirudins; Humans; Iliac Artery; Middle Aged; Munchausen Syndrome; Phenprocoumon; Platelet Aggregation Inhibitors; Recombinant Proteins; Recurrence; Reoperation; Ticlopidine; Treatment Refusal; Vascular Surgical Procedures

The percutaneous transluminal angioplasty (PTA) is the "golden standard" in the therapy of vessel occlusions due to arteriosclerotic plaques. In spite of all improvements of the technique and the equipment with and without stent implantation there is still a restenosis rate of 40%.. Endovascular brachytherapy with an iridium-192 HDR source was performed in cases of a restenosis due to intimal hyperplasia which occurred within 6 months after a former PTA. After PTA and stent implantation a 9-French ReKa catheter was positioned with the tip 2 cm below the stent. This catheter served a centering device and as a guide for the 5-French applicator. After determination of the isodose and individual planning a dose of 12 Gy to 3 mm source distance was applied. After this procedure the patient received heparin for 72 hours followed by marcumar.. From May 1990 until June 1996 28 patients (21 male, 7 female) were treated after PTA and stent implantation with endovascular brachytherapy. All patients had clinical relevant restenosis or reocclusion of the arteria femoralis. The follow-up time ranges from 2 to 71 months. Twenty-seven patients had a reasonable follow-up time longer than 6 months. Twenty-five patients could be followed: 4 patients had no or only minimal flow in the treated area, 2 patients moved with an unknown address, 1 patient died without any follow-up examination. No side effects of the radiation appeared.. Regarding the small number of patients endovascular brachytherapy with iridium 192 HDR seems to be a save and useful adjuvant treatment form to avoid intimal hyperplasia after PTA.

Topics: Aged; Aged, 80 and over; Angioplasty, Balloon; Anticoagulants; Arterial Occlusive Diseases; Brachytherapy; Female; Femoral Artery; Heparin; Humans; Hyperplasia; Iridium Radioisotopes; Male; Middle Aged; Phenprocoumon; Radiotherapy Dosage; Radiotherapy, Adjuvant; Recurrence; Stents; Time Factors; Tunica Intima

Topics: Anticoagulants; Arterial Occlusive Diseases; Aspirin; Drug Resistance; Humans; Male; Middle Aged; Phenprocoumon; Platelet Aggregation Inhibitors; Protein C; Stents; Ticlopidine

1051 extremities with arterial reconstruction and anticoagulant prophylaxis were followed for at least 15 to 25 years. The results as to patency rate were best in patients with anticoagulation permanently in the therapeutic range. Interruption of the prophylaxis led to occlusions in half of the patients, most within the first year. 42 bleeding complications occurred in 37 patients, 0.005 per treatment year, 0.002 gastrointestinal, 0.0004 cerebral, 0.0001 with fatal outcome. Most bleedings occurred within the first ten years, 0.6 per treatment year in the first, 0.38 between the third and the seventh year, reaching a steady level of 0.46 at twelve years. Prophylaxis after arterial reconstruction for peripheral arterial disease should be restricted to patients without contraindications, in whom an optimal anticoagulation can be achieved within the first year.

Topics: Arterial Occlusive Diseases; Combined Modality Therapy; Follow-Up Studies; Hemorrhage; Heparin; Humans; Ischemia; Leg; Long-Term Care; Phenprocoumon; Postoperative Care; Prothrombin Time

Flexible, self-expanding metallic mesh stents were implanted via a percutaneous catheter delivery system, immediately after balloon dilatation, in 68 patients (59 males and 9 females; mean age 56.6 [40-73] years). All had stenoses or occlusion of the iliac or femoral arteries. The bridged vessel segments were 3.5-27 cm long; the stent lumen ranged from 6 to 12 mm diameter. Good blood flow was restored in all 68 patients. The Doppler sonographic index increased on average by 0.33 to a mean of 0.9 (0.4-1.2). An early stent occlusion occurred in three patients (one femoral artery with a stented length of 27 cm thrombosed after 24 hours, two iliac stents were found to be occluded four and eight weeks, respectively, after insertion). Transitory peripheral emboli occurred in two patients with femoral stents. In five patients (four with femoral stents, one with an iliac stent) marked intimal hyperplasia with stenosis developed after 4-10 months; in four of them they were successfully treated by the percutaneous technique. The described percutaneous stent placement method is suitable for treating arterial stenoses or occlusions which cannot be satisfactorily dilated by balloon, as well as restenoses and local complications after angioplasty. It is particularly effective in iliac arteries.

Topics: Adult; Aged; Arterial Occlusive Diseases; Blood Vessel Prosthesis; Catheterization; Constriction, Pathologic; Female; Femoral Artery; Follow-Up Studies; Heparin; Humans; Iliac Artery; Male; Middle Aged; Phenprocoumon; Prosthesis Design; Radiography; Recurrence; Stents

Topics: 4-Hydroxycoumarins; Aged; Arterial Occlusive Diseases; Graft Occlusion, Vascular; Humans; Leg; Middle Aged; Phenprocoumon; Postoperative Complications; Prognosis; Saphenous Vein

Terminal circulation can be studied in vivo using capillaroscopy. This paper presents the results of systematic investigations of capillary permeability (KPU) in the nailfold. In addition to the morphology of capillary loops, we investigated the transcapillary passage and interstitial distribution of sodium fluorescein (Na-flu) in healthy persons (42) and in patients suffering from functional microangiopathies (17) or organic vascular disease (58). The effects of various therapeutic measures on the microcirculation were also studied. First, dynamic processes at the capillary loops were recorded on a video system. The second step consisted of quantification of the pericapillary light intensities (FLI) at predetermined times using a computerized video-densitometer. The measured variables, i.e. maximal interstitial FLI, diameter of the juxtacapillary halo (IK-H) and distance between the intracapillary column of red cells and the interstitial peak of FLI, provided information about the permeability of the capillaries and the interstitial diffusion of Na-flu. In healthy subjects, the interstitial FLI reached its highest values 10 sec after the appearance of Na-flu in the capillary loop, the distance between the peak of FLI and the intracapillary column of erythrocytes increased continuously over a period of 2 min, whereas the diameter of the IK-H reached a constant value after 20 sec. In patients suffering from functional microangiopathy, an increased pericapillary FLI as well as an enlarged juxtacapillary zone with elevated Na-flu concentrations could be established as objective criteria in addition to the already known alterations of the morphology of the capillary loops. Similar observations, but of much greater extent, were made in patients suffering from microvessels disease associated with collagen disease. The regional variation in the pericapillary FLI supports the assumption that morphological changes are present in these patients. KPU in patients suffering from organic macroangiopathy revealed no changes in comparison to healthy persons. The effects of conventional therapy in patients with reduced peripheral arterial perfusion on the parameters measured by KPU were of variable magnitude. The increase in trans-capillary leakage and interstitial dispersion of Na-flu was significant during systemic fibrinolysis and during the intra-arterial application of PGE1. The changes in the measured parameters were considerably smaller during therapy with phenproc

Topics: Adolescent; Adult; Aged; Alprostadil; Arterial Occlusive Diseases; Aspirin; Capillary Permeability; Collagen Diseases; Computers; Cyanosis; Dipyridamole; Drug Therapy, Combination; Factor XIII; Female; Heparin; Humans; Male; Microcomputers; Middle Aged; Nails; Phenprocoumon; Raynaud Disease; Rheology; Streptokinase

Topics: Arterial Occlusive Diseases; Dose-Response Relationship, Drug; Heparin; Humans; Iliac Artery; Infusions, Parenteral; Partial Thromboplastin Time; Phenprocoumon; Streptokinase; Thromboembolism