vitamin-k-semiquinone-radical and Cardiomyopathy--Dilated

Anticoagulation control in patients with atrial fibrillation (AF) has a multidisciplinary approach although is usually managed by general practitioners (GP) or haematologists. The aim of our study was to assess the quality of anticoagulation control with vitamin K antagonists (VKAs) in relation to the responsible specialist in a "real-world" AF population.. We consecutively enrolled VKA anticoagulated patients included in the FANTASIIA Registry from 2013 to 2015. We analysed demographical, clinical characteristics and the quality of anticoagulation control according to the specialist responsible (ie GPs or haematologists).. Data on 1584 patients were included (42.5% females, mean age 74.0 ± 9.4 years): 977 (61.7%) patients were controlled by GPs and 607 (38.3%) by haematologists. Patients managed by GPs had higher previous heart disease (53.2% vs 43.3%, P < .001), heart failure (32.9% vs 26.5%, P < .008) and dilated cardiomyopathy (15.2% vs 8.7%, P < .001) with better renal function (69.3 ± 24.7 vs 63.1 ± 21.4 mL/min, P < .001) compared to patients managed by haematologists. There was no difference between groups in the type of AF, CHA. About 60% of AF patients anticoagulated with VKAs had poor anticoagulation control (ie TTR<70%), and their management was only slightly better than when it is managed by general practitioners.

Topics: Aged; Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Dilated; Electric Countershock; Female; General Practice; Heart Failure; Hematology; Humans; Kidney; Male; Prospective Studies; Quality of Health Care; Registries; Risk Factors; Vitamin K

We report a case of a patient supported with a HeartWare left ventricular assist device for idiopathic cardiomyopathy who was resistance to vitamin-K antagonists three months after implantation. The patient initially started low-molecular-weight heparin therapy and then, after the onset of an ischemic stroke, switched to dabigatran etexilate (DE). The patient had progressive recovery of cardiac function for which the device was explanted. No thrombotic or bleeding events occurred during DE therapy.

Topics: Aged; Antithrombins; Cardiomyopathy, Dilated; Dabigatran; Female; Follow-Up Studies; Heart-Assist Devices; Humans; Postoperative Care; Thrombosis; Vitamin K

Rivaroxaban, a selective inhibitor of active factor X belongs to the group of direct-acting oral anticoagulants (DOAC), more and more often replacing vitamin K antagonists (VKA) in venous thromboembolic disease and nonvalvular atrial fibrillation. Attempts are also being made to use DOAC to treat locally formed intracardiac thrombi, mainly in the left atrium and its appendage, in atrial fibrillation and in heart failure. Rarely diagnosed local right ventricular thrombus (RVT) may be a complication of dilated cardiomyopathy (DCM).. The authors present a case of a 40-year-old male with DCM and RVT located in the apex, which was imaged in echocardiography, magnetic resonance and multislice computed tomography. During treatment with rivaroksaban (2x15 mg: 4 weeks; 1x20 mg: 4 months) diminishing of RVT was not observed. After 2 months of VKA use complete resolution of RVT was noted. The case presented is probably the first described RVT treated with rivaroxaban. The authors conclude that in some cases, anticoagulation with VKA may be more effective than DOAC in intracardiac thrombi therapy, especially when it is meticulously monitored. Overlapping effect on RVT due to anticoagulants use with a different mechanism of action cannot be excluded.

Topics: Adult; Anticoagulants; Cardiomyopathy, Dilated; Coronary Thrombosis; Heart Ventricles; Humans; Male; Poland; Rivaroxaban; Treatment Outcome; Vitamin K

Topics: Aged; Anesthesia, General; Anticoagulants; Appendicitis; Blood Coagulation Disorders; Blood Coagulation Factors; Cardiomyopathy, Dilated; Consciousness Disorders; Female; Heart Failure; Heart Ventricles; Heart-Assist Devices; Hemostatics; Humans; International Normalized Ratio; Male; Middle Aged; Postoperative Care; Postoperative Complications; Tomography, X-Ray Computed; Vitamin K

Anticoagulants, including heparins and antivitamins K are medicines which are largely prescribed in cardiology. Even though the outlines of the treatment have been clearly established for a few decades, new cardiological indications have recently appeared. The long-term treatment of cardiac valvular prosthesis by oral anticoagulants significantly reduces the risk of thrombo-embolic incident among people carrying a cardiac valvular prosthesis. In case of non-operated valvulopathy, treatment indication must be evaluated for each patient; in so doing, the connection benefit/risk must always be taken into account. In case of dilated cardiomyopathy, the treatment prescription must be limited to the patients with a high embolic risk. Other cardiological indications (apart from atrial fibrillation) must be carefully weighed up.

Topics: Anticoagulants; Arrhythmias, Cardiac; Cardiomyopathy, Dilated; Heart Diseases; Heart Valve Diseases; Heart Valve Prosthesis; Heparin; Humans; Risk Assessment; Risk Factors; Thromboembolism; Vitamin K