warfarin and Metabolic-Syndrome

Pregnancy is a specific state of heightened coagulability related to the increase in procoagulant agents and to the reduced fibrinolysis. Pregnancy is associated with a 4-fold increased risk of developing venous thromboembolism (VTE) and this risk still increases to 14-fold during puerperium. A correlation between the metabolic syndrome and development of cardiovascular events and cerebrovascular incidents has been described. Such a relationship is referred to a hypercoagulable state due to increased serum levels of the plasminogen activator inhibitor-1 (PAI-1), fibrinogen, factor (F) VII and VIII, von Willebrand factor and from endothelial activation, caused by increased circulating adhesion molecules. As to the risk of VTE, the probability for its association with cardiovascular incidents is increased by common underlying mechanisms such as the activation of platelets and the blood coagulation. A correlation between idiopathic VTE and the metabolic syndrome has been reported. The anticoagulant therapy may be recommended during the pregnancy for the treatment or the prophylaxis of VTE and, in women with artificial heart valves, for the prevention of the valve thrombosis and systemic embolisation. There are also specific conditions during pregnancy which benefit from anticoagulant use, such as recurrent fetal loss, thrombophilia and assisted reproductive technology. There are no published specific data about using of anticoagulant agents in pregnant patients with the metabolic syndrome except for a few articles addressing reproductive problems. The mechanisms of anticoagulant action were studied with the focus on heparinoids, because of their safety not only for the patient but also for the fetus. The new oral anticoagulants were also shortly described although they have been contraindicated during the pregnancy.

Topics: Animals; Anticoagulants; Aspirin; Female; Fondaparinux; Heparin; Humans; Metabolic Syndrome; Polysaccharides; Pregnancy; Venous Thromboembolism; Warfarin

Topics: Acanthosis Nigricans; Anti-Bacterial Agents; Anticoagulants; Child; Drug Therapy, Combination; Echocardiography, Doppler; Heart Atria; Heart Diseases; Heparin, Low-Molecular-Weight; Humans; Male; Metabolic Syndrome; Obesity; Penicillanic Acid; Piperacillin; Positive-Pressure Respiration; Tazobactam; Thrombosis; Treatment Outcome; Warfarin

The metabolic syndrome (MetS) is a cluster of risk factors linked to insulin resistance that increase an individual's risk of atherosclerotic vascular disease. The authors evaluated the prevalence and prognosis of the MetS among individuals with symptomatic intracranial arterial stenosis.. Patients enrolled in the Warfarin-Aspirin Symptomatic Intracranial Disease trial were evaluated in this post-hoc analysis. Baseline characteristics and outcome were compared in patients with the MetS vs patients without the MetS.. Among 476 patients, the prevalence of the MetS was 43%. MetS patients were more likely to be younger, female, and white. During a mean follow-up period of 1.8 years, time to the first of ischemic stroke, myocardial infarction, or vascular death was shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.6 (95% CI = 1.1 to 2.4, p = 0.0097). Time to ischemic stroke alone was also shorter among patients with the MetS with a hazard ratio (syndrome/no syndrome) of 1.7 (95% CI = 1.1 to 2.6, p = 0.012). When controlling for individual factors of the definition, MetS was not significant (combined outcome: p = 0.14; ischemic stroke: p = 0.074).. The metabolic syndrome is present in about half of individuals with symptomatic intracranial atherosclerotic disease and is associated with a substantially higher risk of major vascular events. The metabolic syndrome may not provide additional ability to predict outcomes beyond the individual factors for patients with intracranial stenosis.

Topics: Aged; Aspirin; Brain Ischemia; Cohort Studies; Comorbidity; Disease Progression; Double-Blind Method; Female; Follow-Up Studies; Humans; Incidence; Intracranial Arteriosclerosis; Male; Metabolic Syndrome; Middle Aged; Multicenter Studies as Topic; Myocardial Infarction; Proportional Hazards Models; Prospective Studies; Racial Groups; Randomized Controlled Trials as Topic; Risk; Risk Factors; Survival Analysis; Vascular Diseases; Warfarin