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At least 433 records · Page 24Linked to original sources
PubMed1996

[Mesenteric vein infarction associated with congenital antithrombin III (ATIII) deficiency].

A venous mesenteric infarction in a 27-year-old patient is reported. This patient presented a genetic quantitative AT-III deficiency without anticoagulation therapy. Ultrasonography revealed portal vein thrombosis and laparoscopy showed mesenteric vein infarction. Laparotomy was performed mmediately and revealed segmental infarction of 60 cm of the jejunum which was resected; the portal vein was considered to be partially occluded on palpation. No strangulation or mechanical factors were identified. Immediately postoperatively the patient received therapeutic doses of heparin with AT-III concentrates to increase AT-III levels; no recurrent thrombotic episode was observed. A systematic second-look operation 24 hours postoperatively showed good bowel viability. Five days later, long-term anticoagulation with acenocoumarol was decided. Twelve days later, ultrasonography showed complete portal revascularization which was confirmed by a third surgical operation on D60.

Adult↗
PubMed1995

Subcutaneous low-molecular weight heparin or oral anticoagulants for the prevention of deep-vein thrombosis in elective hip and knee replacement? Fraxiparine Oral Anticoagulant Study Group.

OBJECTIVE: To compare efficacy, safety, and feasibility of adjusted-dose oral anticoagulants (OAC) versus fixed-dose subcutaneous low molecular weight heparin (LMWH) for the prevention of deep venous thrombosis (DVT) in patients who have undergone elective hip or knee replacement. DESIGN: Multicentre, single blind randomised trial. OAC (acenocoumarol, target International Normalised Ratio, 2.0-3.0) and LMWH (nadroparine, 60 aXa IU/kg once daily) were started preoperatively and continued for 10 days. All outcome measures were adjudicated by an independent committee unaware of treatment allocation. SUBJECTS: 672 consecutive patients scheduled for elective hip or knee replacement surgery. All patients wore bilateral graduated compression stockings. MAIN OUTCOME MEASURES: The endpoint for the assessment of efficacy was venography confirmed DVT or confirmed symptomatic pulmonary embolism. The endpoint for the assessment of safety was clinically important bleeding during study treatment or within 48 h of the end of treatment. RESULTS: Among the 517 patients with interpretable venograms, 391 had a hip replacement and 126 had a knee implant. DVT was demonstrated in 50 (20%) of 257 patients allocated to OAC and 43 (17%) of 260 patients allocated to nadroparine (p = 0.45), for an absolute difference in DVT incidence of 2.9% in favour of nadroparine (95% CI, -3.7-9.5). Clinically important bleeding occurred in eight (2.3%) of the 342 oral anticoagulant treated patients and in five (1.5%) of the 330 nadroparine treated patients (p = 0.62), for an absolute difference in favour of nadroparine of 0.8% (95% Cl, -1.3-2.9). CONCLUSION: Patients who undergo major orthopaedic operations have a high risk of venous thromboembolism. Once daily fixed-dose subcutaneous nadroparine is at least as efficacious and safe as daily adjusted OAC for prophylaxis against DVT after hip or knee implantation but is more simple to administer.

Administration, Oral↗
PubMed1996

Potential failure of the International Normalized Ratio (INR) System in the monitoring of oral anticoagulation in patients with lupus anticoagulants.

Patients with antiphospholipid antibody syndrome (APS) experience a higher rate of recurrence of thrombosis than the general population of patients with thrombotic disease. Based on a retrospective analysis, it has been suggested that patients with APS should be kept on prolonged anticoagulation aiming at international normalised ratio (INR) values > 3.0. To evaluate whether the requirement for more intense anticoagulation depends on the variable sensitivity of thromboplastin reagents to the influence of aPLA, we monitored oral anticoagulant treatment in 10 patients with persistent lupus anticoagulants (LA) and venous thromboembolic disease using two thromboplastin reagents: Pro-IL-Complex (Instrumentation Laboratory, combined) and Recombiplastin (Ortho, recombinant). Acenocoumarol dosage was always assigned based on INR values obtained with the combined thromboplastin using diluted (1:20) test plasma, aiming at an INR interval of 2.0 to 3.0. Single INR determinations with both reagents were obtained throughout the study period for 110 aPLA-free patients on stable oral anticoagulation. Using the manufacturer's instrument-certified international sensitivity index (ISI) values, INR obtained with the recombinant reagent were significantly higher than those obtained with the combined reagent in LA-positive patients, but they were lower in LA-negative patients. After correction for local ISI calibration in LA-negative patients, INR values of 3.1 and 4.6 with Recombiplastin corresponded, respectively, to INR values of 2.0 and 3.0 with Pro-IL-Complex. These results indicate the thromboplastin-dependency of INR values in patients with LA, thereby questioning the validity of the INR system for the monitoring of oral anticoagulant treatment in these patients.

Administration, Oral↗
PubMed1997

[Hemorrhagic complications of oral anticoagulant therapy: results of a prospective multicenter study ISCOAT (Italian Study on Complications of Oral Anticoagulant Therapy)].

BACKGROUND: To assess the incidence of bleeding complications during oral anticoagulant therapy (OAT) in a population of patients representative of daily practice in Italian anticoagulation clinics. METHODS DESIGN: prospective, inception-cohort, multicentre. SETTING: Thirty-four anticoagulation clinics federated in the Italian Federation of Anticoagulation Clinics. PATIENTS: 2745 consecutive patients, included from beginning of their first OAT course. Most patients were aged between 60 and 79 y (57.8%), with 8% being > or = 80 y. Venous thromboembolism was the most frequent indication for OAT (one third of all the patients), followed by non ischemic heart disease which mainly included atrial fibrillation (16.8% of patients). Warfarin (in 63.8% of patients) and acenocoumarol were the only anticoagulant drugs used. The targeted anticoagulation intensity was low (INR < or = 2.8) in 71% of patients and high (INR > 2.8) in the remainder. OUTCOMES: Fatal, major and minor bleeding events. Thrombotic events were also recorded, though not analyzed in the present report. FINDINGS: During the 2011 patient-years (pt-y) of follow-up, 153 bleeding complications (7.6% pt-y) were recorded--5 fatal (all cerebral haemorrhages, 0.25% pt-y), 23 major (1.1% pt-y) and 125 minor (6.2% pt-y). The rate of events did not vary according to sex, coumarin type, size of enrolling centre or targeted therapeutic range; it was higher in older patients (10.5% pt-y in those aged > or = 70 y, relative risk--RR--1.75, p < 0.001), in cases where indication for anti-coagulant treatment was peripheral and/or cerebrovascular disease (12.5% pt-y; RR 1.80, p < 0.01) and during the first 90 days of treatment (11% pt-y, RR 1.75, p < 0.001). One fifth of bleeding events occurred at a very low anticoagulation intensity (INR < 2; the category rate being 7.7% pt-y); the rate was 4.8% pt-y in the 2.0-2.9 INR category, reaching 9.5% pt-y, 40.5% pt-y and 200% pt-y in the 3-4.4, 4.5-6.9 and > or = 7 INR categories respectively (RR for INR levels > 4.5 = 7.91, p < 0.0001). CONCLUSIONS: The overall rate of bleeding events recorded in the present study was much lower than that recorded in other (including recent) observational and experimental studies. The risk of bleeding increased in the following cases: age > 70 y; arterial vascular disease as indication for OAT; first 3 months of treatment; INR values > or = 4.5. OAT has become safer in recent years, particularly if monitored in special anticoagulation clinics. Caution should be exercised when prescribing OAT in elderly patients and the intensity anticoagulation levels should be closely monitored to minimize incidental periods of overanticoagulation.

Aged↗
PubMed1996

[Non-steroid anti-inflammatory agents and gastrointestinal protection: adequate prescription in primary care?].

OBJECTIVES: To find the frequency of prescription of gastro-intestinal protectors (GIP) at the same time as non-steroidal anti-inflammatory drugs (NSAID). To find certain characteristics linked to their use in primary care. To evaluate how correctly they are prescribed. DESIGN: A crossover descriptive study. SETTING: A base urban health area. PATIENTS: Patients over 14, who attended in 1994, who had a medical history and were treated with NSAID. MEASUREMENTS AND INTERVENTIONS: 1,115 medical histories were obtained by simple randomised sampling, of whom 205 were under treatment with NSAID. A questionnaire was used to evaluate: age, sex, NSAID treatment, GIP, history of peptic ulcer, corticoid or acenocoumarol treatment, tobacco, alcohol and related pathology. After a complete bibliographic review, some criteria were fixed for when it is correct to give GIP-NSAID. RESULTS: The prevalence of NSAID prescription was 18.39%. 34 patients treated with NSAID received GIP at the same time. Aceclophenac was the most widely prescribed NSAID; and H2 antihistamines, the drugs most commonly used as GIP.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Capillary electrophoresis enantioseparation of noncharged and anionic chiral compounds using anionic cyclodextrin derivatives as chiral selectors.

The electrophoretic profiles of anionic cyclodextrin derivatives were studied in benzoic acid and phosphate buffers. All anionic derivatives studied exhibited a multicomponent profile. The mobilities of beta-cyclodextrin (beta-CD) sulfates do not depend substantially on the pH. Carboxymethyl ether of beta-cyclodextrin (CM-beta-CD) possesses marked self-mobility at pH 4.5, and as a result, it separates a number of neutral analytes at this pH. Sulfated beta-CD derivatives also exhibit chiral recognition abilities toward neutral compounds, and additionally, the anionic sulfobutyl ether of beta-cyclodextrin (SBE-beta-CD) successfully resolves the chiral solutes warfarin and acenocoumarol also in the anionic form.

Anions↗
PubMed1998

Home treatment of deep vein thrombosis: a two-years experience of a single institution.

BACKGROUND AND OBJECTIVE: Low molecular weight heparin (LMWH) is known to be safe and effective for the initial treatment of patients with acute deep-vein thrombosis (DVT). Moreover, LMWH allows patients to be treated at home. However, only limited data are available on the feasibility of LMWH treatment at home in daily clinical practice. DESIGN AND METHODS: We evaluated the feasibility, efficacy and safety of home treatment of DVT in a consecutive series of outpatients using LMWH over a two year period. The two main reasons for exclusion were concomitant pulmonary embolism and a high hemorrhagic risk. Patients were treated with 95 IU/kg bid of nadroparin for a minimum of 7 days. The study design allowed patients to go home immediately after diagnosis or to be discharged after a short hospital stay. Anticoagulation with acenocoumarol was started 2 days before discontinuing nadroparin. RESULTS: From 1995 to 1997, 71 consecutive outpatients with DVT were treated with nadroparin. Ambulatory treatment was feasible in 39 patients (24 patients did not require admission and 15 patients were discharged in less than 48 hours). The remaining 32 patients were treated in hospital. The main causes for admission were the presence of serious comorbid conditions, the severity of symptoms in the involved leg and the inability to obtain a diagnosis. None of the patients had clinical recurrent venous thromboembolism during the initial treatment with nadroparin. One patient receiving nadroparin at home had a non-fatal major bleeding. None of the patients to whom the possibility of home therapy was offered wished to remain at hospital. However, only 26% of the home-treated patients injected the drug by themselves. INTERPRETATION AND CONCLUSIONS: Home therapy of DVT with LMWH bid at doses adjusted to patient's body weight is feasible, efficient and safe. Over 50% of outpatients with DVT can be treated at home, either entirely or after a short stay in hospital. Nevertheless, before using this therapeutic alternative as a standard of practice, an adequate assessment of embolic and hemorrhagic risks, and comorbid conditions, should be made.

Adult↗