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At least 613 records · Page 34Linked to original sources
PubMed1973

Disseminated intravascular coagulation associated with hepatitis in late pregnancy.

A patient with viral hepatitis in the third trimester of pregnancy is described. She developed acute hepatic failure in the postpartum period which was associated with evidence of intravascular coagulation. Following therapy with heparin and fresh-frozen plasma, the patient made a dramatic recovery. Hepatitis developed during the puerperium may predispose to pathological intravascular coagulation and hepatocellular necrosis may thereby be perpetuated.

Acenocoumarol↗
PubMed2003

Experience with enoxaparin in patients with mechanical heart valves who must withhold acenocumarol.

OBJECTIVES: To evaluate the incidence of thromboembolic and haemorrhagic events in a cohort of patients with mechanical heart valves who had to withhold acenocumarol and were treated with enoxaparin. DESIGN: Observational prospective study. SETTING: In hospital; after discharge, and follow up by telephone call. PATIENTS AND METHODS: All consecutive patients with mechanical heart valves admitted to the authors' hospital between May 1999 and January 2002 who had to interrupt treatment with acenocumarol and were treated with enoxaparin as an alternative to other methods were enrolled. In each patient, the following characteristics were prospectively determined: the reason for interrupting acenocumarol, demographic data, estimated global risk for thromboembolic events, international normalised ratio before starting enoxaparin treatment, number of days taking enoxaparin, and mean level of anti-Xa activity during treatment. All patients were followed up through clinical history during the hospitalisation and by telephone after discharge to detect thromboembolic events. MAIN OUTCOME MEASURE: Presence of thromboembolic or haemorrhagic events. RESULTS: 82 patients were identified and followed up for a mean of 2.8 months (range 1.5-3.5 months) after discharge. 61 of them (74%) had one or more associated thromboembolic risk factors. Acenocumarol was interrupted (to perform an invasive procedure in 74 patients and because of haemorrhagic complication in 8) an average of 11.2 days (range 3-40 days). Most patients received the standard enoxaparin dose (1 mg/kg at 12 hour intervals). Mean (SD) anti-Xa activity was 0.58 (0.3) IU/ml (median 0.51). There were 8 minor and 1 major bleeding events during enoxaparin treatment. No thromboembolic complications were clinically detected during hospitalisation or during follow up (95% confidence interval 0% to 3.6%). CONCLUSIONS: Enoxaparin may be an effective and relatively safe substitute anticoagulant for patients with mechanical heart valves who must withhold acenocumarol.

Acenocoumarol↗
PubMed1970

Extent of possible rehabilitation of service personnel with ischaemic heart disease.

Sixty unselected survivors from ischaemic heart disease, all male service personnel, were treated, within 1 to 6 months of recovery from the acute episode, by promotion of physical activity, correction of coronary risk factors, and routine use of nicoumalone and prenylamine lactate. The results showed that this approach was conducive to more rewarding rehabilitation than was obtained in 89 patients who, in the past, were on conventional treatment based on advice regarding weight, diet, and physical and mental activity. Thus within 1 to 30 months of treatment by this approach, out of 60 patients, 12 were fit for medical category A active service duties in operational areas in any part of the world in any terrain, including altitudes between 10,000 and 18,000 feet, 30 were fit for medical category B service duties in non-operational communication zones in any part of the world including altitudes below 10,000 feet, and 17 were fit for medical category C sedentary duties in non-operational areas in India only. One patient, who initially recovered from congestive heart failure, died while in a state of temporary unfitness for service. No patient was released from service on account of ischaemic heart disease. Against this, by the conventional approach, out of 89 patients, 81 were fit for medical category C sedentary duties in non-operational areas in India only, 4 were released from service, and 4 died.

Acenocoumarol↗
PubMed1982

Haemorrhagic breast infarction complicating anticoagulant therapy.

Haemorrhagic infarction of the breast induced by anticoagulant therapy is rare and has been infrequently reported in the literature. The following report illustrates such a case in which there was development of massive haemorrhagic infarction of the breast during treatment with nicoumalone for deep venous thrombosis after an operation for carcinoma of the colon.

Acenocoumarol↗
PubMed1990

Type I protein S deficiency and skin necrosis.

A kindred with Type I protein S deficiency is described in which the index case developed skin necrosis during induction of oral anticoagulant therapy for deep venous thrombosis. Two other family members with protein S deficiency have been detected, and demonstrate the clinical variability of this condition.

Acenocoumarol↗
PubMedDate not supplied

[Portal-splenic-mesenteric venous thrombosis secondary to a mutation of the prothrombin gene].

Thrombosis of the portal-mesenteric axis is an infrequent cause of intestinal ischemia or infarction. In addition to the multiple acquired factors that contribute to the development of this entity, hereditary risk factors, especially the factor V Leiden mutation and the G20210A mutation of the prothrombin gene, have been implicated. The G20210A mutation of the prothrombin gene is found in up to 40% of patients with splenic-portal-mesenteric thrombosis. The present case illustrates the unusual and nonspecific presentation of this mutation in the form of diarrhea and images of thrombosis of the superior mesenteric-portal vein and cavernous transformation of the portal vein. Delayed diagnosis is highly frequent since the clinical signs, laboratory investigations and radiological tests do not suggest the diagnosis. The patient received anticoagulant treatment and showed clinical improvement with complete portal-mesenteric recanalization. Currently the diagnostic technique of choice is magnetic resonance angiography or computerized tomography angiography and treatment consists of indefinite anticoagulation. This case illustrates that an unusual or atypical localization of venous thrombosis may be a manifestation of thrombophilia, emphasizing the importance of genetic screening in these cases.

3' Untranslated Regions↗
PubMedDate not supplied

Treatment with vitamin K antagonists: frequency of indications and appropriateness of continuation.

To prevent venous and arterial thrombosis vitamin K antagonists (VKA) are the treatment of choice for many indications. It is important to balance the benefits and the potential hazards of this treatment. An effective way to prevent unnecessary bleeding during VKA treatment is to stop treatment when the indication is no longer present. In this study, we analyze the distribution of indications in a randomly selected group of 250 patients starting VKA treatment at the Amsterdam Thrombosis Service. The proportion of patients still treated after one year of follow-up was also investigated. The distribution of the indications among patients starting VKA therapy was approximately 50% for venous thromboembolism treatment and prophylaxis, and approximately 50% for prophylaxis of arterial thrombosis. After one year of follow-up, 164 (65.6%) of the 250 patients had stopped VKA therapy. Reasons for stopping included: no indication for continuing VKA treatment, e.g. end of treatment, prophylaxis or restoration of sinus rhythm (137 patients); death (17) and other reasons (10). Six (2.4%; 95% CI: 0.9-5.1%) patients had a questionable indication for long-term treatment, and 9 (3.6%, 95% CI: 1.6-6.7%) patients had no clear indication for continued VKA treatment. We conclude that in the setting of the Amsterdam Thrombosis Service, only a small proportion of patients is treated with long-term VKA therapy without a valid indication after 1 year.

Acenocoumarol↗
PubMed2003

Ischaemic stroke in young people: a prospective and long-term follow-up study.

BACKGROUND: A few studies have comprehensively assessed the epidemiology, aetiology, prognosis, and secondary prevention of ischaemic stroke in young adults. To gain further information on this field, we have prospectively studied a hospital-based series of young adults with a first-ever episode of cerebral ischaemia (CI). METHODS: Sixty consecutive patients aged 17-45 with ischaemic stroke (55 patients) or transient ischaemic attack within 24 h before hospital admission were recruited and investigated by a standardized rigorous protocol. The patients were followed up for >or=1 year after hospital discharge. Arbitrary doses of aspirin 100 mg/d or ticlopidine 250 mg b.i.d. in case of intolerance to aspirin were given for the secondary prevention. Adjusted-dose oral anticoagulation (INR target 2.5) was used in the presence of cardioembolism or hypercoagulable states. Endpoints included the residual disability, rated by modified Rankin Scale (RS) and Barthel Index (BI), and poststroke recurrence. RESULTS: CI was associated with two or more risk factors in 61.6% of patients. Cigarette smoking was more frequently associated with male gender (p < 0.05) and migraine history with female sex (p < 0.05). The atherothrombotic diagnostic subtype and the subtype from 'other cause' predominated significantly among patients >or=35 years old (p < 0.05) and <35 years (p < 0.025), respectively. The 'other cause' subset was more frequent in female gender (p < 0.05). Transoesophageal echocardiography (TEE) detected potential cardiac sources of emboli (PCSE) at an extent 3 times higher (p < 0.0001) than transthoracic echocardiography. Congenital heart defects were nearly threefold more frequent than acquired ones, with a prevalence of patent foramen ovale. At a mean of 6.1 +/- 2.6 years (confidence interval 5.4 to 6.8), follow-up data were available for only 54 patients, since five patients were lost and one died in the acute phase. Poststroke recurrence rate was low (7.4%) and no event was fatal. General handicap was severe to moderately severe (RS>3) in 11% of the patients, slight to moderate (1>or=RS or=95), 38.9% partially dependent (BI 60 to 86), and 11.1% fully dependent (BI <60). Thirty-seven (68.5%) patients returned to work, although adjustments (other job or part-time employment) were necessary for 10 out of them (27%). CONCLUSIONS: The present study, though limited by the relatively small number of subjects, suggests that the overall prognosis of ischaemic stroke in young adults is good. We strongly recommend TEE in all patients with ischaemic stroke as an essential tool to increase the detection of PCSE and make the therapeutic approach more efficient.

Acenocoumarol↗
PubMed1978

Binding of coumarin anticoagulants to human and bovine serum albumin. Circular dichroism studies.

The interaction of acenocoumarin, coumachlor, phenprocoumon, and warfarin with human and bovine serum albumin was investigated by ultracentrifugation and circular dichroism measurements. Although all four drugs generate extrinsic Cotton effects when bound to human and bovine serum albumin, large differences in the signs and the intensities of the Cotton effects are observed. The differences in the induced Cotton effects suggest differential molecular binding mechanisms.

Acenocoumarol↗