Anticoagulation Group Research Articles

Optimal time of resuming anticoagulant after endoscopic sphincterotomy in patients at risk for thromboembolism: a retrospective cohort study.

One major adverse event of endoscopic sphincterotomy (EST) is bleeding, which could be more common and severe in patients receiving anticoagulant therapy. However, the cessation of anticoagulants for long periods could lead to thromboembolic events. We aimed to evaluate the optimal timing of resumption of anticoagulants after EST in patients at risk for thromboembolism. From January 2010 through October 2017, a retrospective cohort at risk for thromboembolism who had taken warfarin and bridging therapy with heparin around EST from three tertiary hospitals in South Korea was investigated. The primary outcome was to compare the incidence of post-EST delayed bleeding according to the resumption time of anticoagulant. The secondary outcome was to investigate any thromboembolic adverse events related to interruption of the anticoagulant. A total of 96 patients (46 males and 50 females; median age 75years [range, 24-91years]) were enrolled. Overall, the patient numbers of very early (< 24h), early (24-48h), and late resumption (> 48h) of anticoagulant after EST were 56, 23, and 17, respectively. The baseline characteristics were similar between groups except resumption time of anticoagulant. There was no significant difference in the rate of post-EST delayed bleeding (5% in very early group vs. 9% in early group vs. 0 in late group, p = 0.47). The rate of thromboembolic adverse events was significantly higher in the late resumption of anticoagulant group (0 vs. 0 vs. 24%, p < 0.001). There was no significant difference in the incidence of post-EST delayed bleeding according to the resuming time of anticoagulant. Since long cessation of anticoagulant could increase the risk of thrombotic adverse events, the early resumption of anticoagulant seems to be preferred.

Impacto de la anticoagulación y antiagregación plaquetaria en la anemia y los eventos hemorrágicos y ateroscleróticos de pacientes con enfermedad renal crónica en estadios 3 y 4

Background and objectiveThere is controversy concerning the risk/benefit of anticoagulation/antiaggregation in chronic kidney disease (CKD) patients. We analysed the impact of anticoagulation/antiaggregation on anaemia and haemorrhagic events in CKD patients. Patients and methodsA total of 232 CKD patients stages 3 and 4 were followed during a mean follow-up time of 36.7 ± 11.6 months: 81 patients did not receive any anticoagulation or antiaggregation treatment, 91 received anticoagulation treatment and 60 patients received platelet antiaggregation. Haemorrhagic and cardiovascular events were recorded. ResultsHaemoglobin and ferritine levels were significantly higher in patients who did not receive anticoagulation or antiaggregation (Hb 13.7 ± 1.6, 13.3 ± 1.8 and 12.7±1.9g/dl, p=0.004; ferritine 170 ± 145, 140 ± 138, 105 ± 99μg/l, p=0.023). During follow up, 36 haemorrhagic events were registered: 4in the control group, 23 in the anticoagulation group and 9in the antiaggregation group (log rank 12.5; p=0.002). In a Cox model adjusted by age, renal function and haemoglobin levels, the anticoagulation increased the risk of bleeding by 4times (HR 4.180, 1.955-8.937); p=0,001) and antiaggregation by almost 3times (HR 2.780, 1.257-6.149, p=0.012). A total of 64 cardiovascular events were registered, 21 of which were classified as atherosclerotic events: 10 in the antiaggregation group, 8in the control group and 3in the anticoagulation group (log rank: 8.351; p=0.015). Anticoagulation treatment showed a reduction in the risk of atherosclerotic events (HR 0.136, 0.033-0.551, p=0.005) while platelet antiaggregation did not modified this risk (HR 1,566, 0.569-4.308). ConclusionsAnticoagulation and antiaggregation increase haemorrhagic risk in patients with CKD and worsen anaemia. Anticoagulation reduces atherosclerotic events by more than 85% while platelet antiaggregation does not modify this risk.

Bezpečnější antikoagulační léčba - použití idarucizumabu (Praxbind®): série kazuistik ze studie RE-VERSE AD a klinické praxe

RE-VERSE AD, a prospective multicentric cohort study, examined the effect of idarucizumab on 2 cohorts of patients anticoagulated with dabigatran - in cohort A in patients with uncontrollable or life threatening bleeding, in cohort B in patients who undergo acute surgery. Within the study patients were intravenously administered 5 g antidote divided into 2 doses per 2.5 g within 15 min to eliminate the anticoagulation effect of dabigatran. A series of case studies is presented to describe the use of idarucizumab within the RE-VERSE AD study and in clinical practice in the period of 2015-2016 at the University Hospital Hradec Králové. The included examples illustrate the benefit of dabigatran as the only drug so far from the group of direct oral anticoagulants which has an antidote.Key words: antidote - bleeding - dabigatran - direct oral anticoagulants - DOAC - high risk of bleeding - idarucizumab - intervention.

The Outcome of Anticoagulation on Endovenous Laser Therapy for Superficial Venous Incompetence.

The purpose of this study was to evaluate whether anticoagulation (warfarin or direct oral inhibitors) affected the success of endovenous treatment. Patients taking anticoagulation (warfarin or direct oral inhibitors) undergoing endovenous treatment in the form of endovenous laser ablation (EVLA) were matched against controls for sex, age, leg, and vein. Data were collected prospectively between January 2012 and March 2017. The primary endpoint was failure of treatment at 6-week postoperative duplex scan. The rates of major bleeding, hematoma, endothermal heat-induced thrombosis, venous thromboembolism, or pulmonary embolism were also compared between groups. Two hundred eighty-four limbs underwent EVLA during the study period. Of this, 23/284 (8.1%) procedures were done in patients on anticoagulation. 21/23 (91.3%) limbs had venous occlusion at follow-up compared with 23/23 (100%) of controls ( P = .49). The patient who failed treatment in the anticoagulation group had undergone small saphenous vein (SSV) ablation. There was no difference in the complication rates between groups. This study demonstrates that anticoagulation does not affect success rates of EVLA though there was higher recanalization rate in patients undergoing SSV ablation. Anticoagulation can be continued safely in patients undergoing this procedure.

Taking Warfarin with Heparin Replacement and Direct Oral Anticoagulant Is a Risk Factor for Bleeding after Endoscopic Submucosal Dissection for Early Gastric Cancer

Background: Although bleeding after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) remains problematic, especially in patients taking anticoagulants, there are differing views on the ideal and optimal management for these patients. This study investigated the risk of bleeding after ESD in patients taking anticoagulants. Methods: We enrolled 61 consecutive patients taking anticoagulants (anticoagulant group) and 968 patients taking no antithrombotic agents (non-antithrombotic group) treated with ESD for EGC between December 2010 and October 2016. We analyzed the risk factors for bleeding after ESD in relation to the various clinical factors. Results: Incidences of bleeding after ESD were significantly higher (14%; 11/76) in the anticoagulant group compared to the non-antithrombotic group (3%; 40/1,167). Moreover, bleeding after ESD was significantly more common in patients in the warfarin monotherapy group (14%; 5/37) and in the direct oral anticoagulant (DOAC) monotherapy group (22%; 4/18), compared to the non-antithrombotic group. Multivariate analysis revealed that dialysis, the use of anticoagulants, and an operation time ≥75 min were independent risk factors for bleeding after ESD. Conclusions: Our data suggest that patients who take warfarin and receive heparin bridging, and those who take DOAC medication, are prone to bleeding after ESD for EGC.

Abstract WP66: Anticoagulant Use is Not Associated With Higher Post tPA Hemorrhagic Conversion

Introduction: Even though tissue plasminogen activator (tPA) has unequivocally shown to improve outcomes in Acute Ischemic stroke (AIS), its utilization remains low due to various concerns/contraindications. Many clinicians are concerned about the risk of hemorrhage after tPA in patients on anti-coagulation (AC). With the rise of AC use, we aimed to explored the relationship between anticoagulation use and hemorrhagic conversions (HC) in patients treated with IV tPA in a large and representative national patient registry. Method: We analyzed Nationwide Inpatient Sample (NIS) and Healthcare Cost and Utilization Project (HCUP) data for years 2002-2014. We identified AIS with ICD-9-CM codes 433.xx-436, IV tPA with procedure code 99.10, and HC with ICD-9 431. Anticoagulation use was identified by previously validated ICD-9-CM codes. Parametric tests and survey logistic procedure were used to analyze group comparison and multivariate regression. Results: A total of 264,643 patients with AIS received IV tPA, of which 12,690 (4.8%) were on AC prior to admission. Unadjusted, the frequency of HC was higher among AC group (9.1% v 8.0%; p&lt;0.001). However, after adjusting for confounders with multivariate analysis, there was no difference in HC between AC and ‘not on AC’ group [OR 0.87; 95% Confidence Interval(CI) 0.75-1.01; p=0.071]. Additionally, there was no difference in in-hospital mortality [OR 0.91; 95% CI 0.79-1.05; p=0.178] and discharge to home [OR 1.1; 95% CI 0.99-1.2; p=0.05] among AC and ‘not on AC’ group. Conclusion: Our study shows, AC use prior to AIS onset is not associated with higher HC with tPA use. Moreover, no significant differences in outcomes were observed in AC and ‘not on AC’ group. Being on AC should not be a prohibitive factor for tPA utilization in AIS patients. Further prospective studies, that includes precise anticoagulant measurements, are required to better understand the relationship between AC use and HC.

Abstract WP3: Cerebral Venous Sinus Thrombosis: Clinical Outcomes in Medical Management and Mechanical Thrombectomy

Introduction: Anticoagulation (AC) is the mainstay treatment for cerebral venous sinus thrombosis (CVST). However, not all patients respond to AC alone. Patients may benefit from mechanical thrombectomy (MT), however, there is limited data. We assessed the clinical outcomes of CVST patients who underwent MT compared to those treated with AC alone. Methods: Retrospective analysis of the electronic medical record was performed from January 2012 to July 2017. Those with CVST secondary to infection, trauma, and those without follow-up were excluded. Primary analysis was modified Rankin Score (mRS) within one year. Recanalization was assessed as a secondary outcome. Results: Chart review identified 169 acute CVST patients; 81 were included in the analysis. All were treated with AC. Of these, six underwent MT. Adjusting for age, initial NIH stroke score (NIHSS) was higher in the MT group (11 vs 2.5, p = 0.0006). Intracranial hemorrhage (ICH) was seen at presentation in 67% of the MT patients, and 28% of the AC group. The majority of patients with CVST achieved functional independence (85.2% mRS ≤ 2) at follow-up. Patients who presented with an infarction or intracranial hemorrhage (ICH) had a higher mean mRS at follow-up (infarct 1.9 vs. 0.66, p = 0.034. ICH 2.0 vs. 0.51, p = 0.004). The MT group had a higher mean mRS at follow-up (2.7 ± 2.1 vs 0.80 ± 1.5, p = 0.0057). There was no significant difference in recanalization between the two groups. Discussion: While patients who received MT had a higher mean mRS at follow-up, the initial clinical presentation was worse than those treated with AC alone. The majority of patients achieved functional independence, even with ICH or infarction at presentation. Conclusion: MT may be an efficacious therapy in CVST. However, with good clinical outcomes in most patients, it is unclear which patients benefit from MT. Further investigation is ongoing to determine predictors of poor outcomes in CVST.

Impact of non-anticoagulant therapy on patients with sepsis-induced disseminated intravascular coagulation: A multicenter, case-control study

IntroductionAnticoagulant therapy for patients with sepsis is not recommended in the latest Surviving Sepsis Campaign guidelines, and non-anticoagulant therapy is the global standard treatment approach at present. We aimed at elucidating the effect of non-anticoagulant therapy on patients with sepsis-induced disseminated intravascular coagulation (DIC), as evidence on this topic has remained inconclusive. Materials and methodsData from 3195 consecutive adult patients admitted to 42 intensive care units for the treatment of severe sepsis were retrospectively analyzed via propensity score analyses with and without multiple imputation. The primary outcome was in-hospital all-cause mortality. ResultsAmong 1784 patients with sepsis-induced DIC, 745 (41.8%) were not treated with anticoagulants. The inverse probability of treatment-weighted (with and without multiple imputation) and quintile-stratified propensity score analyses (without multiple imputation) indicated a significant association between non-anticoagulant therapy and higher in-hospital all-cause mortality (odds ratio [95% confidence interval]: 1.59 [1.19–2.12], 1.32 [1.02–1.81], and 1.32 [1.03–1.69], respectively). However, quintile-stratified propensity score analyses with multiple imputation and propensity score matching analysis with and without multiple imputation did not show this association. Survival duration was not significantly different between patients in the propensity score-matched non-anticoagulant therapy group and those in the anticoagulant therapy group (Cox regression analysis with and without multiple imputation: hazard ratio [95% confidence interval]: 1.26 [1.00–1.60] and 1.22 [0.93–1.59], respectively). ConclusionsIt remains controversial if non-anticoagulant therapy is harmful, equivalent, or beneficial compared with anticoagulant therapy in the treatment of patients with sepsis-induced DIC.

Safety and efficacy of regional citrate anticoagulation in continuous blood purification treatment of patients with multiple organ dysfunction syndrome.

The aim of this study was to discuss the safety and efficacy of regional citrate anticoagulation (RCA) on continuous blood purification (CBP) during the treatment of multiple organ dysfunction syndrome (MODS). Thirty-five patients with MODS were divided into two groups: the local citrate anticoagulation (RCA) group, and the heparin-free blood purification (hfBP) group. The MODS severity was assessed according to Marshall’s MODS score criteria. Blood coagulation indicators, blood pressure, filter lifespan, filter replacement frequency, anticoagulation indicators, and main metabolic and electrolyte indicators were analyzed and compared between RCA and hfBP groups. RCA resulted in lower blood pressure than hfBP. The filter efficacy in RCA treatment was longer than in the hfBP group. The blood clearance of creatine, blood urea nitrogen and uric acid was better in the RCA group. RCA also led to higher pH than hfBP. Neither treatment resulted in severe bleeding events. In addition, MODS score was positively correlated with prothrombin time and activated partial thromboplastin time but negatively correlated with platelet concentration. RCA is a safer and more effective method in CBP treatment; however, it could also lead to low blood pressure and blood alkalosis.

Chronic Kidney Disease as Basis of High Thrombotic and Bleeding Risk in Patients With Atrial Fibrillation: Place of Oral Anticoagulants.

Chronic kidney disease (CKD) aggravates course of practically all diseases by worsening outcomes and hindering adequate treatment. Specificities of renal excretion of various drugs, changes of parameters of their pharmacokinetics and pharmacodynamics, nephrotoxic effects of drugs, tactics of drug therapy in conditions of CKD, terminal stage of kidney failure and dialysis are in the focus of attention of internists. To a greatest degree difficulties of drug therapy in CKD and associated clinical states refer to the group of anticoagulants. Kidney diseases and related complications of anticoagulant therapy served as stimulus for search for new pharmacological approaches in anticoagulation, which resulted in creation and elaboration of novel oral anticoagulants (NOACs). NOACs are characterized by rapid onset and cessation of action, predictable pharmacokinetics, low potential of interaction with drugs and foods. Indicators of efficacy and safety of NOACs are similar to those of warfarin. Nevertheless, hemorrhagic and thrombotic events constitute the basis of further theoretical and practical investigations. These complications also stimulate aiming at selection of safest and balanced medicines. In this article we present various aspects of use of direct oral anticoagulants mostly in patients with CKD associated with atrial fibrillation.

ANALYSIS OF THE FREQUENCY OF USING VARIOUS ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION IN REAL PRACTICE

This article makes a retrospective analysis of the prevalence of the use of oral anticoagulants in patients with atrial fibrillation at the outpatient level. The frequency of the sex-age structure of patients with AF, the risk of thromboembolic complications, the risk of bleeding, and the appointment of various groups of anticoagulants after hospitalization are investigated. A retrospective analysis of the data of patients with a history of AF and CHA2DS2-VASc &gt;1 points hospitalized in the Moscow hospital for the next paroxysm of AF showed that slightly more than 2/3 of them in the pre-hospital stage were taken by the oral anticoagulants (OAC) and about / by the (new oral anticoagulants) NOACs . The proportion of patients with the value of the scale CHA2DS2-VASc &gt;4 was 49.3%, the proportion of patients with the HAS-BLED &gt;3 scale was 17.9%. Among all OAK patients, 96 people (68.6%) were admitted prior to admission. Among the remaining 44 patients, 22 received an antiaggregant (aspirin, clopidogrel or a combination thereof), and 22 more did not take any antithrombotic drugs.

Routine use of anticoagulation after transcatheter aortic valve replacement: Initial safety outcomes from a single-center experience.

Subclinical leaflet thrombosis (SCLT) can be seen in up to 12% of patients after transcatheter aortic valve replacement (TAVR). Anticoagulation appears to prevent and reverse SCLT but concerns exist about bleeding risk. Our program adopted a strategy of routine anticoagulation after TAVR, starting warfarin on post-procedure day 0 and continuing for 3months in 10/2015. We report the initial safety and efficacy outcomes of this approach. Bleeding events were assessed using Valve Academic Research Consortium (VARC) and Bleeding Academic Research Consortium (BARC) definitions. The median (IQR) age of the population (n=191) was 82years (72-87) and the median (IQR) STS score was 5.6% (3-8). A total of 101 (53%) patients were discharged on anticoagulation (warfarin 97%) while 90 (47%) received antiplatelet therapy alone. The mean duration of anticoagulation therapy was 81±17 days. During follow-up 7 patients (4%) had a stroke or TIA, 3 (3%) in the anticoagulation group and 4 (4%) in the antiplatelet group (p=0.71). A total of 8 patients (4.2%) had BARC bleeding events during follow-up, 3 patients in the anticoagulation group (2.9%) and 5 in the antiplatelet group (5.5%, p=0.48). All bleeding events (VARC and BARC) were numerically lower in the anticoagulation group (8% versus 13%, p=0.20). A strategy of routine anticoagulation for 3-months after TAVR is well tolerated and associated with similar or lower bleeding risk compared to antiplatelet therapy.

Catheter-Directed Thrombolysis Versus Standard Anticoagulation for Acute Lower Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials.

Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis. Compared with anticoagulant alone, CDT was shown to significantly increase the percentage patency of the iliofemoral vein (P < .00001; I 2 = 44%) and reduce the risk of PTS (P = .0002; I 2 = 79%). In subgroup analysis of randomized controlled trials, CDT was not shown to prevent PTS (P = .2; I 2 = 59%). A reduced PTS risk was shown, however, in nonrandomized trials (P < .00001; I 2 = 47%). Meta-analysis showed that CDT can reduce severe PTS risk (P = .002; I 2 = 0%). However, CDT was not indicated to prevent mild PTS (P = .91; I 2 = 79%). A significant increase in bleeding events (P < .00001; I 2 = 33%) and pulmonary embolism (PE) (P < .00001; I 2 = 14%) were also demonstrated. However, for the CDT group, the duration of stay in the hospital was significantly prolonged compared to the anticoagulant group (P < .00001; I 2 = 0%). There was no significant difference in death (P = .09; I 2 = 0%) or recurrent venous thromboembolism events (P = .52; I 2 = 58%). This meta-analysis showed that CDT may improve patency of the iliofemoral vein or severe PTS compared with anticoagulation therapy alone, but measuring PTS risk remains controversial. However, CDT could increase the risk of bleeding events, PE events, and duration of hospital stay.

Botulinum toxin therapy in patients with oral anticoagulation: is it safe?

When used therapeutically, botulinum toxin (BT) has to be injected into its target tissues. All manufacturers warn not to do so in patients with oral anticoagulation to avoid haematoma. We wanted to study the haematoma frequency (HF) in patients with anticoagulation receiving BT therapy. 32 patients (16 females, 16 males, age 69.3±10.0years) with blepharospasm (n=6), hemifacial spasm (n=8), post-stroke spasticity (n=16), and cervical dystonia (n=2) received BT therapy (needle size 27G, post-injection tissue compression) whilst on anticoagulation (anticoagulation group, AG). 32 patients matched for disease, target muscles, age, and gender received identical BT therapy without anticoagulation (control group, CG). Anticoagulation was performed with phenprocoumon. International normalised ratio (INR) at the time of BT injection was in all patients within the recommended margins of 2.0 and 3.0 (mean 2.6±0.27). Overall HF was 3.0% in AG and 1.8% in CG (not significant). All hematomas occurred in blepharospasm patients (AG 5.2%, CG 2.6%, not significant) and hemifacial spasm patients (AG 3.9%, CG 2.9%, not significant). In cervical dystonia and spasticity there were no haematomas. Throughout an observation period of 4years, none of the haematomas was surgically relevant. Haematomas are a rare complication of BT therapy, mainly occurring in periocular injections. Anticoagulation only marginally increases HF, provided INR is controlled and appropriate injection techniques are used. Surgically relevant haematomas do not occur. Interruption of oral anticoagulation to perform BT therapy is not justified.

Does Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis.

Due to limited evidence, it is unclear whether postoperative anticoagulation therapy may lead to higher success rates for microvascular free-flap surgery in the head and neck. This review evaluated whether postoperative anticoagulation therapy can lead to a better result in head and neck reconstruction. PubMed, Embase, and the Cochrane Library were used to search for articles on the efficacy of postoperative antithrombotic therapy in free-flap transfer during head and neck reconstruction without language restrictions in February of 2017. A random-effects model was used to estimate the relative risk ratio (RR) with 95% confidence intervals (CIs). The measured outcomes were flap loss, thromboembolic events, and hematoma formation. A total of 2,048 free-flap surgery procedures in the head and neck were analyzed. There was no significant difference in the occurrence of flap loss and thromboembolic events in the anticoagulation group compared with the nonanticoagulation group (RR = 1.25, 95% CI = 0.85-1.81, p = 0.26; and RR = 1.05, 95% CI = 0.74-1.48, p = 0.79, respectively). The risk of hematoma was twice as high in the anticoagulation group than the nonanticoagulation group, which was statistically significant (RR = 2.02, 95% CI = 1.08-3.76, p = 0.03). The findings from our meta-analysis indicate that postoperative anticoagulation therapy barely decreases the risks of flap loss and thromboembolic events in free-flap surgery in the head and neck. However, it may significantly increase the risk of hematoma formation. Considering the limitations of this meta-analysis, additional high-quality, multicenter, prospective, randomized controlled studies are needed to confirm these findings.

Evaluation of anticoagulant therapy after cerebral hemorrhage combined with deep vein thrombosis of lower extremity

Objective To evaluate the efficacy and safety of anticoagulant therapy with low-molecular-weight heparin after cerebral hemorrhage combined with deep vein thrombosis of lower extremity. Methods One hundred and fifty-three cases of deep vein thrombosis of lower extremity after intracerebral hemorrhage were collected of Beijing Tiantan Hospital, Capital Medical University from June 2014 to June 2016. According to whether accepted anticoagulant therapy with low-molecular-weight heparin, the patients were divided into treatment group (n=79) and control group(n=74). Compared the head CT images and the ultrasound of lower extremity venous in the day when admissed to hospital and in the 7th day after treatment. The measurement data was adopted by t test, Chi-square test was adopted in the count data. Results Before the low-molecular-weight heparin therapy, the average bleeding volume in intracerebral was(1.38±0.45) ml for the anticoagulant therapy group. After 7 days of low-molecular-weight heparin therapy, the average bleeding volume in intracerebral was(1.01±0.54) ml, there was no increasing cerebral hemorrhage, with a statistically significant difference(P=0.000). The bleeding volume in intracerebral was(1.47±0.47) ml of control group cases, and after 7 days it became (1.17±0.52) ml, with a statistically significant difference (P=0.000), all these showed that cerebral hemorrhage had significantly absorbed. There was no statistically significant difference between the treatment group and the control group (P=0.123). It explained that anticoagulation was not increased intracranial hemorrhage with low-molecular-weight heparin. ultrasound showed that the lower extremity venous thrombosis was stable or decreased before and after anticoagulant therapy, and the difference was statistically significant (P=0.000), indicating that the anticoagulant therapy was effective. Conclusions It is safe and effective in low-molecular-weight heparin anticoagulant therapy for deep vein thrombosis of lower extremity after intracerebral hemorrhage. But patients need strict screening, and follow the individualized treatment. Key words: Cerebral hemorrhage; Venous thrombosis; Heparin, low-molecular-weight; Anticoagulants

Comparison of Therapeutic Efficacy of Anticoagulation and Its Combination with Catheter-directed Thrombolysis for Deep Venous Thrombosis of Lower Extremities

To investigate the therapeutic efficacy of anticoagulation(AC) and its combination with catheter-directed thrombolysis(CDT) for deep venous thrombosis of lower extremities. One hundred and thirty-nine patients with deep venous thrombosis of early lower extremities treated in our hospital from May 2011 to September 2013 were selected and randomly divided into the AC group(n= 66) and CDT+AC group(n= 73). The thrombolytic effects, adverse reactions, post-thrombotic syndrome (PTS) and quality of life were evaluated. There were no serious adverse events during treatment and after treatment in the 2 groups. Hematomas in 2 cases and gross hematuria in 3 cases were observed in the CDT+AC group. The gums bleed or gross hematuria in 3 cases were observed in the AC group. Compared with the AC group, the number of grade I thrombolysis in CDT+AC group decreased significantly (60.61% vs 9.59%)(P< 0.05), and the number of grade III thrombolysis increased significantly(7.57% vs 49.31%)(P< 0.05). During follow-up, the incidence of PTS in both groups showed increase year by year, and none of the patients had severe PTS. The incidence PTS in CDT+AC group at 12 months and 18 months were lower than those of AC group(17.81% vs 33.33%, 24.66% vs 43.94%)(P< 0.05). Compared with the AC group, the scores of physiological role and vitality in CDT+AC group at 6 months, 12 months and 18 months were higher (P< 0.05). Catheter-directed thrombolysis combined with AC therapy can promote the mitigation of clinical symptoms in patients with DVT of lower extremities and is beneficial to promoting the life quality of patients.

Influence of Temperature And Storage Duration on Measurement of Prothrombin TimeV

Objectives:toinvestigate the sample stabilitywith regard to the temperatureand the storage time and to detect influence of temperature and storage duration on Prothrombin time in citrated plasma. Patients and Method:This study was carried out in the period between April, 2016 and March, 2017 in the department of clinical pathology, Sohag University Hospital, Sohag, Egypt, during the study period whole blood samples were collected from groups of patients: 43apparently normal healthy (not receiving anticoagulant) as control (group A) and43receiving anticoagulant (17 on warfarin and 26 on heparin) (group B).Each sample of each group will be analyzed forProthrombin time immediately and after 4hrs, 8hrs, and 24hrs of storage.Also each sample will be tested at room temperature (18-22 °C) and at refrigerator temperature (4 °C). Results andConclusion:samples for Prothrombin time were acceptable for analyses up to 24 h in those not receiving anticoagulant and up to 8 h in those receiving anticoagulant.

Could anticoagulation avoid bioprosthesis subclinical thrombosis in patients undergoing transcatheter aortic valve replacement?

Despite a lack of clear evidence, current European guidelines recommend antiplatelet therapy after transcatheter aortic valve replacement (TAVR). Recent investigations suggest that bioprosthesis thrombosis after TAVR is not uncommon and may be prevented by anticoagulation, but not by antiplatelet therapy. The study objective was to assess the impact of the antithrombotic regimen on post-TAVR early haemodynamics. Patients eligible for TAVR with an Edwards SAPIEN 3 valve were included in this prospective observational study. Patients undergoing long-term anticoagulation before TAVR continued their treatment, whereas previously non-anticoagulated patients received antiplatelet therapy. The primary endpoint was the mean transaortic gradient assessed by transthoracic echocardiography at the first post-TAVR follow-up. Safety was assessed by two composite endpoints: bleeding/vascular complications and major adverse postoperative events. Among 135 included patients, 78 were discharged on antiplatelet therapy and 57 on anticoagulation. Both groups had similar baseline characteristics, except for supraventricular arrhythmia (7.7% on antiplatelets vs. 89.5% on anticoagulation; P<0.001). At 1-2months after TAVR, the mean transaortic gradient was significantly higher in the antiplatelet therapy group versus the anticoagulation group (13.0±4.0 vs. 9.0±2.8mmHg; P<0.001, independently of prosthesis size). Safety analyses showed no significant differences of the composite endpoints. Prolonged anticoagulation after TAVR was associated with lower early transaortic gradients than antiplatelet therapy. Anticoagulation treatment may limit clinical and subclinical thrombosis without increasing early postoperative complications.

Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke

BackgroundTrials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy.MethodsIn a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1). Patients with contraindications to anticoagulants or to PFO closure were randomly assigned to the alternative noncontraindicated treatment or to antiplatelet therapy (randomization groups 2 and 3). The primary outcome was occurrence of stroke. The comparison of PFO closure plus antiplatelet therapy with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 2, and the comparison of oral anticoagulation with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 3.ResultsA total of 663 patients underwent randomization and were followed for a mean (±SD) of 5.3±2.0 years. In the analysis of randomization groups 1 and 2, no stroke occurred among the 238 patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet-only group (hazard ratio, 0.03; 95% confidence interval, 0 to 0.26; P<0.001). Procedural complications from PFO closure occurred in 14 patients (5.9%). The rate of atrial fibrillation was higher in the PFO closure group than in the antiplatelet-only group (4.6% vs. 0.9%, P=0.02). The number of serious adverse events did not differ significantly between the treatment groups (P=0.56). In the analysis of randomization groups 1 and 3, stroke occurred in 3 of 187 patients assigned to oral anticoagulants and in 7 of 174 patients assigned to antiplatelet therapy alone.ConclusionsAmong patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation. (Funded by the French Ministry of Health; CLOSE ClinicalTrials.gov number, NCT00562289.)