Evaluation Of Anticoagulation Therapy Research Articles

Value of ventilation/perfusion SPECT in evaluation of anticoagulant therapy for patients with pulmonary embolism and the influencing factors of treatment effect

Objective To investigate the value of pulmonary ventilation/perfusion (V/Q) SPECT in evaluation of anticoagulant therapy for patients with pulmonary embolism (PE) and identify factors which may affect the therapy. Methods From July 2014 to December 2016, sixty-three patients (23 males, 40 females, age (60±14) years), who were clinically diagnosed as PE and underwent V/Q SPECT before and after anticoagulant therapy, were recruited retrospectively in this study. According to the percentage of lung perfusion defect (PD) out of total lung volume, the patients were divided into mild ( 50%) PE groups. The lung PD decreased≥50% after anticoagulant therapy and no new PD detected was defined as the standard of effective therapy, otherwise the treatment were defined as ineffective. Data of different groups were compared. Factors that may predict the severity of PD or affect the treatment were analyzed. χ2 test and logistic regression were used for data analysis. Results PE were detected in 476 pulmonary segments and sub segments. The distribution of PE in different lung lobes had no statistically significant difference (χ2=4.995, P>0.05). More pulmonary arterial hypertension (PAH) were detected in patients with severe PE (80%, 12/15) and moderate PE (66.7%, 16/24) in comparison with patients with mild PE (41.7%, 10/24; χ2=7.062, P<0.05). The occurrence of PAH was related to the severity of PD, with odds ratio (OR) value of 2.680 (95% CI: 1.115-6.446, P<0.05). PAH was an independent risk factor for treatment effect (OR value: 3.134(95% CI: 1.341-7.324), P<0.05). Conclusions V/Q SPECT has an important value for evaluating the effect of anticoagulant therapy and guiding individual therapy. The more extent of PE involved, the higher prevalence of PAH. Anticoagulant therapy may be ineffective in PE patients with moderate or severe PAH. Key words: Pulmonary embolism; Anticoagulants; Treatment outcome; Tomography, emission-computed, single-photon; Technetium Tc 99m aggregated albumin

A Low Rivaroxaban Plasma Level May Indicate Anticoagulation Undertreatment.

Few reports have been published on the correlation between plasma concentrations of rivaroxaban and clinical outcome in patients who have experienced venous thromboembolism. This article describes the case of a 44-year-old woman who experienced deep vein thrombosis during anticoagulation therapy with rivaroxaban, with evidence of repeated low plasma levels of the drug. We postulate that the determination of plasma rivaroxaban anti-Xa activity can be useful in the evaluation of anticoagulation therapy in selected cases.LEARNING POINTSSome patients with deep vein thrombosis do not respond to rivaroxaban therapy.Accurate determination of rivaroxaban plasma concentrations is important in clinical practice.The clinical value of rivaroxaban plasma concentrations might be limited by intra- and inter-individual variations.

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

Evaluation of Anticoagulation Therapy in an Academic Nursing Home

Objective: To evaluate the warfarin management patterns in an academic nursing home and evaluate what predetermined factors are associated with variability in the international normalized ratio (INR). Setting: A 566-bed academic nursing home. Methods: A retrospective chart review of all residents receiving warfarin therapy for &gt;3 consecutive months in a calendar year was conducted. Data were collected regarding the number of times the INR fluctuated during the follow-up period and the degree of fluctuation between each blood sampling. An INR that changed by 0.5–0.99 between samplings was classified as a small fluctuation; a change &gt;0.99 was defined as a large fluctuation. The sample was divided into 2 groups, easy management and difficult management, based on variability in the INR. The easy-management group consisted of residents who had small fluctuations in the INR and who had INRs outside of the therapeutic range ≤10% of the time. The difficult- management group had large fluctuations in the INR, with the ratio outside of the therapeutic range &gt;10% of the time. Results: Thirty-seven patients were taking warfarin (mean ± SD age 71 ± 14 y; mean number of medical illnesses 7.6 ± 3). The mean length of time of warfarin therapy was 10.6 ± 3.2 months. The average dose and INR were 4.0 ± 1.9 mg and 2.0 ± 0.3, respectively. No statistically significant differences were found between age, dose, or INR. For patients who had INR values exceeding the therapeutic range, there was no significant difference between the management groups in length of treatment, age, number of medical illnesses, number of high-risk factors, dose, average monthly INR, number of medication adjustments per year, albumin and creatinine levels, total number of medications, or number of routine medications known to interact with warfarin. The difficult-management group received more medications known to interact with warfarin than the easy-management group. These medications may have caused the INR to increase above the normal range (p = 0.003), as well as producing a large (p = 0.001) or small fluctuation (p = 0.0007) in the INR. Of all the interacting medications, 55% were antibiotics and 28% were analgesics. No statistically significant differences in outcome were seen between groups. Conclusions: Results of this study indicate that large variations (&gt;0.99) in the INR may be due to newly prescribed medications that enhance the anticoagulant effect of warfarin. These variations may be minimized by closely monitoring the INR when a drug known to interact with warfarin is prescribed.

Evaluation of anticoagulant therapy in cloth-covered prosthetic valves.

Over a period of four years, a series of 303 patients had prosthetic valve replacement with the Starr-Edwards cloth-covered metallic ball prosthesis. There were 135 aortic replacements, 105 mitral, 42 combined mitral and aortic, and 21 combined mitral and tricuspid. The frequency of thromboembolism and hemorrhage was studied in patients receiving warfarin sodium (Coumadin) and in those not receiving warfarin. No thromboemboli occurred during 2,052 patient-months of observation in patients with aortic prostheses who were receiving warfarin, but 10 episodes of hemorrhage occurred. By comparison, after anticoagulants were discontinued, there was 1 episode of thromboembolism during 786 months of patient observation. Among patients with mitral prostheses who were receiving warfarin, 3 episodes of thromboembolism occurred in 2,081 patient-months of observation, during which 5 hemorrhagic episodes also occurred. By comparison, after warfarin was discontinued, there were 3 episodes of thromboembolism during 402 months. In patients with mitral and aortic prostheses who were receiving warfarin, 1 episode of thromboembolism occurred in 670 patient-months, and no episodes of hemorrhage. Without anticoagulation, 2 episodes of thromboembolism occurred in 130 patient-months. In patients with mitral and tricuspid prostheses who were receiving warfarin, there were no episodes of thromboembolism during 186 patient-months, but there was 1 episode of hemorrhage. Without anticoagulation, however, there were 3 episodes of thromboembolism during 32 months of patient observation.

Self-Coagulogram

SummaryA curve named “self-coagulogram” and obtained by means of the “self thromboplastin-prothrombin time” is described. The beginning of the curve reflects clot formation dynamics, while the tail reflects the fibrinolytic activity. The self-coagulogram helps the detection of hemorrhagic syndromes, the evaluation of anticoagulant therapy and fibrinolytic activity, natural or induced. It is a very simple and practical method.

An evaluation of anticoagulant therapy in the treatment of cerebrovascular disease. Report of the Veterans Administration Cooperative Study of Atherosclerosis, Neruology Section.

An evaluation of anticoagulant therapy in the treatment of cerebrovascular disease. Report of the Veterans Administration Cooperative Study of Atherosclerosis, Neruology Section.

Simplified heparin therapy of impending and acute myocardial infarction.

Excerpt It is now recognized that premonitory symptoms occur in a substantial proportion of all attacks of acute myocardial infarction.1There is a definite change in the clinical picture, with incr...

An evaluation of anticoagulant therapy in acute myocardial infarction.

An evaluation of anticoagulant therapy in acute myocardial infarction.

THE SELECTIVE USE OF ANTICOAGULANTS IN ACUTE MYOCARDIAL INFARCTION BASED ON INITIAL PROGNOSIS

Excerpt Reliable evidence accumulated in the last 10 years has indicated that anticoagulants are of decided value in the prevention and treatment of thromboembolic diseases. Beginning with Wright's...

An evaluation of anticoagulant therapy in myocardial infarction based on prognostic categories

Dicumarol or dicumarol and heparin were administered during one hundred episodes of acute myocardial infarction. An earlier group of 211 patients served as controls. Patients were sorted into prognostic categories according to the following criteria: (1) Very poor risks: (a) The attack was the patient's first; shock and diabetes or shock and azotemia were present; ( b) a previous attack had occurred; shock was present or congestive failure and diabetes and azotemia were present. (2) Poor risks: Shock, congestive failure, diabetes or azotemia were present within the first week of admission. (3) Good risks: None of the concomitant manifestations in groups 1 and 2 were present. Anticoagulants failed to improve the mortality in the “very poor risk” category. The mortality in the “good risk” category was very small with or without anticoagulants. The beneficial effects of anticoagulants were most apparent in the “poor risk” group of patients and then chiefly so in those less severely ill. Such beneficial effects cannot be entirely ascribed to a reduction in thromboembolic phenomena. The need for further evaluation of anticoagulant therapy in myocardial infarction within a framework of prognostic categories is emphasized.

An evaluation of anticoagulant therapy in the treatment of acute myocardial infarction

T HE possibility that anticoagulants may be of value in the prevention and treatment of acute myocardial infarction was suggested by a series of animal experiments in which the incidence of artifically induced intravascular clots was observed to be dramatically reduced by the use of heparin.‘e4 In 1941 and 1942, heparin or Dicumarol was first used clinically in individual cases or in small series of cases of acute myocardial infarction. The first American report concerned exclusively with the use of Dicumarol in acute coronary occiusion appeared in December, 1945, when Wright5 described his experience with seventy-six cases. Between the time of that report and 1949, over twenty individual series of cases were published in the American literature. As reflected in these reports, the greatest experience with this means of therapy was obtained by Peters, Guyther, and Brambe16s7 in Baltimore, by Nichol8-1a in Miami, by Parker and Barker 11~12 at the Mayo Clinic, and by Wright and his associates13-l7 in New York. Although the early reports seemed consistently favorable, the results were in no instance based upon a sufficiently large series of properly controlled cases to warrant statistical analysis. These initial observations did, however, lead to the more extensive study carried out by the American Heart Association’s committee for the evaluation of anticoagulants in the treatment of coronary occlusion with myocardial infarction. This large-scale investigation1GJ8Jg at sixteen leading hospital centers provided data for statistical analysis of 1,031 cases of acute myocardial infarction. Of this number, 442 received conventional treatment for coronary thrombosis while 589 received heparin or Dicumarol or both. Of those patients not receiving anticoagulant therapy, 23.4 per cent died as compared to a mortality of 16.0 per cent in the group receiving this form of treatment. It appeared from these findings that approximately one-third of the expected deaths was prevented by the administration of anticoagulant drugs. Similarly, when the percentage of cases developing thrombo-embolic complications was examined, it was found that in the control group 26.0 per cent developed one or more of these complications as compared with 10.9 per cent in the treated group. The greatest benefits in the reduction of mortality were in patients 60 years of age or over. The crude death rates for patients less than 60 years in both the treated and control

Evaluation of anticoagulant therapy in congestive heart failure.

A one year study evaluating anticoagulant drugs as an adjunct in the management of congestive heart failure has been carried out on 300 patients. Depo-Heparin and dicumarol were the drugs employed. The effect of anticoagulant therapy upon the incidence of thromboembolic complications and mortality has been studied.