The Incidence of Deep Venous Thrombosis in Patients with an Acute Myocardial Infarction Treated with Acenocoumarol or Indobufen

1982 ◽  
Vol 48 (02) ◽  
pp. 222-225 ◽  
Author(s):  
S H A Peters ◽  
J J C Jonker ◽  
A C de Boer ◽  
G J H den Ottolander
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Prognostic Index ◽  
Impedance Plethysmography ◽  
Antiplatelet Drug ◽  
Bleeding Complications ◽  
Double Blind ◽  
Significant Difference

SummaryIn a randomized double blind clinical trial, we compared indobufen, an antiplatelet drug, with acenocoumarol for the prevention of deep venous thrombosis (D. V. T.) in patients with acute myocardial infarction. Therapy was started on admission and continued for 10 days. All patients were screened daily with impedance plethysmography (I.P.G.) and 125I-fibrinogen leg scanning. Diagnosis of D.V.T. was made when either one or both tests became positive. 74 patients were randomized to treatment with indobufen (200 mg b.i.d.) and 76 patients to acenocoumarol (controlled by thrombotest). The incidence of venous thrombosis in patients with indobufen was 11% and in those treated with acenocoumarol 9%. Major bleeding was observed in 2 patients treated with acenocoumarol. In the indobufen group, no bleeding complications or other serious side-effects were observed. The majority of patients developed thrombosis after the first week of admission. For patients with and without thrombosis, there was no significant difference between the two treatment groups concerning the age, the coronary prognostic index, the maximum C.P.K. value, mobility, incidence of congestive heart failure and the site or extent of the infarct. In this study no clinical or laboratory (fibrinogen, platelet count and anti-thrombin III) parameter, either alone or in combination, was of predictive value for the development of D.V.T. It can be concluded that indobufen appears to be as good as acenocoumarol for the prevention of D.V.T. in patients with acute myocardial infarction. Because it is safe and easy to administer, indobufen seems to be preferable. Prophylaxis is required for at least 10 days.

scholarly journals The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.S Yeh ◽  
C.Y Hsu ◽  
C.Y Huang ◽  
W.T Chen ◽  
Y.C Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Funding Source ◽  
P2y12 Inhibitor ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

Subcutaneous Heparin in the Prevention of Venous Thrombosis After Elective Aortic Bifurcation Graft Surgery

1979 ◽  
Author(s):  
J.J.F. Belch ◽  
G.D.O. Lowe ◽  
J.G. Pollock ◽  
C.D. Forbes ◽  
C.R.M. Prentice
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Controlled Trial ◽  
Bleeding Complications ◽  
Aortic Bifurcation ◽  
Double Blind ◽  
Risk Of Bleeding ◽  
Subcutaneous Heparin ◽  
Calcium Heparin ◽  
Intravenous Sodium

In a randomised double-blind controlled trial 24 patients undergoing elective aortic bifurcation graft surgery received subcutaneous calcium heparin (2, 500 u preoperatively then 5,000 u 12 hourly or 7 days) and 25 control patients received saline injections. All patients received the routine dose of intravenous sodium heparin intraoperatively. The trial was terminated because of excess bleeding complications in patients on subcutaneous heparin (8 vs. 1, p<0.05). Deep venous thrombosis was diagnosed by 125I-fibrinogen scanning in 8 control patients and 3 patients on heparin (p>0.05). In this group of patients the risk of bleeding due to subcutaneous heparin appeared to outweigh the benefit of thrombotic prophylaxis.

Subcutaneous Heparin For Prophylaxis For Recurrent ThromBoembolism

1981 ◽  
Author(s):  
J A Caprini ◽  
C J Thorpe ◽  
S J Torkelson ◽  
J P Vagher ◽  
A Z Delos Reyes ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Pulmonary Embolus ◽  
Oral Anticoagulant Therapy ◽  
Clinical Signs ◽  
Impedance Plethysmography ◽  
Heparin Therapy ◽  
Bleeding Complications ◽  
Subcutaneous Heparin ◽  
Intravenous Heparin

One hundred consecutive patients with thromboembolic disease were treated with subcutaneous heparin to prevent recurrence of deep venous thrombosis (70 patients), pulmonary embolus (21), or both deep venous thrombosis and pulmonary embolus (9). Thrombosis was documented by venography, doppler ultrasound, impedance plethysmography, V-P lung scanning, or pulmonary angiography. The hospitalized patients received intravenous heparin for an average of 12.3 days. Intravenous heparin was overlapped with the first dose of 5000 units of subcutaneous heparin which was then given every 12 hours. Fifteen patients had the subcutaneous dosage increased before discharge and 52 had changes in dosage at some point during therapy according to test results. Subcutaneous heparin therapy averaged 111 days per patient (range - 15 days to 16 months). No episodes of major bleeding occurred, although 5 patients had minor localized eccymosis or rash. Self-injection was well accepted and tolerated by the patients. Clinical examination, hematocrit platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin split products, and thrombelastography were performed every six weeks. Doppler and impedance plethysmography studies were repeated if clinical signs persisted or recurred. Two patients had recurrent nonfatal deep vein thrombosis 3 months after starting subcutaneous heparin therapy. Both of these patients originally had above knee thrombi.The results suggest that self-administered subcutaneous heparin injections titered to laboratory tests are effective in preventing recurrent thromboembolism without bleeding complications. This approach represents an effective alternative to oral anticoagulant therapy.

scholarly journals Coronary flow and hemorrhagic complications after alteplase and streptokinase administration in patients with acute myocardial infarction

2009 ◽  
Vol 66 (3) ◽  
pp. 218-222
Author(s):  
Tomislav Kostic ◽  
Zoran Perisic ◽  
Dragan Milic ◽  
Svetlana Apostolovic ◽  
Sonja Salinger-Martinovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Major Bleeding ◽  
Coronary Flow ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Group I ◽  
Number Of Patients ◽  
Significant Difference ◽  
St Elevation

Background/Aim. Up-to-date treatment of acute myocardial infarction (AIM) has been based on as early as possible establishment of circulation in ischemic myocardium whether by the use of fibrinolythic therapy and/or urgent coronary intervention which significantly changes the destiny of patients with AMI, but also increases the risk of bleeding. The aim of this study was to compare coronary flow and bleeding complications in patients with acute myocardial infarction with ST-elevation (STEMI) after administration of alteplase or streptokinase. Methods. The study included 254 patients with STEMI. The group I (n = 174) received streptokinase, and the group II (n = 80) received alteplase. We followed frequency of complications such as bleeding and hypotension in the investigated groups of patients, based on the TIMI classification of bleeding, as well as the transience of infarction artery in accordance with TIMI flow. Results. The patients with myocardial infarction after administration of alteplase had statistically significantly higher coronary flow (TIMI- 3), 72.5% as compared to the patients who received streptokinase, 39.2%. Hypotension as complication of fibrynolythic therapy administration occurred in a significantly higher percentage in the group of patients who received streptokinase. There was no statistically significant difference in the appearance of major bleeding in the groups of patients who received streptokinasis and alteplase (6.9% and 7.5%, respectively). Also, there was no difference in the appearance of minor and minimal bleeding among the investigated groups of patients. Conclusion. It was shown that alteplase in a higher number of patients provided TIMI-3 coronary flow as compared to streptokinese. In comparison with streptokinase, a combination of alteplase, enoxaparin and double antiplatelet therapy enabled earlier achievement of coronary flow through previously blocked coronary artery that was more complete (higher frequency of TIMI-3 flow). There were no statistically significant difference in frequency of bleeding, first of all major bleeding, between the groups treated by alteplase and streptokinase.

EARLY RESULTS OF A RANDOMIZED, DOUBLE-BLIND DOSE-RANGING STUDY OF I.V. STREPTOKINASE FOR ACUTE MYOCARDIAL INFARCTION

1987 ◽  
Author(s):  
A J Six ◽  
J W Louwerenburg ◽  
R Braams ◽  
W L Mosterd ◽  
A C Bredero ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Bleeding Complications ◽  
Puncture Site ◽  
Double Blind ◽  
Early Results ◽  
Life Threatening ◽  
Dose Ranging ◽  
Concomitant Medications ◽  
Higher Doses

101 patients suffering from acute myocardial infarction during less than 4 hours were immediately treated with intravenous (i.v.) streptokinase (SK), infused in 1 hour. No concomitant medications like steroids, salicylates or anti-arrhythmic drugs were routinely given.Patients were blindly allocated to one of four dosages of SK (see below). Coronary angiography was performed within 3 hours after SK infusion in 90% of all patients . The infarct-related vessel was open in 59% of 91 patients. The results in the four dosage groups were as follows:Haematomas at the puncture site were common complications in all groups. No strokes occurred, nor life-threatening bleeding complications. Blood transfusion was needed in only one parient, who had an important bleeding and formation of a large haematoma at the puncture site.It is concluded that there is a trend to better results of higher doses of i.v. SK in patients suffering from acute myocardial infarction without an evident rise of the rate of complications. The efficacy and safety of recently developed fibrinolytic drugs and streptokinase should be compared at optimal dosages.

Deep Venous Thrombosis and Pulmonary Embolism in Acute Myocardial Infarction

2015 ◽  
pp. 113-119
Author(s):  
P. Niederle ◽  
I. Prerovsk� ◽  
J. šimonov� ◽  
V. št�dlerov� ◽  
M. Riedel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis

INFLUENCE OF RECOMBINANT PRO-UROKINASE ON THE HEMOSTATIC SYSTEM IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

1987 ◽  
Author(s):  
U Schmitz-Huebner ◽  
H Ostermann ◽  
D G Mathey ◽  
J Schofer ◽  
Ch Diefenbach ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Multicenter Trial ◽  
Bleeding Complications ◽  
Single Chain ◽  
Double Blind ◽  
Mean Values ◽  
Hemostatic System ◽  
Type Plasminogen Activator ◽  
Urokinase Type Plasminogen Activator

Recombinant unglycosylated pro-urokinase (recombinant single chain urokinase-type plasminogen activator, CG4509) was given to twelve patients (pts.) with acute myocardial infarction as a 20 mg bolus followed by a 60 mg intravenous infusion (iv.inf.) over 1 hour and to twelve pts. as a 10 mg bolus followed by a 30 mg iv.inf. over 1 hour. Reperfusion was angiographically confirmed in 9/12 pts. with the higher dose and in 6/12 pts. who obtained the lower dose. Different parameters of hemostasis were determined before administration, 30 min after the beginning of inf.,at the end of inf., 60 min thereafter and 6-12 hours afterwards .The most significant systemic changes were observed 60 min after the end of inf. when the following mean values ± SEM were determined (pre-inf. values in brackets):Fibrinolytic activity in plasma determined on fibrin plates was highest in both groups 30 min after the beginning of inf. and hardly measurable 60 min after the end of inf. No bleeding complications were observed. Based on these results,a randomized double-blind multicenter trial was started to study the effects of 80 mg CG 4509 versus 1.5 million U streptokinase iv.

Value of Low Dose Heparin in Prevention of Deep Venous Thrombosis After Acute Myocardial Infarction

1979 ◽  
Author(s):  
J.F. Cade
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Cardiac Failure ◽  
Low Dose ◽  
Medical Patients ◽  
Dose Heparin ◽  
Coronary Care ◽  
Low Dose Heparin

Low-dose heparin has become widely used in the prophylaxis of venous thromboembolism in surgical patients but its use in medical patients is less well established. In particular, the reported incidence of deep venous thrombosis (DVT) after acute myocardial infarction (AMI) has varied considerably, as has its response to low-dose heparin prophylaxis. In 94 patients admitted with a provisional diagnosis of AMI, treatment was allocated randomly and blindly as either heparin 5,000 U subcutaneously twice daily or placebo. DVT was diagnosed by daily 125-I fibrinogen leg scanning. DVT occurred in 10% of control patients and in 3% of treated patients. All DVT’s occurred in patients with subsequently proven AMI (68% of admissions) in whom the incidence was 19% in those untreated and 5% in those treated. DVT was more common in patients with cardiac failure (14%) than in those without (3%). There was no difference in incidence of DVT between patients with or without clinically significantly arrhythmias or hypotension. Multivariate analysis combining these factors failed to improve the prediction of DVT. It is concluded that patients admitted for acute Coronary Care are a relatively low risk group for DVT. Minidose heparin appears to be warranted only in those with proven AMI and cardiac failure.

Fibrinolytic drugs in acute myocardial infarction

1988 ◽  
Vol 26 (12) ◽  
pp. 45-48
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Coronary Arteries ◽  
Myocardial Necrosis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Activator Complex

Fibrinolytic drugs have been used with varying degrees of enthusiasm for treating various thrombotic disorders including deep venous thrombosis and pulmonary embolism.1,2 Recently, the use of fibrinolysis in acute myocardial infarction has come to the fore. Streptokinase and two new fibrinolytic drugs (Anisoylated Plasminogen Streptokinase Activator Complex - APSAC, and Recombinant Tissue Plasminogen Activator - rTPA) have been investigated and shown to achieve reperfusion of thrombosed coronary arteries, so reducing myocardial necrosis. Only streptokinase and APSAC have been shown to decrease mortality, and then only if they are given soon after the onset of symptoms.

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