A prospective and randomized comparison of the safety and effects of therapeutic levels of enoxaparin versus unfractionated heparin in chronically anticoagulated patients undergoing elective cardiac catheterization

2003 ◽  
Vol 90 (08) ◽  
pp. 267-271 ◽  
Author(s):  
Christoph Hammerstingl ◽  
Harald Schmidt ◽  
Giso von der Recke ◽  
Wilhelm Paar ◽  
Berndt Lüderitz ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Unfractionated Heparin ◽  
Cardiac Catheterization ◽  
Heart Valves ◽  
Factor Xa ◽  
International Normalized Ratio ◽  
Prosthetic Heart Valves ◽  
Enoxaparin Group ◽  
Subcutaneous Enoxaparin ◽  
Anticoagulated Patients

SummaryConsecutive patients with atrial fibrillation and/or prosthetic heart valves, receiving chronic anticoagulation with phenprocoumon and scheduled to undergo cardiac catheterization, were randomized to subcutaneous enoxaparin twice daily (n = 32) or intravenous UFH (n = 36). Cardiac catheterization was performed at an international normalized ratio <1.5. Activated partial thromboplastin times and levels of anti-Factor Xa activity were measured daily. The time until effective anticoagulation (primary endpoint) was significantly shorter for enoxaparin than for UFH (1.1 ± 0.4 days versus 3.7 ± 2.5 days, p <0.0001). The percentage of days of effective anticoagulation was significantly higher in the enoxaparin group than in the UFH group (93.3 ± 9.5% versus 53.7 ± 26.6%, p <0.0001). In conclusion, enoxaparin achieves therapeutic levels of anticoagulation more rapidly and consistently than UFH in chronically anticoagulated patients with prosthetic heart valves and/or atrial fibrillation undergoing cardiac catheterization.

scholarly journals Changes in Prescribing Antithrombotic Therapy in Patients with Atrial Fibrillation in the Multidisciplinary Hospital in Volgograd from 2012 to 2020

2022 ◽  
Vol 17 (6) ◽  
pp. 831-836
Author(s):  
A. S. Gerasimenko ◽  
O. V. Shatalova ◽  
V. S. Gorbatenko ◽  
V. I. Petrov
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Clinical Guidelines ◽  
Antithrombotic Therapy ◽  
Heart Valves ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
International Normalized Ratio ◽  
Prosthetic Heart Valves ◽  
Discharge From Hospital

Aim. To study the frequency of prescribing antithrombotic agents in patients with non-valvular atrial fibrillation (AF) in real clinical practice, to evaluate changes of prescriptions from 2012 till 2020.Material and methods. The medical records of inpatients (Form 003/y) with the diagnosis AF, hospitalized in the cardiological department were analyzed. According to the inclusion criteria, the patients were over 18 years of age, established diagnosis of non-valvular AF. There were two exclusion criteria: congenital and acquired valvular heart disease and prosthetic heart valves. In retrospective analysis we have included 263 case histories in 2012, 502 ones in 2016 and 524 in 2020. CHA2DS2-VASc score was used for individual stroke risk assessment in AF. The rational use of the antithrombotic therapy was evaluated according with current clinical practice guidelines at analyzing moment.Results. During period of observation the frequency of antiplatelet therapy significantly decreased from 25,5% to 5,5% (р<0.001), decreased the frequency of administration of warfarin from 71,9% to 18,3% (р<0.001). The frequency of use of direct oral anticoagulants increased in 2020 compared to 2016 (р<0.001). For patients with a high risk of stroke anticoagulant therapy was administered in 71.8% of cases in 2012, 88.5% in 2016 and 92.5% in 2020. Before discharge from hospital majority of patients (72%) achieved a desired minimum international normalized ratio (INR) from 2.0 to 3.0 in 2012. In 2016 and 2020 an only 33% and 40.6% of patients achieved INR (2.0-3.0).Conclusion. Doctors have become more committed to following clinical guidelines during the period of the investigation. In 2020 antithrombotic therapy for atrial fibrillation was suitable according to current clinical guidelines.

scholarly journals Factors That Determine the Prothrombin Time in Patients With Atrial Fibrillation Receiving Rivaroxaban

2018 ◽  
Vol 24 (9_suppl) ◽  
pp. 188S-193S
Author(s):  
Jen-Hung Huang ◽  
Yung-Kuo Lin ◽  
Cheng-Chih Chung ◽  
Ming-Hsiung Hsieh ◽  
Wan-Chun Chiu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Prothrombin Time ◽  
Factor Xa ◽  
International Normalized Ratio ◽  
Biochemical Properties ◽  
Study Patient ◽  
Group 3 ◽  
Multiple Variables ◽  
Group 2 ◽  
Group 1

Rivaroxaban, a direct factor Xa inhibitor, is widely used to reduce the chance of stroke in patients with atrial fibrillation (AF). It is not clear why the prothrombin time (PT) of the international normalized ratio (INR) fails to correlate with treatment using rivaroxaban in patients with AF. In this study, patient characteristics, the rivaroxaban dosage, AF type, drug history, biochemical properties, and hematological profiles were assessed in patients treated with rivaroxaban. In 69 patients with AF receiving rivaroxaban, 27 (39.1%) patients had a normal INR (≤1.1, group 1), 27 (39.1%) patients had a slightly prolonged INR (1.1∼1.5, group 2), and 15 (21.7%) patients had a significantly prolonged INR (>1.5, group 3). Group 1 patients had a higher incidence of a stroke history than did patients in group 2 ( P = .026) and group 3 ( P = .032). We scored patients with a persistent AF pattern (1 point), paroxysmal AF pattern (0 point), renal function (ie, the creatinine clearance rate in mL/min/1.73 m2 of >60 as 0 points, of 30∼60 as 1 point, and of <30 as 2 points), and no history of stroke (1 point), and we found that group 3 had a higher score than groups 2 or 1 (2.9 ± 0.8, 2.4 ± 0.7, and 2 ± 0.7, respectively; P < .05). There were similar incidences of bleeding, stroke, and unexpected hospitalizations among the 3 groups. The PT of the INR is determined by multiple variables in patients with AF receiving rivaroxaban. Rivaroxaban-treated patients with AF having different INR values may have similar clinical outcomes.

scholarly journals Murcia atrial fibrillation project II: protocol for a prospective observational study in patients with atrial fibrillation

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033712
Author(s):  
José Miguel Rivera-Caravaca ◽  
Francisco Marín ◽  
María Asunción Esteve-Pastor ◽  
Josefa Gálvez ◽  
Gregory Y.H. Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Observational Study ◽  
Heart Valves ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Real Life ◽  
Poor Quality ◽  
Prosthetic Heart Valves

IntroductionAtrial fibrillation (AF) is characterised by a high stroke risk. Vitamin K antagonists (VKAs) are the most commonly used oral anticoagulants (OACs) in Spain, but their efficacy and safety depend on the time in therapeutic range of International Normalized Ratio (INR) 2.0–3.0 over 65%–70%. Unfortunately, the difficulties of maintaining an optimal level of anticoagulation and the complications of VKAs (particularly haemorrhagic ones), frequently lead to cessation of this therapy, which has been associated with higher risk of adverse events (AEs), including ischaemic stroke. Our aims are as follows: (1) to evaluate the quality of oral anticoagulation with VKAs, the prevalence of poor quality of anticoagulation, and to identify factors predisposing to poor quality anticoagulation; and (2) to identify patients who will stop OAC and to investigate what factors influence the decision of OAC withdrawal.Methods and analysisProspective observational cohort study including outpatients newly diagnosed with AF and naïve for OACs from July 2016 to June 2018 in an anticoagulation clinic. Patients with prosthetic heart valves, rheumatic mitral valves or valvular AF will be excluded. Follow-up will extend for up to 3 years. During this period, the INR results and changes in the anticoagulant therapy will be recorded, as well as all AEs, or any other information that would be relevant to the proper conduct of research.Ethics and disseminationAll patients were informed about the nature and purpose of the study, and the protocol was approved by the Ethics Committee of Hospital General Universitario Morales Meseguer (reference: EST:20/16). This is an observational study focusing on ‘real life’ practice and therefore all treatments and follow-up will be performed in accordance to the routine clinical practice with no specific interventions or visits. The results of our study will be disseminated by presentations at national and international meetings, and publications in peer-reviewed journals.

Anticoagulation after Artificial Valve Replacement with or without Atrial Fibrillation: How Much Is Really Needed?

1999 ◽  
Vol 82 (S 01) ◽  
pp. 130-135 ◽  
Author(s):  
Freek W. A. Verheugt
Keyword(s):  
Atrial Fibrillation ◽  
Heart Valve ◽  
Oral Anticoagulation ◽  
Artificial Heart ◽  
Heart Valves ◽  
Oral Anticoagulant Therapy ◽  
International Normalized Ratio ◽  
Artificial Heart Valve ◽  
Artificial Valve ◽  
Artificial Heart Valves

SummaryInsertion of a mechanical artificial heart valve is an absolute indication for the use of lifelong oral anticoagulation, irrespective the presence or absence of atrial fibrillation. Depending on the type and position of the artificial valve the optimal International Normalized Ratio (INR) for these patients is between 2.5 and 4.5, although more prospective studies on the optimal range of oral anticoagulation are necessary. Addition of low dose antiplatelet therapy may further decrease the rate of thromboembolism, but also here more studies are needed. Patients with a bioprosthesis need only oral anticoagulation for the first three months following surgery in the absence of an indication for anticoagulation for other conditions.Atrial fibrillation is often seen in patients with artificial heart valves. Stroke prevention can be instituted by the mandatory oral anticoagulant therapy. The presence of atrial fibrillation and the use of oral anticoagulation prior to heart valve surgery support the indication for the insertion of a mechanical artificial heart valve. However, relative contraindications to oral anticoagulation and the presence of sinus rhythm may favor the use of a bioprosthesis.

Warfarin Versus Warfarin and Dipyridamole on the Incidence of Arterial Throms Embolism in Prosthetic Heart Valve Patients

1979 ◽  
Author(s):  
S.M. Rajah ◽  
N. Sreeharan ◽  
S. Rao ◽  
D.A. Watson
Keyword(s):  
Atrial Fibrillation ◽  
Heart Valves ◽  
Prosthetic Heart Valve ◽  
Prosthetic Heart Valves ◽  
Post Mortem ◽  
Randomised Study ◽  
Yearly Incidence ◽  
The Mean ◽  
Prospective Randomised Study

The effect of Warfarin (W) was compared with a combination of Warfarin and Dipyridamole (W+D) on the incidence of arterial thrombo-embolism in patients with prosthetic heart valves in a prospective randomised study. Sixty-four and 53 patients were allocated to W and W+D. The two groups were comparable as regards age, sex, arrhythmias and site and type of valves. The dose of W was determined by regular monitoring of prothrombin ratio 0.9 - 3) and that of D by monitoring serum D levels to between 2 and 4 μmol/l. The mean period of follow-up was 26.98 months (range 1 to 36) for W and 22.02 months (range 1 to 36) for W+D. Six patients in W and 1 in W+D developed arterial thrombo-embolic episodes giving an incidence of 0.0035 per patient month for W and 0.0009 per patient month for W+D. An actuarial analysis of the yearly incidence of thrombo-embolism confirmed the superiority of W+D over W. Of the 6 failures in W, 5 were in sinus rhythm and 1 in atrial fibrillation and all had cerebral embolic episodes. The failure in W+D was a patient in atrial fibrillation who died suddenly 6 weeks after surgery and the post-mortem showed clots on both mitral and aortic prostheses.

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