Effect of Ramadan Fasting on the International Normalized Ratio in Patients with Mechanical Prosthetic Heart Valves

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.

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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

Thrombosis and Haemostasis ◽

10.1160/th02-10-0159 ◽

2003 ◽

Vol 90 (08) ◽

pp. 267-271 ◽

Cited By ~ 18

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.

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Assessment of Anticoagulation Control Association with Warfarin Knowledge and Demographic Features of Iranian Population

Multidisciplinary Cardiovascular Annals ◽

10.5812/mca.112369 ◽

2021 ◽

Vol 12 (2) ◽

Author(s):

Mohammad Esmaeel Zangenehfar ◽

Iman Harirforoosh ◽

Bahram Mohebbi ◽

Zahra Khajali

Keyword(s):

Heart Valves ◽

Health Care Systems ◽

Therapeutic Index ◽

International Normalized Ratio ◽

Cross Sectional Study ◽

Anticoagulation Clinic ◽

Prosthetic Heart Valves ◽

Cross Sectional ◽

Vein Thrombosis ◽

Anticoagulation Control

Background: Warfarin is the most commonly used oral anticoagulant for patients with atrial fibrillation, prosthetic heart valves, and deep vein thrombosis with a narrow therapeutic index. Due to the importance of patients’ adherence to treatment and also regular measurements of International normalized ratio (INR), this can have a significant impact on the quality of anticoagulation control. Objectives: The primary aim of this study was to assess the association between warfarin knowledge and time in therapeutic range (TTR) in patients on warfarin anticoagulation for at least 6 months who were referred to anticoagulation clinic in Rajaie Heart Center during 2016 - 2017. Methods: In this cross-sectional study, 620 patients who had been referred to the outpatient Rajaie Hospital anticoagulant clinic and had been taking warfarin for over six months were asked to fill two questionnaires named anticoagulation knowledge assessment (AKA) during a 12-week period. After obtaining the necessary permits, TTR (by Rosendal method) was calculated using the INR results of patients. Results: A total of 620 patients completed the questionnaire. The relation between warfarin knowledge and anticoagulation control was not significant. The mean age of the study population was 52.45 SD ± 14.01 years. This study showed a significant relationship between TTR, duration of warfarin usage (PV = 0.03) and the underlying cause of this usage (PV = 0.016). Conclusions: Prevention of chronic diseases is one of the most important priorities of the health care systems. Reduction in complications such as thrombosis and bleeding can be achieved by efforts to promote patient’s knowledge. By recognition of relation between warfarin knowledge and social and demographic indicators, patient’s education gap can be detected and also planned for dissolving. This study showed that although many of the patients visited in anticoagulation clinic have poor anticoagulation control, but a major part of them have good knowledge of warfarin usage.

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Correlation between different anticoagulation schemes of pregnant women with mechanical prosthetic heart valves and adverse fetal/neonatal outcomes

10.21203/rs.3.rs-340670/v1 ◽

2021 ◽

Author(s):

Ziwen Zhao ◽

Xi Yang ◽

Ying Su ◽

Jun Zhang ◽

Yanna Li ◽

...

Keyword(s):

Pregnant Women ◽

Spontaneous Abortion ◽

Heart Valves ◽

Heart Function ◽

Unplanned Pregnancy ◽

International Normalized Ratio ◽

Prosthetic Heart Valves ◽

Tobit Regression ◽

Warfarin Group ◽

Tobit Regression Analysis

Abstract Pregnant women with mechanical prosthetic heart valves (MPHV) have adverse effects on the growth and development of the fetus. This study investigated the outcomes and correlations of MPHV pregnant women under different anticoagulation methods. Data on MPHV pregnant women and their offspring from our hospital from 2014 to 2020 were retrospectively collected. Various indicators of the offspring were analyzed, using single factor logistic regression and multi-factor Tobit regression to identify the main influencing factors of spontaneous abortion/stillbirth and malformation. There were 137 pregnancies, 96 in the warfarin group, 28 in the low-molecular-weight heparin (LMWH) group, and 13 in the sequential treatment group. Among these, there are 27 cases of spontaneous abortion, 3 cases of stillbirth and 56 live births. The international normalized ratio (INR, P < 0.001), prothrombin time (PT, P = 0.014), activated partial thromboplastin time (APTT, P = 0.035) of the neonates in the warfarin group were increased compared with the other two groups. Multivariate Tobit regression analysis showed that the probability of spontaneous abortion/stillbirth was positively correlated with INR before delivery (OR 1.13, P = 0.009) and valve usage time (OR 1.13, P = 0.009). The probability of malformation was positively correlated with heart function level (OR 1.20, P = 0.025) and INR (OR 1.18, P = 0.011) before delivery. Conclusion: The offspring of MPHV pregnant women who continuously take warfarin have poor outcomes and a significantly higher risk of early bleeding. Prenatal consultations for MPHV women should be strengthened to avoid unplanned pregnancy.

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Correlation between different anticoagulation schemes of pregnant women with mechanical prosthetic heart valves and adverse fetal/neonatal outcomes

10.21203/rs.3.rs-340670/v2 ◽

2021 ◽

Author(s):

Ziwen Zhao ◽

Xi Yang ◽

Ying Su ◽

Jun Zhang ◽

Yanna Li ◽

...

Keyword(s):

Pregnant Women ◽

Spontaneous Abortion ◽

Heart Valves ◽

Heart Function ◽

Unplanned Pregnancy ◽

International Normalized Ratio ◽

Prosthetic Heart Valves ◽

Tobit Regression ◽

Warfarin Group ◽

Tobit Regression Analysis

Abstract Pregnant women with mechanical prosthetic heart valves (MPHV) have adverse effects on the growth and development of the fetus. Data on MPHV pregnant women and their offspring from our hospital from 2014 to 2020 were retrospectively collected. There were 137 pregnancies, 96 in the warfarin group, 28 in the low-molecular-weight heparin (LMWH) group, 13 in the sequential treatment group. There are 27 cases of spontaneous abortion, 3 cases of stillbirth, 56 live births and 51 artificial abortion. The international normalized ratio (INR, P < 0.001), prothrombin time (PT, P = 0.014), activated partial thromboplastin time (APTT, P = 0.035) of the neonates in the warfarin group were increased compared with the other two groups. Multivariate Tobit regression analysis showed that the probability of spontaneous abortion/stillbirth was positively correlated with INR before delivery (OR 1.13, P = 0.009) and valve usage time (OR 1.13, P = 0.009). The probability of malformation was positively correlated with worse heart function level (OR 1.20, P = 0.025) and INR (OR 1.18, P = 0.011) before delivery. The offspring of MPHV pregnant women who continuously take warfarin have poor outcomes and a significantly higher risk of early bleeding. Prenatal consultations for MPHV women should be strengthened to avoid unplanned pregnancy.

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Decreased warfarin effects in elder with recurrent Clostridium difficile infection during fidaxomicin therapy: a case report

Clinical Management Issues ◽

10.7175/cmi.v9i1.953 ◽

2015 ◽

Vol 9 (1) ◽

pp. 7-12

Author(s):

Antonio Riccardo Buonuomo ◽

Maria Alessandra Foggia ◽

Emanuela Zappulo ◽

Guglielmo Borgia ◽

Ivan Gentile

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Heart Valves ◽

Product Information ◽

Anticoagulation Therapy ◽

The Elderly ◽

International Normalized Ratio ◽

First Episode ◽

Prosthetic Heart Valves ◽

Recurrent Clostridium Difficile Infection

Clostridium difficile infection is a disease with increasing incidence, particularly in high‑riskpatients such as the elderly, immunocompromised patients, etc.We report an unexpected decrease of International Normalized Ratio (INR) response to warfarin during a first recurrence of Clostridium difficile infection (CDI) treated with fidaxomicin. The patient, an old man who has prosthetic heart valves on anticoagulation therapy with warfarin, was treated with an association of vancomycin plus metronidazole for a first episode of CDI. Patient remained symptom‑free for few days and then he presented with recurrent diarrhea. A retreatment with vancomycin and metronidazole didn’t resolve symptoms of CDI, therefore he underwent fidaxomicin treatment for 10 days, with rapid resolution of diarrhea. In the meantime, warfarin effects diminished, and only with increases of dosage INR therapeutic range was achieved few days after discontinuing fidaxomicin. According to product information, fidaxomicin doesn’t interfere with warfarin. The authors highlight the different plausible mechanisms to explain the association between the unexpected decreased effect of warfarin and factors that could have influenced such event. The frequent update of product information through good pharmacovigilance practices could help clinicians in the management of unexpected events.

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The Effect of Dipyridamole and RA 233 on Human Platelet Function in Vitro

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648112 ◽

1973 ◽

Vol 29 (03) ◽

pp. 694-700 ◽

Cited By ~ 4

Author(s):

Paul L. Rifkin ◽

Marjorie B. Zucker

Keyword(s):

Mechanism Of Action ◽

Human Blood ◽

Glass Bead ◽

Heart Valves ◽

Human Platelet ◽

Drug Effects ◽

Simple Relation ◽

Prosthetic Heart Valves ◽

Induced Aggregation

SummaryDipyridamole (Persantin) is reported to prolong platelet survival and inhibit embolism in patients with prosthetic heart valves, but its mechanism of action is unknown. Fifty jxM dipyridamole failed to reduce the high percentage of platelets retained when heparinized human blood was passed through a glass bead column, but prolonged the inhibition of retention caused by disturbing blood in vitro. Possibly the prostheses act like disturbance. Although RA 233 was as effective as dipyridamole in inhibiting the return of retention, it was less effective in preventing the uptake of adenosine into erythrocytes, and more active in inhibiting ADP-induced aggregation and release. Thus there is no simple relation between these drug effects.

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