Objective To explore the efficacy and safety of different Wafarin anticoagulation intensities in preventing thromboembolism in patients with paroxysmal non-valvular atrial fibrillation (PAF). Methods The patients with PAF were enrolled and divided into four groups. The patients were treated by different Wafarin anticoagulation intensities. The values of the control of international normalized ratio (INR) were 1.3-1.6 in Group 1, 1.7-2.0 in Group 2, 2.0-2.5 in Group 3, and 2.6-3.0 in Group 4. Main destination events, secondary destination events, main bleeding events, secondary bleeding events, main events (main destination events + main bleeding events), secondary events (secondary destination events + secondary bleeding events), and total events (main events + secondary events) were observed and compared in the four groups, respectively. Relevance between events of thromboembolism as well as bleeding and INR was analyzed. Results A total of 868 patients with moderate-high risk PAF were enrolled, and 826 patients (167 cases in Group 1, 220 cases in Group 2, 215 cases in Group 3, and 224 in Group 4) were included in final analysis. The follow-up results showed that the increase of INR led to a reduction in the destination events (there were significant differences between Group 1 and Group 2, 3, and 4 with Plt;0.05), but the bleeding events tended to rise. In terms of the incidence of main events, secondary events and total events, Group 1 was higher than Group 2, 3, and 4 with significant differences (Plt;0.05), except that the main event incidence of Group 1 was not significantly different from that of Group 4 (Pgt;0.05). Conclusion For Chinese patients with PAF, anticoagulation intensities of Wafarin with INR 1.7-2.5 can reduce the destination events with no rise in bleeding events. The anticoagulation intensities within this extent are safe and effective
Objective To explore the role of thrombus precursor protein(TPP) in the monitoring of anticoagulation in the patients with atrial fibrillation (Af) after mechanical heart valve replacement, and suggest the reasonable anticoagulant range. Methods Ninety patients were divided into Af group (n=45), sinus rhythm group (SR group, n=45), and control group (20 patients with non-valvular heart diseases), according to whether Af exist after mitral valve replacement. TPP concentrations and International Normalized Ratio(INR) in the anticoagulant patients were analyzed. Results In patients after mechanical mitral valve replacement, plasma TPP concentrations in both SR group and Af group were lower than that in control group (Plt;0.05,0.01), their INR value were higher than that in control group (Plt;0.01), and Af group had higher plasma TPP concentrations than that in SR group((Plt;)0.05). It was found that there existed contradictions between INR and plasma TPP concentrations in Af group. There were 28 patients with plasma TPP concentrations below 6 μg/ml and without spontaneous bleeding complications in the group with Af, who might be at the optimal anticoagulant status. Their 95% confidence of INR value was 1.90-2.30 and their plasma TPP concentration was 4.29±0.75μg/ml. Conclusion Patients with Af after mechanical heart valve replacement might have higher risk of thromboembolism, INR between 1.90 - 2.30 and plasma TPP concentration between 2.84-6.00 μg/ml might be the optimal anticoagulant therapeutic range.
ObjectiveTo investigate therapeutic strategy of acute pulmonary embolism. MethodsClinical data of 48 patients with acute pulmonary embolism who were treated in Affiliated Hospital of North Sichuan Medical College form January 2009 to May 2014 were analyzed retrospectively. ResultsOf the 48 cases, 14 cases of low risk (low risk group) were treated with anticoagulation, 24 cases of middle risk (middle risk group) were treated with anticoagulation and systematic thrombolysis or interventional therapy (local thrombolysis after thrombus fragmentation or thrombolytic catheter placement in pulmonary artery), 10 cases of high risk (high risk group) were treated with anticoagulation and interventional therapy. In low risk group, 12 cases (85.7%) were cured and 2 cases (14.3%) were markedly effective, and total effective rate was 100%. In middle risk group, 16 cases (66.7%) were cured and 8 cases (33.3%) were markedly effective, and total effective rate was 100%. In high risk group, 1 case died, 3 cases were cured, 2 cases were markedly effective, and 4 cases were better, and the total effective ratio was 9/10. All cases suffered from no complication such as hemorrhage of cerebral and digestive system. Forty-eight cases were followed up for 3-12 months, with a median time of 8 months. During the follow-up period, there was no complication occurred such as dyspnea, pulmonary embolism, placement change of filter net, and thrombosis. ConclusionsCorresponding therapeutic strategy would be taken according to risk stratification of the acute pulmonary embolism.
Objective To compare the clinical efficacy and safety of thrombolysis with anticoagulation therapy for patients with acute sub-massive pulmonary thromboembolism. Methods The clinical data of 84 patients with acute sub-massive pulmonary thromboembolism were analyzed retrospectively, mainly focusing on the in-hospital efficacy and safety of thrombolysis and/ or anticoagulation. The efficacy was evaluated based on 6 grades: cured, markedly improved, improved, not changed, deteriorated and died. Results Among the 84 patients,49 patients received thrombolysis and sequential anticoagulation therapy( thrombolysis group) , 35 patients received anticoagulation therapy alone( anticoagulation group) . As compared with the anticoagulation group, the thrombolysis group had higher effective rate( defined as patients who were cured, markedly improved or improved, 81. 6% versus 54. 3%, P = 0. 007) , lower critical event occurrence ( defined as clinical condition deteriorated or died, 2. 0% versus 14. 3% , P = 0. 032) . There was no significant difference in bleeding rates between the two groups ( thrombolysis group 20. 4% versus anticoagulation group 14. 3% , P gt; 0. 05) . No major bleeding or intracranial hemorrhage occurred in any of the patients. Conclusions Thrombolysis therapy may be more effective than anticoagulation therapy alone in patients with acute sub-massive pulmonary thromboembolism, and thus warrants further prospective randomized control study in large population.
Coronary heart disease with gastrointestinal bleeding is common in clinical practice. The disease is dangerous and has a high mortality rate. This article will review the risk factors for coronary heart disease with gastrointestinal bleeding (including Helicobacter pylori infection, long-term use of antiplatelet drugs and combined anticoagulation drugs), blood transfusion strategies (including hemoglobin transfusion thresholds and platelet transfusion strategies), and the management of antithrombotic drugs after bleeding (including the management of antiplatelet drugs and the management of anticoagulation combined with antiplatelet drugs). The purpose is to provide a theoretical basis for the diagnosis and treatment of coronary heart disease with gastrointestinal bleeding.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
Patients with heparin-induced thrombocytopenia have a poor prognosis and high mortality, thus surgical risk under extracorporeal circulation increased. Early diagnosis, safe and effective alternative anticoagulation strategy are crucial for these patients to receive extracorporeal circulation surgery. This review focuses on the pathophysiology, laboratory examination, diagnosis and alternative anticoagulation strategy of extracorporeal circulation for patients with heparin-induced thrombocytopenia.
In recent years, the field of transcatheter heart valve interventional therapy has developed rapidly. Valvular thrombosis is a rare postoperative complication, which can affect valvular function early or lead to clinical embolic events, and is gradually being valued by surgeons. The clinical manifestations of thrombosis after different types of interventional valve replacement are different. Although anticoagulant therapy is believed to be effective for valve thrombosis, the selection of anticoagulant drugs and the duration of anticoagulation are still controversial. This article reviews the definition, clinical features, prevention and treatment of valve thrombosis after several types of transcatheter heart valve replacement, mainly related to transcatheter aortic valve replacement and transcatheter mitral valve replacement, and aims to provide a reference for the diagnosis and treatment of valve thrombosis after transcatheter heart valve replacement.
Objective To investigate the risk factors and the prevention and cure methods of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Methods From March 2004 to July 2008，twentythree patients with ischemic stroke after mechanical heart valve replacement had been researched(ischemic stroke group). One hundred and twenty patients who had undergone mechanical heart valve replacement were randomly chosen in the same period as control group. Gender, age, the dose of warfarin , anticoagulation intensity(INR), INR review interval, left atrial diameter and heart rhythm were compared between the two groups, and the risk factors of ischemic stroke were analyzed by logistic regression analysis. Results (1) Patients in ischemic stroke group all discharged from hospital after treatment, and they were followed up for 1 month-3 years after discharged. All the patients’ neurological complications improved obviously, and no recurrent embolism and severe hemorrhage was found. (2) There was no statistical significance between two groups in gender, age and the dose of warfarin（Pgt;0.05）. (3) Nonconditional logistic regression analysis on influence factors showed that atrial fibrillation（P=0.000）, left atrial enlargement（P=0.002）, low anticoagulation intensity（P=0.012） and longtime INR review interval（P=0.047）were the risk factors of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Conclusions (1)The prognosis of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement is better than that of intracranial hemorrhage, and the occurrence of ischemic stroke is related to many risk factors. (2)The influences of risk factors should be minimized in order to avoid ischemic stroke. (3) Early low intensity anticoagulation therapy is safe and effective for patients with ischemic stroke after heart valve replacement.
Abstract： Objective To construct an Anticoagulation Therapy Database of Chinese Patients after Heart Valve Replacement in accordance with blood coagulation characteristics of Chinese patients， fill the gap of Chinese clinical research in valvular heart diseases， and provide a scientific and objective basic data and information exchange platform. Methods A national multicentre，prospective and cohort clinical research method was applied to establish an anticoagulation therapy database of Chinese patients after heart valve replacement， using the Internet as a platform. A case report form （CRF）， which was in line with the actual situation of Chinese anticoagulation patients after heart valve surgery， was formulated through the discussion of experts from 36 cardiovascular surgery centers in China in the starting meeting of National Science amp; Technology Support Program during the Twelfth Five-year Plan Period.We planned to prospectively include patients receiving warfarin anticoagulation therapy and formal anticoagulation monitoring after heart valve replacement from January 1, 2011 to December 31, 2014. Database was constructed using warehousing technology， which allowed not only data monitoring， query and statistics， but also regular data backup and system updates. Results A network database entitled Anticoagulant Therapy Database of Chinese Patients after Heart Valve Replacement was constructed and linked with the homepage of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery （http：//www. zgxxwkzz. com）， which constituted a national Internet information platform. From 1 January 2011 to 1 December 2012， 8 452 anticoagulation patients after heart valve replacement from 34 level-3A hospitals in China had been registered in the database. Further follow-up of these patients was being carried out in respective hospitals. Conclusion A large multi-center and open database and network information platform has been constructed. The database variables are in line with clinical characteristics of Chinese anticoagulation patients after heart valve replacement， which provide scientific and objective basic data and support for future clinical research and systemic analysis.