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.
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.
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
ObjectiveTo analyze the global status, hotspots, and trends in atrial fibrillation anticoagulation research.MethodsWe searched Web of Science Core Collection to collect relevant literature on atrial fibrillation anticoagulation from 2006 to 2020. The visualization software CiteSpace and VOSviewer were used to analyze co-citation, co-occurrence, and emergence analysis on publishing organizations, journals, and keywords and to explore the research hotspots and frontiers.ResultsA total of 11764 related studies were retrieved. In recent years, research on anticoagulation of atrial fibrillation has become increasingly popular. Most of the published researches were from North America, and the primary institution was the University of Birmingham. Research hotspots mainly focused on warfarin, stroke prevention, new oral anticoagulants, antithrombotic and anticoagulants, and complicating diseases. The research frontiers were the new oral anticoagulants, and the antithrombotic management of atrial fibrillation with coronary heart disease.ConclusionsThe global hotspot in atrial fibrillation anticoagulant research is warfarin, stroke prevention, new oral anticoagulants, antithrombotic and antiplatelet therapy, and complicated diseases. The research focuses on the study of novel oral anticoagulants and the antithrombotic management of atrial fibrillation complicated with coronary heart disease.
Abstract: There is a 1% - 4% incidence of cardiac disease in pregnancy, and rheumatic heart disease is the most common diagnosis. On the condition that medical treatment is inefficacious, an open heart surgery should be performed. Because of the changes in physiological functions, there is a major difference between pregnant patients and the general population in perioperative management of valve replacement. Now , the pregnancy is not an absolute contraindication for cardiopulmonary bypass, though the incidence of mortality and birth defects remains high. It is helpful in decreasing complications and increasing survival rate by improving themethods of cardiopulmonary bypass, postoperative monitoring, anticoagulation etc. In this article, the progress in t reatments of perioperative period of cardiac valve replacement during pregnancy is reviewed.
Objective?To explore the clinical and imaging features of cranial venous sinus thrombosis (CVST).
MethodsThe clinical data of 20 patients with CVST treated between January 2008 and December 2012 were retrospectively analyzed, including the clinical manifestations, neuroimaging characters and treatment outcomes.
ResultsAmong the 20 patients, there were 10 infected cases; D-dimer was detected positively in only 2 cases; cerebrospinal fluid pressure increased in 13 patients; and red blood cell population of cerebrospinal fluid increased in 12 patients. The common clinical symptoms included headache in 16 cases, eye symptoms in 12 cases, and vomiting in 10 cases. CT showed the direct signs of CVST in 3 cases, and MRI showed the direct signs of CVST in 6 cases. The common disease regions were in left transverse sinus and sigmoid sinus in 5 cases, superior sagittal sinus in 5 cases, and multiple venous sinus in 5 cases. Eighteen patients only received anticoagulation, and 2 received anticoagulation and local thrombolytic treatment. Fourteen cases recovered fully, 6 had dysfunctions.
ConclusionThe clinical manifestations of CVST are nonspecific. This disorder predominantly affects childbearing women. Infection is a common cause of CVST. The occlusive venous sinus can be confirmed by enhanced magnetic resonance venography or digital subtraction angiography. Anticoagulation and local thrombolytic therapy are both proved to be safe and effective in the treatment of CVST. The early diagnosis rate of CVST remains to be improved.
Recent clinical trials showed that dabigatran was superior to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation, however whether it is suitable for the lifelong anticoagulation in patients after heart valve replacement, remains controversial. Many animal experiments showed that dabigatran group was better than heparin and warfarin in the prevention of thrombosis and bleeding complications after valve replacement. Randomized, phaseⅡstudy to evaluate the safety and pharmacokinetics of oral dabigatran etexilate in patients after heart valve replacement (RE-ALIGN) clinical trial showed that dabigatran wasn't as effective as warfarin in preventing thrombosis, but increases the risk of bleeding. And there are some case reports about thrombosis and bleeding complications after taking dabigatran. At present, the efficacy and safety of dabigatran applying in patients after heart valve replacement still needs further study.
This article reports a patient diagnosed with severe aortic stenosis. After admission, the cardiac multidisciplinary team performed transcatheter aortic valve replacement (TAVR) emergently due to its unstable hemodynamics. The procedure was successful, and the initial cardiogram during the operation after TAVR suggested that the stenosis was greatly improved. But gradually the next day bedside echocardiography suggested that the transvalvular pressure difference increased and the prosthetic valve forward blood flow accelerated. Acute valve thrombosis after TAVR was taken into consideration. Warfarin and heparin were administrated for anticoagulation, after which the pressure difference across the valve and the forward blood flow rate of the artificial valve were evenly improved.
Objective
To explorer the application value of the inferior vena cava filter (IVCF) implantation in the prevention of recurrent pulmonary embolism (PE).
Methods
Clinical data of 265 inpatients with PE admitted from November 2014 to November 2016 were retrospectively analyzed. The patients were divided into an IVCF treatment group (55 cases) and an anticoagulant therapy group (210 cases) according to treatment measure. All patients were followed up for 3 months to 2 years through regular review. The one-year PE and deep vein thrombosis (DVT) recurrence rates, one-year mortality and two-year mortality were compared between two groups.
Results
The PE and DVT recurrence rates were 9.1% and 21.8% in the IVCF treatment group, and were 18.6% and 11.0% in the anticoagulant therapy group, respectively. The PE recurrence rate was lower and the DVT recurrence rate was higher in the IVCF treatment group compared with the anticoagulant therapy group, the differences were statistically significant (P<0.05). The one-year mortality (29.1% vs. 12.9%) and two-year mortality (34.5% vs. 14.8%) were significantly higher in the IVCF treatment group than those in the anticoagulant therapy group (P<0.05).
Conclusions
IVCF without anticoagulation can reduce incidence of pulmonary embolism caused by the lower extremity DVT, but will increase DVT recurrence rate. It may be an alternative option for prevention of PE in patients with contraindications to anticoagulant therapy or recurrent PE patients after regular anticoagulant therapy.
