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warfarin in mechanical valve

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https://www.readbyqxmd.com/read/28079798/clinical-and-genetic-factors-associated-with-warfarin-maintenance-dose-in-northern-chinese-patients-with-mechanical-heart-valve-replacement
#1
Rui Liu, Jian Cao, Qian Zhang, Xin-Miao Shi, Xiao-Dong Pan, Ran Dong
The effects of genetic variants on warfarin dosing vary among different ethnic groups, especially in the Chinese population. The objective of this study was to recruit patients through a rigorous experimental design and to perform a comprehensive screen to identify gene polymorphisms that may influence warfarin dosing in northern Han Chinese patients with mechanical heart valve replacement. Consenting patients (n = 183) with a stable warfarin dose were included in this study. Ninety-six single nucleotide polymorphisms (SNPs) in 30 genes involved in warfarin pharmacological pathways were genotyped using the Illumina SNP GoldenGate Assay, and their associations with warfarin dosing were assessed using univariate regression analysis with post hoc comparison using least significant difference analysis...
January 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28070934/long-term-outcomes-after-mechanical-aortic-valve-replacement-with-aortic-root-enlargement-in-adolescents
#2
Zhiwei Xu, Qiuxia Shi, Ju Mei, Yan Tan
BACKGROUND: Deciding which prosthetic aortic valve to choose is difficult in adolescents who have not yet met their full growth potential. The aim of this study was to assess long-term outcomes following mechanical aortic valve replacement with aortic root enlargement in adolescents. METHODS: Between September 1997 and December 2006, 58 consecutive adolescents (49 male, 9 female, median age 15.5, range 13 to 17 years) underwent mechanical aortic valve replacement with aortic root enlargement...
January 10, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28061906/bilateral-rectus-sheath-haematoma-complicating-dengue-virus-infection-in-a-patient-on-warfarin-for-mechanical-aortic-valve-replacement-a-case-report
#3
Chamith Thushanga Rosa, Mitrakrishnan Rayno Navinan, Sincy Samarawickrama, Himam Hamza, Maheshika Gunarathne, Arulprashanth Arulanantham, Neeha Subba, Udari Samarasiri, Thushara Mathias, Aruna Kulatunga
BACKGROUND: The management of Dengue virus infection can be challenging. Varied presentations and numerous complications intrinsic to dengue by itself increase the complexity of treatment and potential mortality. When burdened with the presence of additional comorbidities and the need to continue compulsory medications, clear stepwise definitive guidance is lacking and patients tend to have more complex complications and outcomes calling to question the clinical decisions that may have been taken...
January 7, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28004413/direct-oral-anticoagulant-use-in-nonvalvular-atrial-fibrillation-with-valvular-heart-disease-a-systematic-review
#4
REVIEW
Ryan E Owens, Rajesh Kabra, Carrie S Oliphant
Direct oral anticoagulants (DOACs) are indicated for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), which, according to the American College of Cardiology/American Heart Association/Heart Rhythm Society atrial fibrillation (AF) guidelines, excludes patients with rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair. However, the data regarding use of DOACs in AF patients with other types of valvular heart disease (VHD) are unclear. We aimed to summarize and evaluate the literature regarding the safety and efficacy of DOAC use in NVAF patients with other types of VHD...
December 22, 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/27989069/successful-treatment-of-very-early-thrombosis-of-sapien-3-valve-with-direct-oral-anticoagulant-therapy
#5
Neil Ruparelia, Vasileios F Panoulas, Angela Frame, Nilesh Sutaria, Ben Ariff, Deepa Gopalan, Andrew Chukwuemeka, Ghada W Mikhail, Iqbal S Malik
Thrombosis of transcatheter aortic valve implantation (TAVI) is an uncommon complication that commonly occurs weeks to months following the procedure. Herein are described the details of a patient who presented with a recurrence of symptoms days after intervention with a bioprosthesis thrombosis that was successfully treated with direct oral anticoagulant (DOAC) therapy and resulted in hemodynamic improvement and resolution of symptoms. Whilst a previous trial of DOAC therapy with mechanical valves was stopped due to elevated events in comparison to warfarin, a TAVI valve may be different, and the rapid onset of action and reduced bleeding risk may be beneficial in this patient group...
March 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/27823679/incidence-and-risk-factors-for-thromboembolism-and-major-bleeding-in-patients-with-mechanical-valve-prosthesis-a-nationwide-population-based-study
#6
Ashkan Labaf, Peter J Svensson, Henrik Renlund, Anders Jeppsson, Anders Själander
BACKGROUND: Risk factors of stroke/thromboembolism (TE) and major bleeding, and incidence of these events in specific age categories in warfarin-treated patients with mechanical heart valves (MHV) are uncertain. Our objective was to calculate event rates in specific age categories and identify risk factors for adverse events. METHODS AND RESULTS: We identified 4,810 treatment periods with MHV between January 2006 and December 2011 in the Auricula and Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registries...
November 2016: American Heart Journal
https://www.readbyqxmd.com/read/27798318/comparing-usual-care-with-a-warfarin-initiation-protocol-after-mechanical-heart-valve-replacement
#7
Gregory Roberts, Rasha Razooqi, Stephen Quinn
BACKGROUND: The immediate postoperative warfarin sensitivity for patients receiving heart valve prostheses is increased. Established warfarin initiation protocols may lack clinical applicability, resulting in dosing based on clinical judgment. OBJECTIVE: To compare current practice for warfarin initiation with a known warfarin initiation protocol, with doses proportionally reduced to account for the increased postoperative sensitivity. METHODS: We compared the Mechanical Heart Valve Warfarin Initiation Protocol (Protocol group) with current practice (clinical judgment-Empirical group) for patients receiving mechanical heart valves in an observational before-and-after format...
October 25, 2016: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/27754958/point-of-care-testing-inr-an-overview
#8
Doris Barcellona, Lara Fenu, Francesco Marongiu
Oral anticoagulant therapies with the anti-vitamin K drugs (AVK), warfarin, acenocoumarol and phenprocoumon, are employed in primary and secondary anti-thrombotic prophylaxis in patients with venous thromboembolism, atrial fibrillation and cardiac mechanical valves. However, a monitoring test such as the International Normalized Ratio (INR) is required. The periodic monitoring of this therapy entails discomfort for the patients. Telemedicine and telecare can provide significant aid in the management of this therapy allowing patients to perform the test at home or anywhere else with a portable device, i...
October 18, 2016: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/27733991/a-korean-multi-center-survey-about-warfarin-management-before-gastroenterological-endoscopy-in-patients-with-a-history-of-mechanical-valve-replacement-surgery
#9
Kuk Hui Son, Chang-Hyu Choi, Jae-Ik Lee, Kun Woo Kim, Ji Sung Kim, So Young Lee, Kook Yang Park, Chul Hyun Park
BACKGROUND: Guidelines for esophagogastroduodenoscopy (EGD) in the West allow the continued use of warfarin under therapeutic international normalized ratio (INR) level. In Korea, no guidelines have been issued regarding warfarin treatment before EGD. The authors surveyed Korean cardiac surgeons about how Korean cardiac surgeons handle warfarin therapy before EGD using a questionnaire. Participants were requested to make decisions regarding the continuation of warfarin therapy in two hypothetical cases...
October 2016: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27706532/optimal-anticoagulation-for-pregnant-women-with-mechanical-heart-valves
#10
Rohan D'Souza, Candice K Silversides, Claire McLintock
The prothrombotic state of pregnancy increases the risk of thromboembolic complications and death in women with mechanical heart valves (MHVs). Although it is accepted that these women must be on therapeutic anticoagulation throughout pregnancy, competing maternal and fetal risks, as well as the lack of high-quality data from prospective studies, make the choice of the optimal method of anticoagulation challenging. Vitamin K antagonists (VKAs) are associated with fewer maternal complications, but conversely also the lowest live birth rates as well as warfarin-related embryopathy and fetopathy...
October 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27679745/documentation-of-various-approaches-and-outcomes-in-patients-on-warfarin-undergoing-dental-procedures-a-review-article
#11
Fayez El Shaer, Ismael Raslan, Nora Al Osaimi, Ghada Bawazeer, Fhakr Alayobi, Tarek Alhogbani, Suliman Kharabsheh, Walid Al Habeeb
Appropriate management of patients with mechanical prosthetic valves on warfarin during dental procedures is crucial. If the patients continue warfarin, they might develop bleeding, while interruption of therapy can cause thromboembolic events. Bridging therapy (mostly heparin) is used in some patients, while others stop medications. There is no unifying protocol. Information on management of patients on warfarin undergoing dental procedures in Saudi Arabia is lacking. Therefore, the current study aimed to provide more insight into various approaches utilized by clinicians to deal with such patients at a large teaching hospital in Riyadh, and to evaluate the frequency and severity of bleeding and thromboembolic complications during different types of dental procedures in this population...
2016: American Journal of Cardiovascular Disease
https://www.readbyqxmd.com/read/27621487/anticoagulant-and-antiplatelet-prescribing-patterns-for-patients-with-atrial-fibrillation-after-percutaneous-coronary-intervention
#12
Erin A Woods, Margaret L Ackman, Michelle M Graham, Sheri L Koshman, Rosaleen M Boswell, Arden R Barry
BACKGROUND: Current guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, for patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation. The choice of anticoagulant/antiplatelet therapy in this population is ambiguous and complex, and prescribing patterns are not well documented. OBJECTIVE: To characterize local prescribing patterns for anticoagulant/antiplatelet therapy after percutaneous coronary intervention in patients with nonvalvular atrial fibrillation...
July 2016: Canadian Journal of Hospital Pharmacy
https://www.readbyqxmd.com/read/27595409/practical-considerations-for-the-nonvitamin-k-antagonist-oral-anticoagulants
#13
Rahul Trikha, Peter R Kowey
OBJECTIVES: Dabigatran, rivaroxaban, apixaban, and edoxaban are nonvitamin K antagonist oral anticoagulants (NOACs) approved for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). Phase-3 clinical trials demonstrated NOACs were as effective as warfarin in the prevention of stroke or systemic embolism and associated with decreased incidences of intracranial bleeding. Additionally, NOACs provide quicker onset of action, simpler dosing, more predictable pharmacokinetic profiles, and decreased food and drug interactions compared with warfarin...
2017: Cardiology
https://www.readbyqxmd.com/read/27590664/warfarin-treatment-quality-and-prognosis-in-patients-with-mechanical-heart-valve-prosthesis
#14
Bartosz Grzymala-Lubanski, Peter J Svensson, Henrik Renlund, Anders Jeppsson, Anders Själander
OBJECTIVES: To study the impact of time in therapeutic range (TTR) and international normalised ratio (INR) variability on the risk of thromboembolic events, major bleeding complications and death after mechanical heart valve (MHV) implantation. Additionally, the importance of different target INR levels was elucidated. METHODS: A retrospective, non-randomised multicentre cohort study including all patients with mechanical heart valve (MVH) prosthesis registered in the Swedish National Quality Registry Auricula from 2006 to 2011...
September 2, 2016: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/27553594/a-unique-surgical-technique-for-tracheostomy-in-heterotopic-ossification-a-case-report
#15
Esther Cheng, Eric Thorpe
OBJECTIVE: To describe a technique for tracheostomy in heterotopic ossification that has not yet been described in the literature. METHODS: We report a case of difficult tracheostomy while using conventional techniques in a 68-year-old patient who underwent mitral valve replacement requiring warfarin therapy three months prior. Imaging revealed heterotopic ossification overlying the trachea. A literature review was performed to identify similar cases or techniques...
November 2016: Annals of Otology, Rhinology, and Laryngology
https://www.readbyqxmd.com/read/27530875/fortune-or-misfortune-asymptomatic-delayed-presentation-of-complete-dehiscence-of-mechanical-aortic-valve-conduit-and-pseudoaneurysm
#16
Kyung Taek Oh, Joseph Derose, Cynthia Taub
Complete dehiscence of a composite aortic valve graft with pseudoaneurysm formation is a rare complication following aortic root replacement. This complication often takes place in the setting of acute graft infection and accompanies symptoms of heart failure, valve insufficiency or sepsis. We present a delayed, asymptomatic presentation of this complication in a young man with distant history of aortic root replacement and medically treated prosthetic valve endocarditis a year postoperatively. He had been non-adherent to warfarin over 10 years, but otherwise maintained a healthy life...
August 16, 2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27441538/assessment-of-warfarin-treatment-efficacy-by-means-of-using-coagulation-test-results-within-the-therapeutic-range
#17
P Varim, C Varim, H Ergenç, M Uyanık, S Yaylacı, M Vatan, H Gündüz
Time in Therapeutic Range (TTR) is a value used to assess the efficacy of Warfarin treatment. The aim of our study is to determine the effective INR levels and the rate of TTR in patients on Warfarin regimen due to Atrial Fibrillation (AF) or Mechanical Prosthetic Valve (MPV). A total of 94 patients (58 female, and 36 male, mean age: 64.9±11years) on Warfarin treatment due to AF or MPV with at least 10 INR levels measurements in the last 6 months were included in this retrospective study. The patients were divided into 2 groups...
June 2016: Georgian Medical News
https://www.readbyqxmd.com/read/27402230/atrial-fibrillation-patients-treated-with-long-term-warfarin-anticoagulation-have-higher-rates-of-all-dementia-types-compared-with-patients-receiving-long-term-warfarin-for-other-indications
#18
T Jared Bunch, Heidi T May, Tami L Bair, Brian G Crandall, Michael J Cutler, John D Day, Victoria Jacobs, Charles Mallender, Jeffrey S Osborn, Scott M Stevens, J Peter Weiss, Scott C Woller
BACKGROUND: The mechanisms behind the association of atrial fibrillation (AF) and dementia are unknown. We previously found a significantly increased risk of dementia in AF patients taking warfarin with a low percentage of time in therapeutic range. The purpose of this study was to determine the extent to which AF itself increases dementia risk, in addition to long-term anticoagulation exposure. METHODS AND RESULTS: A total of 10 537 patients anticoagulated with warfarin (target INR 2-3), managed by the Clinical Pharmacist Anticoagulation Service with no history of dementia were included...
July 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27401780/safety-and-feasibility-of-treatment-with-rivaroxaban-for-non-canonical-indications-a-case-series-analysis
#19
Domenico Acanfora, Chiara Acanfora, Pietro Scicchitano, Marialaura Longobardi, Giuseppe Furgi, Gerardo Casucci, Bernardo Lanzillo, Ilaria Dentamaro, Annapaola Zito, Raffaele Antonelli Incalzi, Marco Matteo Ciccone
BACKGROUND AND OBJECTIVES: The new oral anticoagulants (NOACs) are used for the prevention of thromboembolic complications in patients with non-valvular atrial fibrillation (AF) and those at risk of deep venous thrombosis. Their rapid onset of action and predictable pharmacokinetic and pharmacodynamic profiles make them the optimal alternative to warfarin in the treatment of these two categories of patients. Unfortunately, however, NOACs cannot be used in patients with valvular AF or valvular cardiac prostheses...
October 2016: Clinical Drug Investigation
https://www.readbyqxmd.com/read/27386381/association-of-inflammatory-gene-polymorphisms-with-mechanical-heart-valve-reoperation
#20
Kyung Eun Lee, Joo Hee Kim, Jee Eun Chung, Gwan Yung Lee, Yoon Jeong Cho, Byung Chul Chang, Hye Sun Gwak
BACKGROUND: Various complications lead to reoperation in patients who undergo prosthetic valve replacement where inflammatory process could be involved. The goals of this study were to identify risk factors that correlate with reoperation in patients with prosthetic heart valves and to investigate the relationship between reoperation and inflammatory gene polymorphisms. RESULTS: The study included 228 patients from the EwhA-Severance Treatment Group of Warfarin...
2016: SpringerPlus
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