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warfarin in mechanical valve

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https://www.readbyqxmd.com/read/29745996/how-do-anticoagulated-atrial-fibrillation-patients-who-suffer-ischemic-stroke-or-spontaneous-intracerebral-hemorrhage-differ
#1
Heidi Lehtola, Juha Hartikainen, Päivi Hartikainen, Tuomas Kiviniemi, Ilpo Nuotio, Antti Palomäki, Antti Ylitalo, K E Juhani Airaksinen, Pirjo Mustonen
BACKGROUND: Atrial fibrillation (AF) increases risk of ischemic stroke, and oral anticoagulation (OAC) increases risk of intracerebral hemorrhage (ICH). This study aimed to compare OAC-treated AF patients with an ischemic stroke/transient ischemic attack (TIA) or spontaneous ICH as their first lifetime cerebrovascular event, especially focusing on patients with therapeutic international normalized ratio (INR). HYPOTHESIS: We assumed that in AF patients suffering ischemic stroke/TIA or ICH, patient characteristics could be different in patients with therapeutic INR than in patients with warfarin...
May 10, 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29731051/a-70-year-old-woman-with-a-prosthetic-mitral-valve-and-sudden-chest-pain
#2
María José Romero-Castro, Tania Seoane-García, Marinela Chaparro-Muñoz, Rafael García-Borbolla, Juan C García-Rubira
A 70-year-old woman presented to the ED with oppressive ongoing chest pain that had lasted for 1 hour and was accompanied by intense sweating. The patient had a previous history of bronchial asthma, severe degenerative mitral regurgitation, and an ostium secundum atrial septal defect that had been treated 6 years ago with a prosthetic mechanical mitral valve, Bicarbon 25, and an atrial septal defect closure. She was being treated with ciclesonide, tiotropium bromide, olodaterol, theophylline, and warfarin, adjusted according to the international normalized ratio...
May 2018: Chest
https://www.readbyqxmd.com/read/29710221/what-surgeons-should-know-about-non-vitamin-k-oral-anticoagulants-a-review
#3
Atul Verma, Andrew C T Ha, James T Rutka, Subodh Verma
Importance: Non-vitamin K oral anticoagulants (NOACs) are increasingly prescribed for patients to treat or prevent arterial or venous thromboembolism. The following 4 NOAC agents are approved by the US Food and Drug Administration for clinical use: dabigatran etexilate, apixaban, edoxaban tosylate, and rivaroxaban. A good understanding of these agents' pharmacologic properties is important for surgeons given their marked differences compared with warfarin sodium. This review highlights key practical issues surrounding the use of NOACs in the perioperative setting...
April 18, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29608495/medical-management-of-rheumatic-heart-disease-a-systematic-review-of-the-evidence
#4
E Anne Russell, Warren F Walsh, Ben Costello, Alex Ja McLellan, Alex Brown, Christopher M Reid, Lavinia Tran, Graeme P Maguire
Rheumatic heart disease (RHD) is an important cause of heart disease globally. Its management can encompass medical and procedural (catheter and surgical) interventions. Literature pertaining to the medical management of RHD from PubMed 1990-2016 and via selected article reference lists was reviewed. Areas included symptom management, left ventricular (LV) dysfunction, rate control in mitral stenosis (MS), atrial fibrillation (AF), anticoagulation, infective endocarditis prophylaxis and management in pregnancy...
March 30, 2018: Cardiology in Review
https://www.readbyqxmd.com/read/29496441/adjustments-to-warfarin-dosing-after-gastric-bypass-and-sleeve-gastrectomy
#5
Andrew T Strong, Gautam Sharma, Zubaidah Nor Hanipah, Chao Tu, Stacy A Brethauer, Philip R Schauer, Derrick Cetin, Ali Aminian
BACKGROUND: Warfarin dosing after bariatric surgery may be influenced by alterations in gastrointestinal pH, transit time, absorptive surface area, gut microbiota, food intake, and adipose tissue. OBJECTIVES: The aim of this study was to describe trends in warfarin dosing after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). SETTING: Single academic center. METHODS: All patients chronically on warfarin anticoagulation before RYGB or SG were retrospectively identified...
January 2, 2018: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/29458277/inductive-effect-of-a-ritonavir-containing-hepatitis-c-treatment-regimen-on-warfarin-in-a-patient-a-case-report
#6
Audrey C Rosene, Jaymee L Gaspar
The warfarin management strategy for a mechanical mitral valve patient initiated on a ritonavir-based hepatitis C treatment regimen is described. A 62-year-old male with a past medical history of hepatitis C genotype 1a and stable warfarin dose history was initiated on a concomitant Viekira Pak® (VP) regimen containing ritonavir. Prior to initiation of the VP for hepatitis C treatment, the patient was stable on a warfarin dose of 40 mg/wk for 5 months. During treatment with VP, the patient experienced a markedly decreased international normalized ratio (INR) and warfarin requirements ultimately increased 125% from baseline (90 mg/wk)...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29448930/a-prediction-study-of-warfarin-individual-stable-dose-after-mechanical-heart-valve-replacement-adaptive-neural-fuzzy-inference-system-prediction
#7
Huan Tao, Qian Li, Qin Zhou, Jie Chen, Bo Fu, Jing Wang, Wenzhe Qin, Jianglong Hou, Jin Chen, Li Dong
BACKGROUND: It's difficult but urgent to achieve the individualized rational medication of the warfarin, we aim to predict the individualized warfarin stable dose though the artificial intelligent Adaptive neural-fuzzy inference system (ANFIS). METHODS: Our retrospective analysis based on a clinical database, involving 21,863 patients from 15 Chinese provinces who receive oral warfarin after the heart valve replacement. They were allocated into four groups: the external validation group (A group), the internal validation group (B group), training group (C group) and stratified training group (D group)...
February 15, 2018: BMC Surgery
https://www.readbyqxmd.com/read/29358327/low-level-overexpression-of-p53-promotes-warfarin-induced-calcification-of-porcine-aortic-valve-interstitial-cells-by-activating-slug-gene-transcription
#8
Li Gao, Yue Ji, Yan Lu, Ming Qiu, Yejiao Shen, Yaqing Wang, Xiangqing Kong, Yongfeng Shao, Yanhui Sheng, Wei Sun
The most frequently used oral anti-coagulant warfarin has been implicated in inducing calcification of aortic valve interstitial cells (AVICs), whereas the mechanism is not fully understood. The low-level activation of p53 is found to be involved in osteogenic transdifferentiation and calcification of AVICs. Whether p53 participates in warfarin-induced AVIC calcification remains unknown. In this study, we investigated the role of low-level p53 overexpression in warfarin-induced porcine AVIC (pAVIC) calcification...
March 9, 2018: Journal of Biological Chemistry
https://www.readbyqxmd.com/read/29334746/-the-current-role-of-warfarin
#9
Jana Michalcová, Alena Buliková, Jiřina Zavřelová, Marie Prudková, Miroslav Penka
Well-managed warfarin therapy remains an important method of anticoagulation in the 21st century, despite the introduction of new antithrombotics into the clinical practice. The main advantages of warfarin are decades of treatment experience, the possibility to monitor its anticoagulant effect using the INR and the last, but not least, the low cost. Currently, approximately 75 % of anticoagulated patients in the Czech Republic are treated with warfarin and warfarin remains the only option for oral anticoagulant therapy in certain clinical conditions (particularly in patients with valvular atrial fibrillation or mechanical heart valves)...
December 0: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/29296264/relative-expression-of-pbmc-microrna-133a-analysis-in-patients-receiving-warfarin-after-mechanical-heart-valve-replacement
#10
Hamid Kabiri Rad, Mahta Mazaheri, Ali Dehghani Firozabadi
Background: MicroRNAs (miRNAs) are implicated in various biological processes including anticoagulation. However, the modulation of miRNA by pharmacological intervention such as warfarin treatment in patients receiving warfarin has not been disclosed yet. The aim of this study work was to assess the effect of warfarin drug on expression level of mir-133a-3p in patients with mechanical heart valve replacement. Methods: In this research, the expression level of miRNA-133a-3p was analyzed in Peripheral Blood Mononuclear Cells (PBMCs) from mechanical valve replacement patients who had received warfarin for at least 3 months continuously...
January 2018: Avicenna Journal of Medical Biotechnology
https://www.readbyqxmd.com/read/29258394/quality-of-anticoagulation-with-warfarin-at-a-tertiary-hospital-in-botswana
#11
Julius C Mwita, Joel M Francis, Anthony A Oyekunle, Marea Gaenamong, Monkgogi Goepamang, Mgaywa G M D Magafu
Warfarin treatment requires regular and proper monitoring to avoid overanticoagulation and at the same time to prevent thromboembolic complications. This study assessed the quality of warfarin anticoagulation at Princess Marina Hospital in Botswana. This cross-sectional study consecutively enrolled patients who were on warfarin for at least 3 months in the outpatient medical clinic. The level of anticoagulation was determined by the time in therapeutic range (TTR) using the Rosendaal method that calculates the percentage of days when the international normalized ratio is in the therapeutic range (2...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29167146/impact-of-educational-intervention-on-management-of-periprocedural-anticoagulation
#12
Amy L Awker, Melissa A Bell, Megan McGraw, Mark A Klein
PURPOSE: The effect of education regarding new evidence in periprocedural anticoagulation, with a focus on reducing use in patients at only moderate thromboembolic risk, is presented. METHODS: A retrospective cohort analysis and quasiexperimental design were used. The initial review identified the current state of practice regarding bridging anticoagulation. Education was then provided to primary care providers and pharmacists on recent evidence. A subsequent review was completed to assess the impact of this education on clinical decision-making...
December 1, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29066099/effects-of-home-prothrombin-international-ratio-pt-inr-management-in-children-with-mechanical-prosthetic-valves-importance-of-individual-correlations-between-laboratory-and-coaguchek-device-pt-inrs
#13
Naomi Ino, Satoshi Masutani, Shoyo Tanikawa, Yoichi Iwamoto, Hirofumi Saiki, Hirotaka Ishido, Masanori Tamura, Hideaki Senzaki
BACKGROUND: Warfarin administration is essential but requires difficult management and frequent clinic visits in patients with mechanical prosthetic atrioventricular valve replacement (MPAVVR). This study investigated how home prothrombin international ratio (PT-INR) monitoring with CoaguChek® (Roche Diagnostics, Basel, Switzerland) safely reduced clinic visits in children with MPAVVR. We also compared individual correlations between the CoaguChek and laboratory PT-INR. METHODS: This study included four pediatric patients who started frequent warfarin home-monitoring after MPAVVR (three mitral valves and one tricuspid valve)...
February 2018: Journal of Cardiology
https://www.readbyqxmd.com/read/28982306/optimal-intensity-of-warfarin-therapy-in-patients-with-mechanical-aortic-valves
#14
Kazuhiko Kido, Jennifer Ball
OBJECTIVE: To review the current guidelines and published literature in order to identify the evidence-based international normalized ratio (INR) goal in patients with a mechanical aortic valve. DATA SOURCES: Medline/PubMed, Cochrane and Google Scholar database searches for relevant articles from 1946 through March 2017 were executed using the key words "mechanical aortic valve" and "antithrombotic therapy or anticoagulation therapy or warfarin." STUDY SELECTION AND DATA EXTRACTION: All English-language observational and interventional studies assessing INR goals in patients with a mechanical aortic valve were evaluated...
January 1, 2017: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/28914415/a-randomized-trial-of-restarting-warfarin-at-maintenance-versus-loading-doses-following-an-elective-procedure
#15
Tammy J Bungard, Jay Mutch, Bruce Ritchie
Guidelines suggest restarting warfarin at known maintenance doses, although this may result in a delay to achieving therapeutic anticoagulation. As such, we compared the time to achieve an INR ≥ 2.0 between those restarting warfarin maintenance vs loading doses after transient interruption, and the impact on protein C, S and factor II levels. Patients requiring interruption of warfarin for elective procedures without hospitalization were randomized 1:1 to receive warfarin maintenance or loading doses (1...
November 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28913590/challenges-of-anticoagulation-therapy-in-pregnancy
#16
REVIEW
Annemarie E Fogerty
Thrombotic complications in pregnancy represent a major cause of morbidity and mortality. Pregnancy is a primary hypercoagulable state due to enhanced production of clotting factors, a decrease in protein S activity, and inhibition of fibrinolysis. These physiologic changes will yield a collective rate of venous thromboembolism (VTE) of about 1-2 in 1000 pregnancies for the general obstetric population, which represents a five- to tenfold increased risk in pregnancy compared to age-matched non-pregnant peers...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28876686/management-of-failed-mitral-valve-replacement-the-durban-experience
#17
D Kistan, M Booysen, G Alexander, T E Madiba
BACKGROUND: Mitral valve replacement is the procedure of choice in patients with severe mitral valve disease. However, these patients are surviving longer and are thus at an increased risk of prosthesis failure or valve-related complications. METHOD: Study setting: Inkosi Albert Luthuli Central Hospital, a tertiary referral Hospital in Durban. Study population: All patients undergoing redo mechanical mitral valve replacement surgery between January 2005 and December 2014...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28820554/warfarin-therapy-after-mechanical-valve-replacement-a-tool-for-predicting-bleeding-events
#18
Insil Jang, Sukjung Choo, Kyunghee Kim
BACKGROUND: Mechanical valve replacement is associated with positive outcomes, but patients must undergo life-long anticoagulation therapy with warfarin, which carries a significant risk of bleeding complications. Therefore, a systematic and continuous assessment and supervision of warfarin treatment is essential in such patients, and approaches that can predict the risk of bleeding in advance are required. The study aim was to develop a classification tool to predict bleeding events in South Korean patients with mechanical valve replacement undergoing oral warfarin therapy...
March 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/28799251/comparison-of-anticoagulation-regimens-for-pregnant-women-with-prosthetic-heart-valves-a-meta-analysis-of-prospective-studies
#19
Jing Wang, Kangqi Li, Hongyan Li, Weiwei Zhu, Haiyan Sun, Congxiao Lu
INTRODUCTION: Pregnancy is associated with a hypercoagulable state, which makes pregnant women with prosthetic heart valves at high risk of thromboembolism. Proper anticoagulation regimen should take both the maternal protection and the fetal outcomes into consideration. However, no consensus on the present anticoagulation regimen for those women has been reached yet, especially in the first trimester of pregnancy. AIMS: The present meta-analysis is conducted to compare anticoagulation efficiency and feto-maternal complications of heparin and warfarin in the first trimester...
August 11, 2017: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/28762606/d-dimer-to-guide-the-intensity-of-anticoagulation-in-chinese-patients-after-mechanical-heart-valve-replacement-a-randomized-controlled-trial
#20
L Zhang, X Zheng, Y Long, M Wu, Y Chen, J Yang, Z Liu, Z Zhang
Essentials Low anticoagulation intensity reduces bleeding but increases thrombosis during warfarin therapy. Elevated D-dimer level is associated with increased thrombosis events. D-dimer can be used to find potential thrombosis in those receiving low intensity therapy. D-dimer-guided therapy may be the optimal strategy for those with mechanical heart valve replacement. SUMMARY: Background Controversies remain regarding the optimal anticoagulation intensity for Chinese patients after mechanical heart valve replacement despite guidelines having recommended a standard anticoagulation intensity...
October 2017: Journal of Thrombosis and Haemostasis: JTH
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