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warfarin in mechanical valve

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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
#1
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
#2
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
#3
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
#4
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
#5
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 5, 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
#6
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
#7
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
#8
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...
September 6, 2016: Cardiology
https://www.readbyqxmd.com/read/27590664/warfarin-treatment-quality-and-prognosis-in-patients-with-mechanical-heart-valve-prosthesis
#9
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
#10
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
#11
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...
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
#12
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
#13
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
#14
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
#15
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
https://www.readbyqxmd.com/read/27347009/predictors-of-warfarin-non-adherence-in-younger-adults-after-valve-replacement-surgery-in-the-south-pacific
#16
Linda J Thomson Mangnall, David W Sibbritt, Nihaya Al-Sheyab, Robyn D Gallagher
OBJECTIVES: Globally, mechanical valves are predominant as replacements for adolescents and younger adults with rheumatic heart disease (RHD). Mechanical valve implantation necessitates lifelong antithrombotic management (warfarin) and associated lifestyle modification, with event-free survival largely dependent on international normalised therapeutic ratios (INRs) remaining within the target therapeutic range. There is limited information on factors that may influence warfarin adherence among younger people or those in resource-limited settings...
2016: Heart Asia
https://www.readbyqxmd.com/read/27266493/-the-multicenter-study-on-the-registration-and-follow-up-of-low-anticoagulation-therapy-for-the-heart-valve-operation-in-china
#17
L Dong, Y K Shi, J P Xu, E Y Zhang, J C Liu, Y X Li, Y M Ni, Q Yang, T Han, B Fu, J Chen, L Ren, S L Wei, H Chen, K X Liu, F X Yu, J S Liu, M D Xiao, S M Wu, K L Zhang, H L Huang, S L Jiang, C H Qiao, C S Wang, Z Y Xu, X M Zhou, D J Wang, L X Ni, Y B Xiao, S L Jiang, G M Zhang, G Y Liang, S Y Yang, P Bo, Q J Zhong, J B Zhang, X Zhang, Y B Zhu, X Teng, P Zhu, F Huang, Y M Xiao, G Q Cao, H Tian, L M Xia, F L Lu, Y Q Liu, D X Liu, H Xu, Y Yuan, M Li, C Chang, X C Wu, Z Xu, P Guo, Y J Bai, W B Xue, X Y Jiang, Z H Na, Q Y Zeng, H Cai, Y L Wang, R Xiong, S Jin, X M Zheng, D Wu
OBJECTIVE: To investigate the optimal anticoagulation methods and monitoring strategy for Chinese patients undergoing heart valve replacement, which is potentially quite different from western populations. METHODS: In this multicenter prospective cohort study, the anticoagulation and monitoring strategy data was acquired from 25 773 in-hospital patients in 35 medical centers and 20 519 patients in outpatient clinic in 11 medical centers from January 1st, 2011 to December 31th, 2015...
May 24, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/27234663/at-home-versus-in-clinic-inr-monitoring-a-cost-utility-analysis-from-the-home-inr-study-thinrs
#18
Ciaran S Phibbs, Sean R Love, Alan K Jacobson, Robert Edson, Pon Su, Lauren Uyeda, David B Matchar
BACKGROUND: Effective management of patients using warfarin is resource-intensive, requiring frequent in-clinic testing of the international normalized ratio (INR). Patient self-testing (PST) using portable at-home INR monitoring devices has emerged as a convenient alternative. As revealed by The Home INR Study (THINRS), event rates for PST were not significantly different from those for in-clinic high-quality anticoagulation management (HQACM), and a cumulative gain in quality of life was observed for patients undergoing PST...
September 2016: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/27229665/no-difference-between-aspirin-and-warfarin-after-extracardiac-fontan-in-a-propensity-score-analysis-of-475-patients
#19
Ajay J Iyengar, David S Winlaw, John C Galati, Gavin R Wheaton, Thomas L Gentles, Leeanne E Grigg, Robert N Justo, Dorothy J Radford, Chantal Attard, Robert G Weintraub, Andrew Bullock, Gary S Sholler, David S Celermajer, Yves d'Udekem
OBJECTIVES: The most effective method of long-term thromboprophylaxis after the Fontan procedure is not clear. We compared the rates of thromboembolic events between patients receiving aspirin and warfarin after an extracardiac conduit Fontan procedure in a bi-national registry. METHODS: All patients who underwent an extracardiac conduit Fontan procedure from 1997 to 2010 in Australia and New Zealand were identified. Medication status and routine follow-up and echocardiographic data were obtained from all patients...
November 2016: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27173100/a-randomised-double-blind-comparison-of-tecarfarin-a-novel-vitamin-k-antagonist-with-warfarin-the-embraceac-trial
#20
Richard P Whitlock, Christopher B Fordyce, Mark G Midei, Dave Ellis, David Garcia, Jeffrey I Weitz, Daniel M Canafax, Detlef Albrecht, Peter G Milner
Tecarfarin is a novel vitamin K antagonist that is metabolised by carboxyl estererase, thereby eliminating the variability associated with cytochrome-mediated metabolism. EmbraceAC was designed to compare the quality of anticoagulation with tecarfarin and warfarin as determined by time in therapeutic range (TTR). In this phase 2/3 randomised and blinded trial, 607 patients with indications for chronic anticoagulation were assigned to warfarin (n=304) or tecarfarin (n=303). Dosing of study drugs was managed by a centralised dose control centre, which had access to genotyping...
August 1, 2016: Thrombosis and Haemostasis
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