[Advantages of a cardiologic ambulatory care facility specifically organized for patients undergoing treatment with oral anticoagulant drugs].
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In patients with artificial heart valve prosthesis oral anticoagulants reduce but not eliminate the thromboembolic complications however, they do increase the risk of bleeding. In the present study, the incidence of thromboembolic and hemorrhagic complications in two homogeneous groups of patients with artificial heart valves on long term oral anticoagulant treatment has been evaluated. Group A (99 patients; total follow-up = 309 years) were resident in the Triveneto regions and received a questionnaire while group B (104 patients; total follow-up = 370 years) were referred to our department's centre for the control of oral anticoagulant treatment. Both groups were kept at a therapeutic range of 20-30% in terms of prothrombin activity. The incidence of thromboembolic and hemorrhagic complications is expressed as the number of episodes per 100 patient/years. Thromboembolic episodes were 2.6 (1.3 fatal) in group A while they were 1.08 (0.27 fatal) in group B; the reduction of fatal thromboembolic events was statistically significant (p less than 0.05). Hemorrhagic episodes were 1.9 (0.63 fatal) in group A while they were 0.81 (0 fatal) in group B. We concluded that an organized control of oral anticoagulant treatment in patients with artificial heart valves is advantageous as it significantly reduces fatal thromboembolism. Moreover, it could reduce the incidence of total thromboembolic and hemorrhagic episodes by more than 50%.Keywords:
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To the Editor We have several concerns about the recent study1 that demonstrated no significant difference in major bleeding with extended-duration direct oral anticoagulant (DOAC) therapy beyond 90 days after initial discharge for venous thromboembolism (VTE).
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Abstract In order to determine the incidence of pre-operative and postoperative deep venous thrombosis (DVT) in patients not receiving prophylactic anticoagulant therapy, bilateral phlebography was performed in a prospective study pre-operatively and on the 9th postoperative day, in 51 consecutive patients submitted for major abdominal surgery. The presence of a DVT before surgery was demonstrated in 15·7 per cent of the patients. This high frequency confirms objectively the rationale of starting prophylactic anticoagulant therapy before the surgical procedure. Thrombi were demonstrated postoperatively by phlebography in 54·9 per cent of the patients. Thus the true incidence of DVT induced by surgery was 39·2 per cent taking into account the 15·7 per cent pre-operative DVT rate.
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Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
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Oral anticoagulants are generally accepted as secondary prophylaxis in patients with thromboembolic disease. Long term oral anticoagulant treatment of 24 survivors of clinically acute massive pulmonary embolism (AMPE) was assessed. There were following indications for such a treatment: recurrent PE/DVT in history and/or continuous risk factors. In the group of survivors of AMPE with continuing risk factors or the recurrence of that disaster the long-term oral anticoagulant therapy is effective, relatively safe and therefore justified.
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Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
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To the Editor.
—In a recent report in the Archives Errichetti et al1described their 4½-year experience with oral anticoagulant therapy in 141 patients. The incidence of major hemorrhagic complications in this series was 5% of the treatment courses. We would like to emphasize that the incidence of these complications diminishes as the number of patients studied increases; on the other hand, unusual and life-threatening hemorrhagic complications are most frequently seen in large series of patients and/or when patients are being managed for extended periods, as our figures suggest. From 1974 to 1983, 2,012 patients receiving oral anticoagulant therapy were treated in our anticoagulant clinic. Forty-eight percent of these courses were of six months' duration or less, corresponding to deep venous thrombosis of the lower extremities, pulmonary embolism, and cerebro vascular disease, whereas 52% represented long-lasting treatment courses in patients with valvular heart disease with one or more embolicOral anticoagulant
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The FDA approved dabigatran etexilate as the first oral blood thinner for children aged 3 months to 11 years who have venous thromboembolism and received injectable blood thinners for at least 5 days. Previously, the only anticoagulant approved for children was an injectable formulation.
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