• Journal of Chest Surgery
• /
• v.37 no.7
• /
• pp.559-569
• /
• 2004

The CarboMedics mechanical valve has been reported to show acceptable valve-related complication rates. The aim of this study is to evaluate our clinical experience with the CarboMedics valve. Material and Method: Between August 1988 and September 1999, we implanted 1,144 CarboMedics valves in 850 patients (aortic 179; mitral 385; double-valve 234; tricuspid 52). The mean age was 44.5 $\pm$ 12.5 years. Follow-up was completed in 95.2% and median follow-up period was 7.9 years (6753 patient-years). Result: The overall hospital mortality rate was 3.4% and the mortality rate for each group was 1.7% for aortic group, 2.6% for mitral group, 4.7% for double-valve group, and 9.6% for tricuspid group, Tricuspid group showed significantly higher mortality rate than aortic and mitral group (p〈0.05). The actuarial survival at 10 years was 87.1 $\pm$ 2.6%, 88.9 $\pm$ 1.7%, 82.4 $\pm$ 2.9%, and 77.5 $\pm$ 7.0% for aortic, mitral, double, and tricuspid valve group, respectively. Age and tricuspid valve replacement were significant risk factors for long-term survival in multivariate analysis (p 〈 0.05). Freedom from valve thrombosis at 10 years was 99.4 $\pm$ 0.6%, 98.2 $\pm$ 0.8%, 99.2 $\pm$ 0.8%, and 87.6 $\pm$ 0.5% for aortic, mitral, double and tricuspid valve group. Tricuspid valve group showed significantly higher rate of valve thrombosis (p 〈 0.05). Conclusion: Long-term results of our experience demonstrated that CarboMedics valve showed acceptable incidence of valve-related complications. However, tricuspid valve replacement showed higher rate of early mortality and valve thrombosis than other valve replacement groups.

• Journal of Chest Surgery
• /
• v.38 no.11 s.256
• /
• pp.761-772
• /
• 2005

Background: Following the implantation of heart valve prostheses, it is important to maintain therapeutic INR to reduce the risk of thromboembolism. The objective of this study was to suggest a practical dosing guideline for Korean outpatients with prosthetic heart valves managed by a pharmacist-run anticoagulation service (ACS). Material and Method: A retrospective chart review was completed for all patients enrolled in the ACS at Seoul National University Hospital from March, 1997 to September, 2000. Patients who were at least 6 months post-valve replacement and had nontherapeutic INR value (less than 2.0 or greater than 3.0) were included. The data on 688 patients (1,782 visits) requiring dosing adjustment without any known drug or food interaction with warfarin were analyzed. The amount of adjusted dose and INR changes based on the INR at the time of the event were calculated. Aortic valve replacements (AVR) patients and mitral or double valve replacement (MVR/DVR) patients were evaluated separately. Result: Two methods for the warfarin dosage adjustment were suggested: Guideline I (mg-based total weekly dose (TWD) adjustment), Guideline II (percentage-based TWD adjustment). The effectiveness of Guideline 1 was superior to Guideline II overall in patients with both AVR and MVR/DVR. Conclusion: The guideline suggested in this study could be useful when the dosage adjustment of wafarin is necessary in outpatients with mechanical heart valves.

• Journal of Chest Surgery
• /
• v.35 no.11
• /
• pp.826-830
• /
• 2002

Prosthetic valve thrombosis(PVT) may be a life-threatening complication requiring prompt intervention. This is a case report of thrombolytic therapy for thrombosis of prosthetic mitral valve. A 47 year-old male admitted to the emergency room for abrupt onset of dyspnea. He had undergone mitral valve replacement(On-Ⅹ valve, 29mm) for mitral stenosis 8 months ago. The patient's international normalized ratio(INR) on admission was 1.09. The mechanical clicks were muffled and rales were heard in both lung fields. A transesophageal echocardiography(TEE) revealed prosthetic valve thrombosis with increased transvalvular pressure gradient(34 mmHg). The patient's condition needed to intubation for mechanical ventilation due to hemodynamic compromise, however his wife and relatives refused the surgical intervention due to financial problems. The patient was transferred to the cardiac care unit and we decided to perform thrombolytic therapy. A bolus of 1,500,000 IU of urokinase was given, followed by a drip of 1,500,000 IU for 1 hour. The patient did not improved hemodynamically; therefore, we gave 100 mg of tissue plasminogen activator(t-PA) for over 2 hours. During that time mechanical clicks were audible and hemodynamics of the patient improved progressively. A TEE showed disappearance of thrombus and decreased pressure gradient(1.7 mmHg) after 6 hours of thrombolytic therapy. The patient was recovered without any neurologic sequale and was discharged with administration of warfarin.

• Journal of Life Science
• /
• v.24 no.9
• /
• pp.1030-1038
• /
• 2014

Platelet products are used to treat hemorrhagic or platelet dysfunction diseases. Plateletpheresis involves collecting the platelet components of blood using an apheresis blood-collection system. Various indicators are available for evaluating the qualities of the apheresis platelets. The productivity of platelet collection is evaluated through both the collection efficiency and collection rates. Platelet storage quality can be evaluated in vitro using several indicators, including visual appearance, metabolic activities, volume, platelet count, white blood cell count, microparticles, and various platelet activation markers. Platelet activation markers have been used as indicators of storage quality in various studies. Post-transfusion platelet quality can be evaluated based on the corrected count increment and the percentage of platelet recovery. Although various studies have investigated the aspects of plateletpheresis, no article has systemically presented assessments of the platelet products obtained from different plateletpheresis devices. The present study provides a review of plateletpheresis, including the specifics of the process, the types of devices employed, the platelet quality, the overall efficacy, and the evaluation indicator qualities. Furthermore, the differences in functionality among the different apheresis devices are discussed. Although adverse reactions to the citrate anti-coagulant have been reported, apheresis processing may provide a safer option for donors who are at a high risk for presyncopal or syncopal reactions related to whole blood collection.

• Journal of Chest Surgery
• /
• v.38 no.2 s.247
• /
• pp.110-115
• /
• 2005

Background: The aims of this paper were to review the mid term clinical results and to analyze the preoperative risk factors of isolated aortic valve replacement (AVR). Material and Method: Between January 1992 and February 2003, 80 patients underwent isolated AVR. 58 were male and 22 were female patients, raging from 12 to 75 years of age (mean :$46.8{\pm}13.0$ years). 74 patients except one early death and 5 follow-up loss were contacted by OPD or by telephone. The mean duration of follow-up was $44.2{\pm}29.7$ months and the total cumulative period was 272.8 patient-year. Result: The complications in hospital occurred in 35 cases : 12 wound problems (11 superficial, 1 deep), 11 arrhythmias (9 temporary, 2 persistent), 3 low cardiac output, and so forth. The late deaths were 4 cases : the heart-related deaths were 2 cases ($0.7\%$ patient-year). Conclusion: The risk factors that influenced the early mortality and morbidity were older age (> 60 years)(p=0.04), poor preoperative NYHA functional class (> 3) (p=0.048), high preoperative serum creatinin level (> 1.2 mg/100 ml)(p=0.031), long operation time (aortic clamping time>90 min)(p=0.042). The same factors influenced the late mortality and morbidity. Freedom from valve-related complication was $86.4{\pm}5.3\%,$ actuarial survival rate were $96.8{\pm}2.3\%$ at 3 years and $90.8{\pm}4.6\%$ at 10 years.

• Journal of the Korean Orthopaedic Association
• /
• v.54 no.4
• /
• pp.317-326
• /
• 2019

Purpose: To compare and analyze the rate of prevention of two venous thromboembolism prophylaxis guidelines in patients with artificial joint arthroplasty and hip joint fracture. Proper prophylaxis for preventing thromboembolism in orthopedic surgery is significant because of this fetal complication. Materials and Methods: This study compared and retrospective analyzed the rate of prevention using the medical records and radiographs of patients who underwent orthopedic surgery from March 2009 to February 2011 according to the American College of Chest Physicians (ACCP) guidelines and from March 2012 to February 2014 according to the American Academy of Orthopedic Surgeons (AAOS) guidelines. Results: The guidelines for venous thromboembolism prophylaxis have been applied to patients with artificial joint replacement and hip joint fracture, the compliance rate of the ACCP guidelines was 56.0% before surgery, 67.0% after surgery with chemical prophylaxis, and 80.5% with mechanical prophylaxis. In addition, the compliance rate of the AAOS guidelines was 74.1% with chemical prophylaxis, and 88.3% with mechanical prophylaxis, which was higher than the ACCP guidelines. The compliance rates of mechanical and chemical prophylaxis before and after surgery of the ACCP guidelines, and the compliance rate of mechanical and chemical prophylaxis of the AAOS guidelines were compared and analyzed. The results revealed statistical significance (p<0.05) before and after total knee replacement arthroplasty and hip joint fracture internal fixation and total high risk orthopedic surgery. Conclusion: Raising the compliance rate of prophylaxis of venous thromboembolism in high risk orthopedic surgery is necessary and people should follow the guidelines for a unified direction depending on which situation they are in.

• Journal of Life Science
• /
• v.26 no.3
• /
• pp.289-295
• /
• 2016

Sorbus commixta, a flowering plant in the Rosaceae family, is native to Japan and Ulleung Island, Korea. This plant is also called maga-mok or mai-mok in Korea because the bud of the stem has a similar shape to the teeth of a horse. In this study, hot water extracts from different parts of S. commixta, such as leaf, stem, and immature and mature fruits, were prepared, and their antithrombosis and antioxidant activities were evaluated. The extraction yield and pH of stem extracts were 3.99% and 5.5, respectively. The stem extracts contained 89.2 mg/g of total polyphenols and 28.3 mg/g of total flavonoids. The hot water extracts prepared from the leaf, stem, immature, and mature fruit of S. commixta exhibited no hemolytic activity against human red blood cells, up to a concentration of 0.5 mg/ml. In an anticoagulation assay, the stem extracts showed strong extension in thrombin, prothrombin, and activated partial thromboplastin times, whereas the other extracts had no anticoagulation activity. In a platelet aggregation inhibitory activity assay, all the extracts tested had no inhibitory activity against human platelets. With regard to antioxidation activity, the stem extracts showed stronger radical scavenging activity and reducing power activity than the other extracts. The calculated RC₅₀s, the concentration required for 50% radical scavenging activity, for DPPH anions, ABTS cations, and nitrite of the crude stem extracts were 119.7, 53.3, and 117.5 μg/ml, respectively, whereas they were 13.7, 5.2, and 14.9 μg/ml for DPPH anions, ABTS cations, and nitrite, respectively, for vitamin C. The results suggest that the stem extracts of S. commixta have strong potential for use as a novel resource for antithrombosis agents.

• The Journal of Korean Medicine
• /
• v.32 no.2
• /
• pp.14-22
• /
• 2011

Objective: Nowadays the combined use of herbal extracts and western medicines has been prevalent, but concern about its risk is also increasing. Even though the importance of clinical trials is well recognized, there have been only a few studies on the combined use of herbal extracts and western medicines. This study was aimed to examine which herbal extracts and antiplatelets or anticoagulants are most commonly prescribed together to inpatient ischemicstroke patients and investigate the combined prescription rate. Methods: We investigated the most frequently prescribed herbal extracts from two different sources. First, we chose herbal medicine extracts from 2008 Traditional Korean Medicine Utilization Status. Then, among patients who were admitted to Kyung-Hee Oriental Medical Center diagnosed with ischemic stroke, we found patients who were administered with these herbal medicine extracts and among these patients, we investigated how many were concomitantly administered with antiplatelets or anticoagulants. Second, we chose other herbal medicine extracts that were most often prescribed within Kyung-Hee Oriental Medical Center and found patients who were administered with these herbal medicine extracts, then investigated how many of them were concomitantly administered with specific antiplatelets or anticoagulants. Results: The most commonly prescribed herbal medicine extracts among ischemic stroke patients were Ojeok-san, Bojungikgi-tang, Sochungryong-tang and Samsoeum. About 46 to 69 percent were concomitantly administered with either specific antiplatelets or anticoagulants. Conclusions: The most often prescribed herbal medicine extracts in inpatient ischemic stroke patients are Ojeok-san, Bojungikgi-tang, Sochungryong-tang, and Samsoeum. Among patients who were prescribed with Ojeok-san, Bojungikgi-tang, Sochungryong-tang, Samsoeum, patients who were concomitantly administered with either antiplatelets or anticoagulants were about 46% to 69%.

• Korean Journal of Clinical Laboratory Science
• /
• v.51 no.1
• /
• pp.34-41
• /
• 2019

Platelet aggregation is essential for the formation of a hemostatic plug in the case of blood vessel damage. On the other hand, excessive platelet aggregation may cause cardiovascular disorders, such as thrombosis, atherosclerosis, and myocardial infarction. Scopoletin, which found in the root of plants in the genus Scopolia or Artemisia, has anti-coagulation and anti-malaria effects. This study examined the effects of scopoletin on human platelet aggregation induced by collagen. Scopoletin had anti-platelet effects via the down-regulation of thromboxane $A_2$ ($TXA_2$) production and intracellular $Ca^{2+}$ mobilization ($[Ca^{2+}]_i$), which are aggregation-inducing molecules produced in activated platelets. On the other hand, scopoletin increased both the cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) levels, which are known as intracellular $Ca^{2+}$-antagonists and aggregation-inhibiting molecules. In particular, scopoletin increased the potently cAMP level more than cGMP, which led to suppressed fibrinogen binding to ${\alpha}IIb/{\beta}_3$ in collagen-induced human platelet aggregation. In addition, scopoletin inhibited collagen-elevated adenosine triphosphate (ATP) release in a dose-dependent manner. The results suggest that aggregation amplification through granule secretion is inhibited by scopoletin. Therefore, scopoletin has potent anti-platelet effects and may have potential for the prevention of platelet-derived vascular diseases.

• Journal of Chest Surgery
• /
• v.35 no.3
• /
• pp.188-198
• /
• 2002

Background: Reoperations on the aortic root or the ascending aorta are being performed with increasing frequency and remain a challenging problem. This study was performed to analyze the results of reoperations on the ascending aorta and aortic root. Material and Method: Between May 1995 and April 2001, 30 patients had reoperations on the ascending aorta and aortic root and were reviewed retrospectively. The mean interval between the previous repair and the actual reoperation was 56 months(range 3 to 142 months). Seven patients(23.3%) had two or more previous operations. The indications for reoperations were true aneurysm in 7 patients(23.3%), prosthetic valve endocarditis in 6(20%), false aneurysm in 5(16.7%), paravalvular leak associated with Behcet's disease in 4(13.3%), malfunction of prosthetic aortic valve in 4(13.3%), aortic dissection in 3(10%), and annuloaortic ectasia in 1(3.3%). The principal reoperations performed were aortic root replacement in 17 patients(56.7%), replacement of the ascending aorta in 8(26.7%), aortic and mitral valve replacement with reconstruction of fibrous trigone in 2(6.6%), patch aortoplasty in 2(6.6%), and aortic valve replacement after Bentall operation in 1 (3.3%). The cardiopulmonary bypass was started before sternotomy in 7 patients and the hypothermic circulatory arrest was used in 16(53.3%). The mean time of circulatory arrest, total bypass, and aortic crossclamp were 20$\pm$ 12 minutes, 228$\pm$56 minutes, and 143$\pm$62 minutes, respectively Result: There were three early deaths(10%). The postoperative complications were reoperation for bleeding in 7 patients(23.3%), cardiac complications in 5(16.7%), transient acute renal failure in 2(6.6%), transient focal seizure in 2(6.6%), and the others in 5. The mean follow-up was 22.8 $\pm$20.5 months. There were two late deaths(7.4%). The actuarial survival was 92.6$\pm$5.0% at 6 years. One patient required reoperation for complication of reoperation on the ascending aorta and aortic root(3.7%). The 1- and 6-year actuarial freedom from reoperation was 100% and 83.3$\pm$15.2%, respectively. One patient with Behcet's disease are waiting for reoperation due to false aneurysm, which developed after aortic root replacement with homograft. There were no thromboembolisms or anticoagulant related complications. Conclusions: This study suggests that reoperations on the ascending aorta and aortic root can be performed with acceptable early mortality and morbidity, and adequate surgical strategies according to the pathologi conditions are critical to the prevention of the reoperation.