• Tuberculosis and Respiratory Diseases
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• v.77 no.6
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• pp.274-278
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• 2014

Antiphospholipid syndrome (APS) is an acquired systemic autoimmune disorder characterized by a combination of clinical criteria, including vascular thrombosis or pregnancy morbidity and elevated antiphospholipid antibody titers. It is one of the causes of deep vein thrombosis and pulmonary embolism that can be critical due to the mortality risk. Overall recurrence of thromboembolism is very low with adequate anticoagulation prophylaxis. The most effective treatment to prevent recurrent thrombosis is long-term anticoagulation. We report on a 17-year-old male with APS, who manifested blue toe syndrome, deep vein thrombosis, pulmonary thromboembolism, and cerebral infarction despite adequate long-term anticoagulation therapy.

• Korean Journal of Clinical Pharmacy
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• v.26 no.4
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• pp.269-282
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• 2016

Venous thromboembolism, encompassing deep vein thrombosis and pulmonary embolism, has increased in cancer patients and adversely affects their prognosis. Low-molecular-weight heparins are recommended as efficacious and safe anticoagulation treatment in cancer patients. However, in practice, oral anticoagulation is preferred, especially if longterm or extended treatment is necessary. Novel oral anticoagulants have recently emerged as an alternative to the standard therapy owing to the ease of administration, predictable anticoagulation effect without the need of laboratory monitoring, and fewer drug interactions. These new agents have been shown as effective and safe for the management of cancer-associated thrombosis in ongoing head-to-head comparative trials. Here we review the advances and limitation of current anticoagulant therapies.

• The Korea Journal of Herbology
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• v.23 no.4
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• pp.191-196
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• 2008

Objectives: This research was investigated to find out the effect of the anticoagulant Perillae folium extract. Methods: To examine an active effect of anticoagulation in Perillae folium extract, the study measured Prothrombin time(PT) and activated partial thromboplastin time(APTT) of human plasma in vitro and measured bleeding time and arterio-venous shunt model in rats in vivo. Results: Bleeding time of Perillae folium extract in vivo had a significant increase 1.6 times and thrombus weight of Perillae folium extract had a significant reduction of thrombus weight as 68%. Perillae folium extract had an effect of anticoagulation by operating on extrinsic pathway factor II, V, VII, X and intrinsic pathway factor VIII, IX, X, VI, VII in the coagulation system. Conclusions: Considering the above mentioned results, it is judged that a Perillae folium extract has a control effect of thrombus creation.

• Korean Journal of Clinical Pharmacy
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• v.20 no.2
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• pp.159-164
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• 2010

Radiofrequency ablation (RA) is being used to manage atrial fibrillation (AF) with patients failed at the $1^{st}$-line anti-arrhythmic medications. Patients undergoing this procedure are at increased risk of thromboembolism after ablation, and anticoagulation management surrounding the ablation remains controversial. Although no conclusive recommendations can be made, published guidelines and data support therapeutic anticoagulation with warfarin. The purpose of this study was to analyze effectiveness of current therapy and to find factors fluctuate International Normalized Ratio (INR) values in patients undergone RA followed by anticoagulation service (ACS). Retrospective review was conducted utilizing database in a hospital. Among 110 patients under warfarin around ablation between January 2006 to September 2007, 54 patients were selected and allocated into 2 groups: Group A included 47 who discontinued warfarin after ablation, while 7 in B continued the medication. Information on demographics, amount and length of warfarin dosing, INR values and measuring frequencies, and the causing factors on INR fluctuation were abstracted. Differences were analyzed using chi-squared test, Fisher's Exact test, and unpaired Student t-test. Mean amount of warfarin before and after surgery was 4.0 mg, 4.1 mg in Group A and was 5.1 mg, 4.6 mg in Group B, respectively. Average duration of warfarin doing before ablation was 73.7 days in Group A, 129.9 days in B with no significant difference (p = 0.312). The duration time of warfarin on groups after ablation lasted several months. The number of checking INRs was 4.1 and 7.6, respectively. Inter-individual variability of INR fluctuations were $2.1{\pm}0.6$ in Group A and $2.2{\pm}0.7$ in B which were not significantly different (p = 0.062). 164 cases of decreased INR were: 'omission in taking medication, stressfulness and headache, 'increased intake of high vitamin K foods', 'lifestyle change of increased physical activities', and 'increase of food-intakes'. To the contrary, 36 cases of increased INR were: 'reduce of food-intake', 'use of non-prescription drugs', 'reduction in physical activities', and 'excessive restriction on food-intake', consecutively. In conclusion, the study validated therapeutic outcomes of RA patients who we treated with standard guideline and demonstrated 9 factors of INR fluctuations in the patient. A well-trained, pharmacist-monitored anticoagulation service could reduce the risk of adverse effects and prevent complications in patients with AF around RA operation.

• Journal of Life Science
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• v.20 no.6
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• pp.922-928
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• 2010

This study was carried out to develop safe and novel anticoagulation agents from oriental medicinal herbs. From 33 medicinal herbs, 40 different ethanol extracts were prepared according to place of origin or extraction parts, and anticoagulation activities were evaluated by determination of thrombin time (TT), prothrombin time (PT) and activated partial thromboplastin time (aPTT). The average water content and average extraction ratio for the medicinal herbs were $6.85{\pm}2.26%$ and $5.27{\pm}4.25%$, respectively. Evaluation of TT at various concentrations of the extract led to the selection of Mucuna birdwoodiana, Prunus armeniaca, Cacalia ainsliaeiflora, Cinnamonum aromaticum, and Rhus javanica Linneas potent antithrombosis medicinal herbs. Evaluation of PT and aPTT showed that the extracts of R.javanica Linne, M. birdwoodiana, and P. armeniaca have strong anticoagulation activities. Determination of hemolytic activities of 40 different ethanol extracts against human red blood cells, however, showed that only M. birdwoodiana, C. ainsliaeiflora, C. aromaticum, and R. javanica Linnehas strong anticoagulation activity without hemolytic activity at a concentration of 500 mg/ml. Our results suggest that oriental medicinal herbs, which are under a mass-production system, have potentialas a safe and novel source of anticoagulants, as well being a thrombin-specific and coagulation factor-specific inhibitor.

• Journal of Life Science
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• v.20 no.11
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• pp.1640-1647
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• 2010

Seaweeds have been recognized as a health food, having anti-obesity, anti-constipation and anticoagulation activities, and the use of seaweeds in the food, medicine, and cosmetic industries have recently significantly increased. In this study, methanol extracts were prepared from 35 different seaweeds (17 phaeophyta, 11 rhodophyta and 7 chlorophyta), and thrombin time (TT), prothrombin time (PT) and activated partial thromboplastin time (aPTT) were determined in order to develop safe and novel anticoagulation agents from natural products. In TT experiments, Ecklonia cava, Ecklonia stolonifera, Eisenia bicyclis (Kjellman) Setchell, Ishige foliacea, I. okamurai, Sargassum confusum and S. yamade showed strong thrombin inhibition activity among the 35 different seaweeds. In PT experiments, the inhibitions of prothrombin were identified in the selected seaweeds from TT experiment, with the exception of S. yamade. In aPTT experiments, the seaweeds with blood coagulation inhibition factors were E. cava, E. stolonifera, E. bicyclis (Kjellman) Setchell, I. foliacea, I. okamurai, S. confusum and Hixikia fusiforme Okamura. Further anticoagulation assay with the selected 8 seaweeds suggested that S. confusum is most effective in antithrombosis, and E. stolonifera, E. bicyclis (Kjellman) Setchell, and I. foliacea have high potential as antithrombosis agents. Based on components-activity correlation analysis, flavonoids are considered as active anticoagulation components of seaweeds These results suggest that edible seaweeds, especially S. confusum, have potential as safe and novel anticoagulants, and S. yamade and H. fusiforme Okamura could be used as a thrombin-specific and coagulation factor-specific inhibitors.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.48-54
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• 1987

This report provides follow-up data on 557 patients [73 aortic, 357 mitral, and 127 multiple valve replacements] undergone lonescu-Shiley pericardial Xenograft valve replacement at Seoul National University Hospital between January, 1979 and December, 1985. There were 35 early death [6.3%] and 522 operative survivors were observed, and the cumulative follow-up is 1,140 patient-years [mean: 2.18 years per patient] The thromboembolic complications occurred in 34 cases [3.0% per patient-year] and the rate was 2.1% per patient-year for mitral and 0.3% per patient-year for aortic valve replacement in the presence of anticoagulation therapy. Among the 34 embolic episodes, 9 patients were dead [0.8% per patient-year] and the cause of death were 5 cerebral thromboembolism, 2 pulmonary embolism, and 2 intracerebral hemorrhage due to inappropriate anticoagulation after thromboembolic episode. Actuarial probability [+ SEM] of remaining free of thromboembolism for AVR is 88.1 x 11.1% at 5 years, for MVR 79.1 a 13.4% at 7 years and for multiple valve replacement 77.2 e 5.21% at 7 years. The incidence rate of thromboembolic complications after AVR is not less than that of MVR [0.3 Among the potential thromboembolic risk factors, atrial fibrillation is possible risk factor to increase the thromboembolic complication [0.05 < P < 0.1], but the importance of other factors, such as atrial clot, large left atrial size, mitral position, NYHA functional class, and age is less definite. A careful follow-up and the proper control of anticoagulation without omission, poor control, and arbitrary withdrawal is important for the successful management of the thromboembolic complications and the anticoagulation-related morbidity and mortality.

• Journal of Korean Neurosurgical Society
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• v.55 no.2
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• pp.69-72
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• 2014

Objective : There was no abundance of data on the use of anticoagulant in patients with previous high risk of thromboembolic conditions under a newly developed intracranial hemorrhage in Korean society. The purpose of this study was to evaluate the safety of discontinuance and suggest the proper time period for discontinuance of anticoagulant among these patients. Methods : We reviewed the medical records of 19 patients who took anticoagulant because of thromboembolic problems and were admitted to our department with newly developed anticoagulation associated intracranial hemorrhage (AAICH), and stopped taking medicine due to concern of rebleeding from January 2008 to December 2012. Analysis of the incidence of thromboembolic complications and proper withdrawal time of anticoagulant was performed using the Kaplan-Meier method. Results : Our patients showed high risk for thromboembolic complication. The $CHA_2DS_2$-VASc score ranged from two to five. Thromboembolic complication occurred in eight (42.1%) out of 19 patients without restarting anticoagulant since the initial hemorrhage. Among them, three patients (37.5%) died from direct thromboembolic complications. Mean time to outbreak of thromboembolic complication was $21.38{\pm}14.89$ days (range, 8-56 days). The probability of thromboembolic complications at 7, 14, and 30 days since cessation of anticoagulation was 0.00, 10.53, and 38.49%, respectively. Conclusion : Short term discontinuance of anticoagulant within seven days in patients with AAICH who are at high embolic risk ($CHA_2DS_2$-VASc score >2) appears to be relatively safe in Korean people. However, prolonged cessation (more than seven days) may result in increased incidence of catastrophic thromboembolic complications.

• Tuberculosis and Respiratory Diseases
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• v.59 no.5
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• pp.487-496
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• 2005

Background : 'Major pulmonary thromboembolism' is defined as right ventricular (RV) dysfunction, with or without shock, accompanied by significant morbidity and mortality. In this study, those with major pulmonary thromboembolism were divided into the shock and RV dysfunction only groups, and then investigated the mortality and complications in thrombolysis or anticoagulation, respectively. Methods : In a retrospective study, between January 1995 and December 2004, 60 eligible patients with a major pulmonary thromboembolism, admitted in Asan Medical Center, were included. Results : A total of 57 patients were treated with medical therapy. Thrombolysis was performed in 13 patients (23%) and anticoagulation in 44 (77%). There were no differences in the APACHEII and SOFA scores between the two groups. 6 (46%) and 11 (25%) patients died in the thrombolysis and anticoagulation groups, respectively (p=0.176). In the 19 patients (33%) showing shock, thrombolysis was performed in 9 (47%) and anticoagulation in 10 (53%). 4 (44%) of the 9 patients treated with thrombolytic agents and 3 (30%) of the 10 treated with anticoagulants died (p=0.650). In the 38 patients (67%) showing RV dysfunction only, thrombolysis was performed in 4 (11%) and anticoagulation in 34 (89%). 2 (50%) of the 4 patients treated with thrombolytics and 8 (24%) of the 34 treated with anticoagulants died (p=0.279). Three patients (23%) who underwent thrombolysis had a major bleeding episode, compared with 2 (5%) who were treated with anticoagulants (p=0.072). Conclusion: The results of our study showed that thrombolysis did not lower mortality and tended to increase major bleeding compared with anticoagulation in both the shock and RV dysfunction only groups. Further evaluation of the efficacy and safety of thrombolytic therapy for major thromboembolism appears warranted in Korea.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1046-1048
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• 1999

A life-long anticoagulation for the prevention of ischemic cerebral events by thromboemboli has been conventionally introduced for the treatment of an atrial septal aneurysm. However, due to the recent decrease of the risks in the open heart surgery, the alternative therapeutic modality has been introduced for the prevention of complications of the anticoagulation. A 41-year old female with dizziness was admitted to our hospital. She was diagnosed a shaving atrial fibrillation and a cerebellar infarction, and an atrial septal aneurysm was detected by transesophagel echocardiography that was not detected by the transthoracic echocardiography. Surgery was approached to the right submammarial anterolateral thoracotomy. The atrial septal aneurysm was obliterated by a purse-string suture and plication. Surgial results were excellent with normal sinus rhythms and esthetically satisfying appearance.