• Journal of Chest Surgery
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• v.41 no.4
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• pp.484-488
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• 2008

During long-term anticoagulation treatment with using heparin in a pregnant patient with a mechanical mitral prosthesis, we observed several anticoagulation-related complications, including repeated prosthetic valve thrombosis. This was found to be caused by heparin resistance due to an anti-thrombin III deficiency. Thrombolytic therapy using urokinase or tissue plasminogen activator (tPA) was successful and safe for her as well as her baby.

• Journal of Chest Surgery
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• v.26 no.1
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• pp.24-31
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• 1993

The long term clinical results following valve replacement with Hancock and Carpentier-Edwards bioprostheses were compared between tow valve models and between tow groups totaling 249 patients who were discharged after valve replacement from 1976 to 1986. The two groups of patients were treated with nonrandomized fashion. Follow-up was 87% complete. Cummulative duration of follow-up was 1909 patient-years, with maximum follow-up duration of 15 years. The actuarial survival for 122 patients with Hancock valves was 95.2%[\ulcornerstandard deviation] and 84.4% after 5 and 10 years of follow-up, respectively. Comparable figures for 127 patients undergoing valve replacement with Carpentier-Edwards valves were 87.3% and 76.4%, respectively[p=NS]. The probability of freedom from structural valve deterioration after 5 and 10 years of follow-up was 97.2% and 60.6%, respectively, with Hancock valves and 97.2% and 55.7%, respectively, with Carpentier-Edwards valves[p=NS]. Considering all 249 patients, multivariate [Cox model] regression revealed that ejection fraction was only significant predictor of structural valve deterioration. The probability of freedom from thromboembolism after 5 and 10 years of follow-up was 91.3% and 86.4%, respectively, with Hancock valves and 94.2% and 82.5%, respectively, with Carpentier-Edwards valves[p=NS]. Hence more strict control of anticoagulation should be done on patients with left atrial factors. In summary, there were no significant differences in actuarial survival rate and major valve related complications between tow valve models. These results suggests that its use should be confined to older patients or patients with a contraindication of anticoagulation.

• Journal of Chest Surgery
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• v.44 no.3
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• pp.220-224
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• 2011

Background: We investigated changes in the International Normalized Ratio (INR) and its measurement interval in patients with thromboembolic events who were treated by low intensity anticoagulation therapy after isolated mechanical aortic valve replacement. Materials and Methods: Seventy-seven patients who underwent surgery from June 1990 to September 2006 were enrolled in the study and observed until August 2008. The patients were followed up at 4~8 week intervals and their warfarin (Coumadin)$^{(R)}$ dosage was adjusted aiming for a target range of INR 1.5~2.5. The rate of thromboembolic events was obtained. Changes in the mean INR and INR measurement interval were comparatively analyzed between the normal group (event free group, N=52) who had no anticoagulation-related complications and the thromboembolic group (N=10). Hospital records were reviewed retrospectively. Results: The observation period was 666.75 patient-years. Thromboembolic events occurred in 10 patients. The linearized occurrence rate of thromboembolism was 1.50%/patient-years. Actuarial thromboembolism-free rates were $97.10{\pm}2.02%$ at 5 years, $84.30{\pm}5.22%$ at 10 years, and $67.44{\pm}12.14%$ at 15 years. The percentages of INR within the target range and mean INR were not statistically significantly different for the normal and thromboembolic groups. However, the mean INR during the segmented period just before the events showed a significantly lower level in the thromboembolic group (during a 4 month period: normal group, $1.86{\pm}0.14$ vs. thromboembolic group, $1.50{\pm}0.28$, p<0.001). The mean intervals of INR measurement during the whole observation period showed no significant differences between groups, but in the segmented period just before the events, the interval was significantly longer in thromboembolic group (during a 6 month period: normal group, $49.04{\pm}9.47$ days vs. thromboembolic group, $65.89{\pm}44.88$ days, p<0.01). Conclusion: To prevent the occurrence of thromboembolic events in patients who receive isolated aortic valve replacement and low intensity anticoagulation therapy, we suggest that it would be safe to maintain an INR level above 1.8 and to measure the INR at least every 7~8 weeks.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.76-82
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• 2005

Purpose : Regional anticoagulation with trisodium citrate for continuous renal replacement therapy(CRRT) is an effective and safe method, with lower bleeding risk. However it is not widely used because of complex current protocols used to prevent anticipated metabolic derangements. We evaluated simplified regional anticoagulation protocols with ACD-A(R) solution and commercially available calcium-containing dialysis solution. Methods : The medical records of twenty-eight patients who underwent CRRT were reviewed. Hemofilter life span according to the anticoagulation method used was compared, and laboratory findings at Pre- and 48 hours post-CRRT initiation were compared in the citrate-based CRRT group. Results : Of the twenty-eight Patients, five patients underwent citrate-based CRRT Hemofilter life span was 1.60 $\pm$ 0.72 days, showing no significant differences with the hemofilter life span in the heparin based and LMWH based CRRT group. No patients experienced hemorrhagic complications. PT, aPTT, sodium, t$CO_{2}$, iCa levels showed no difference in pre- and post-CRRT. Total calcium levels were increased. At the recommended postfilter iCa level, j.e., 0.25-0.39 mmol/L, all five patients needed increased amount of citrate infusion, and Ca infusion requirement was decreased. Conclusion : Simplified regional citrate anticoagulation with calcium-containing dialysate is an effective and safe method, and is not associated with increased hemofilter clotting. However, increased postfilter iCa level is recommended.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1172-1182
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• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• 한국임상약학회:학술대회논문집
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• 2004.07a
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• pp.51-59
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• 2004

• Journal of Chest Surgery
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• v.29 no.3
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• pp.326-330
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• 1996

Despite anticoagulation, systemic embolization and anticoagulant-related hemorrhage are the major drawbacks of heart valve replacement with mechanical prostheses. Among many predisposing factors, inadequacy of anticoagulation is the most important one. Surgery can be reserved for patients who do not response to thrombolytic therapy, We have experienced 3 cases of prosthetic valve thrombosis treated by thrombolytic therapy by use of urokinase and heparin. Two patients fully recovered and returned to their employments and active lives but 1 patient,died of intracerebral hemorrhage and infarction. We report prosthetic valve thrombosis thrombolytic therapy with urokinase and heparin which was detected and serially followed by 2-dimensional echocardiography, cinefluoro copy, and monitoring of Swan-Ganz catherterized pressures.

• Journal of Korean Neurosurgical Society
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• v.51 no.1
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• pp.51-53
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• 2012

Spontaneous hematomas of the iliacus muscle are rare lesions and these are seen in individuals receiving anticoagulation therapy or patients with blood dyscrasias such as hemophilia. It can cause femoral neuropathy and resultant pain and paralysis. Although there is no clear consensus for the treatment of femoral neuropathy from iliacus muscle hematomas, delays in the surgical evacuation of hematoma for decompression of the femoral nerve can lead to a prolonged or permanent disability. We report here on a rare case of a spontaneous iliacus muscle hematoma that caused femoral neuropathy in a patient who was taking warfarin for occlusive vascular disease and we discuss the treatment.

• YAKHAK HOEJI
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• v.39 no.6
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• pp.666-670
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• 1995

The plasmin activity of euglobulin fraction treated with earthworm extract(EWE) increased concentration dependently when EWE(0.5, 1.0 and 2.0 mg each) were added to normal plasma. It was shown that lumbrokinase in EWE may be moved to euglobulin fraction and activated plasminogen. Also anticoagulation and fibbrinolysis were studied when EWE(7.5, 30 and 120 mg/kg) were added to rat model. Prothrombin time (PT) were 19.7${\pm}$ 3.8, 22.5${\pm}$ 2.5 and 24.5${\pm}$ 5.0sec. activated partial thromboplastin time (APTT) were 25.7${\pm}$ 5.9, 28.7${\pm}$ 5.2 and 36.5${\pm}$ 19.1 sec. After 15 days, the production of D-dimer were 242.3${\pm}$ 47.4, 250.0${\pm}$ 11.9 and 205.8${\pm}$ 12.2mg/ml plasma, respectively. These data showed that EWE acted on the coagulation factor of intrinsic and extrinsic system.

• Journal of the Korean Vacuum Society
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• v.4 no.S2
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• pp.8-19
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• 1995

Ion beam enhanced deopsition(IBED) was adopted to synthesize biocompatible titanium oxide film. Structure characteristics of titanium oxide film were investigated by RBS, AES and XRD. The blood compatibility of the titanium oxide film was studied by measurements of blood clotting time and platelet adhesion. The results show that the anticoagulation property of titanium oxide film is improved significantly. The mechanism of anticoagulation of the titanium oxide film was discussed.