• Korean Circulation Journal
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• v.52 no.7
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• pp.496-512
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• 2022

For almost 20 years, data regarding the effect of rhythm control therapy for atrial fibrillation (AF) on cardiovascular prognosis in comparison with rate control therapy has not been conclusive. The safety of rhythm control and anticoagulation therapy has generally improved. Recently, it was revealed that a rhythm-control strategy reduced the risk of adverse cardiovascular events than usual rate control in patients with recent AF (diagnosed within 1 year). Within 1 year after the AF diagnosis, early initiation of rhythm control led to more favorable cardiovascular outcomes than rate control. Early rhythm control reduced the risks of stroke and heart failure-related admission than rate control. Moreover, rhythm control was associated with lower dementia risk than rate control. Finally, early rhythm control treatment was also effective in patients with asymptomatic AF but less effective in older adults. Therefore, in patients with AF, rhythm control should be considered at earlier stages, regardless of symptom.

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.51-53
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• 2014

Mild traumatic brain injury is common in elderly patients, many of whom are on anticoagulant. The common practice is to discharge these patients from the emergency room if the computed tomography (CT) of the brain is normal. However, a very small proportion of these patients may develop a life threatening intracranial haematoma in the following days. We present here a case of a 66-year-old male on anticoagulant therapy that developed a subdural haematoma 48 hours after a mild head injury, with a normal initial CT scan of the brain. The patient underwent a craniotomy with evacuation of a large subdural clot. Postoperatively he had progressively improved and six months later has a Glasgow Outcome Score of three. This case is characterized by the delayed onset of a subdural haematoma in a patient on anticoagulation and we discuss here the possible pathogenesis related to this phenomenon. We also briefly review the pertinent literature and the current guidelines for the management of this type of head injuries.

• Journal of Chest Surgery
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• v.28 no.12
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• pp.1122-1131
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• 1995

One hundred eighty-eight patients[August.23,1988,through July.30,1994 underwent aortic[AVR , mitral[MVR , or double [DVR valve replacement with the St.Jude Medical prosthesis. The author analyzed 100 patients with valvular heart disease,who underwent valve replacement with the St.Jude Medical prothesis from 1990 to 1994, at Hanyang University hospital Cardiovascular department. Information on volume and functional change of the heart chamber can be obtained by cardiac echocardiography and cartheterization. Out of 100 patients, 40 patients were male[40% and 60 patients were female [60% . Age ranged from 13 years to 68 years, with mean age of 42.6 years. Mean height was 160.3cm and mean body weight was 54.9Kg. According to NYHA functional classification, class III is most frequent and 60 patients could be classfied under it. MVR [involved Redo MVR was performed in 40 patients, AVR [involved Redo AVR was performed in 18 patients, and DVR [involved Redo DVR was performed in 42 patients. Warfarin [Coumadin anticoagulation was recommended for all patients. Life long warfarin anticoagulation was necessary to all patients who underwent valve replacement with St.Jude Medical prosthesis. Ideal prothrombin time was maintained about 30% during warfarinization. There were no case of mechanical failure. It followed a comparison of echocardiography before and after valve replacement at Hanyang University hospital [30 patients and a preoperative evaluation of cardiac catheterization and angiography [64 patients . The St.Jude Medical cardiac valve is a viable alternative in the surgical therapy of valvular heart disease.

• Journal of Chest Surgery
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• v.16 no.4
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• pp.458-469
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• 1983

Between October, 1978, and December, 1982, Glutaraldehyde-stablized pericardial xenografts [Ionescu-Shiley valve] were used for heart valve replacement in 409 patients.[251 mitral, 49 aortic, 11 tricuspid, and 98 multiple valve replacement]. There were 31 early deaths [7.6%], and 371 operative survival were observed for a total of 507.6 years over a period of 1 to 44 months. [mean 17 months]. Actuarial analysis of late results indicates an excepted survival rate at 4 years of 86.25.4% for patients with mitral, 79.37.1% for patients with aortic valve replacement. Actuarial survival rates for total patients at 4 years was 77.88.2%. The rate of systemic embolism has been 1.6% per patient-year for mitral and 1.8% per patient-year for aortic group in the presence of anticoagulation treatment. Among the 6 embolic episodes, 2 patients were died. The incidence of hemorrhagic complication was 1.3% per patient-year for anticoagulated patients. There were 6 confirmed valve failures, five in mitral and one in aortic position. Re-replacement of destructed valve was performed in one patient and others were treated medically. Among the 6 episodes, 3 occurred in children [Below 15 years], it account almost 9 times higher than adult. Our clinical data compare very favorable with those obtained with other available prostheses and tissue valves, but it should be considered to give short-term anticoagulation therapy to hemodynamically stable patients and aortic valve patients, and other prosthetic valve must be considered to use in children.

• Journal of Chest Surgery
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• v.28 no.7
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• pp.666-670
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• 1995

A total of and consecutive 87 patients underwent concomitant double mitral and aortic valve replacement with the St. Jude Medical prosthesis between January 1985 and December 1993. They were 44 males and 43 females with the ages ranging from 18 to 59 years[mean$\pm$SD: 40.9$\pm$9.5 years . Fifteen patients[17.2% had a history of previous cardiac valve replacement. There were 2 early deaths[2.3% , and 85 early survivors were followed up for a total of 352.6 patient-years[mean$\pm$SD: 4.1 $\pm$2.6 years . All were anticoagulated with coumadin keeping the target international normalized ratio within the range of 1.5 and 2.5. There was a single late death[late mortality of 0.284%/patient-year . Thromboembolism was the most frequent complication[1.985%/patient-year , and bleeding related to anticoagulation was experienced in one patient [0.284%/patient-year . The incidences of prosthetic valve endocarditis and of paravalvular leak were also low[0.284%/patient-year, respectively . The survival including operative mortality was 96.1%$\pm$2.2% at 10 years. The actuarial probabilities of freedom from thromboembolism and from all events were 77.9%$\pm$11.1% and 72.4%$\pm$10.7%, respectively, at 10 years. There was no structural failure of the prosthesis. Results from a series of clinical studies suggest strongly that the use of lower intensity of anticoagulation therapy lowers the thromboembolic as well as bleeding rates in patients with the ST. Jude Medical prosthesis.

• Journal of Yeungnam Medical Science
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• v.40 no.3
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• pp.276-282
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• 2023

Background: Bleeding and thrombosis are major complications associated with high mortality in extracorporeal membrane oxygenation (ECMO) management. Anticoagulant therapy should be adequate to reduce thrombosis. However, related studies are limited. Methods: We retrospectively reviewed all patients supported with ECMO at a single institution between January 2014 and July 2022 and included those on all types of ECMO using the Permanent Life Support System. Patients were classified into two groups according to their measured mean activated partial thromboplastin time (aPTT) during ECMO management: a high-anticoagulation (AC) group (aPTT, ≥55 seconds; n=52) and a low-AC group (aPTT, <55 seconds; n=79). The primary outcome was thrombotic or bleeding events during ECMO. Results: We identified 10 patients with bleeding; significantly more of these patients were in the high-AC group (n=8) than in the low-AC group (15.4% vs. 2.5%, p=0.01). However, thrombus events and oxygenator change-free times were not significantly different between the two groups. Four patients in the high-AC group died of bleeding complications (brain hemorrhage, two; hemopericardium, one; and gastrointestinal bleeding, one). One patient in the low-AC group developed a thrombus and died of ECMO dysfunction due to circuit thrombosis. Conclusion: Heparin did not significantly improve thrombotic outcomes. However, maintaining an aPTT of ≥55 seconds was a significant risk factor for bleeding events, especially those associated with mortality.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.443-447
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• 2017

Background: The inferior vena cava filter (IVCF) is very effective for preventing pulmonary embolism in patients who cannot undergo anticoagulation therapy. However, if a filter is placed in the body permanently, it may lead to other complications. Methods: A retrospective study was performed of 159 patients who underwent retrievable Cook Celect IVCF implantation between January 2007 and April 2015 at a single center. Baseline characteristics, indications, and complications caused by the filter were investigated. Results: The most common underlying disease of patients receiving the filter was cancer (24.3%). Venous thrombolysis or thrombectomy was the most common indication for IVCF insertion in this study (47.2%). The most common complication was inferior vena cava penetration, the risk of which increased the longer the filter remained in the body (p=0.032, Exp(B)=1.004). Conclusion: If the patient is able to retry anticoagulation therapy and the filter is no longer needed, the filter should be removed, even if a long time has elapsed since implantation. If the filter cannot be removed, it is recommended that follow-up computed tomography be performed regularly to monitor the progress of venous thromboembolisms as well as any filter-related complications.

• Journal of Chest Surgery
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• v.20 no.3
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• pp.512-519
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• 1987

In the department of chest surgery of Pusan National University hospital cardiac valve surgery was done in 118 cases from March, 1982, to June, 1986. Among these, 90 were mitral valve replacement, 9 mitral commissurotomy, 5 mitral valvuloplasty, 4 aortic valve replacement, 4 double valve replacement, 4 mitral annuloplasty, one mitral annuloplasty with commissurotomy and valvuloplasty. 48 were male and 70 were female and age distribution ranged from 6 to 57 years [mean 30.6 years]. Early death within 30 days after operation was 14 cases: 10 had mitral valve replacement, 2 double valve replacement and 2 mitral annuloplasty respectively. Confirmed causes of death were low cardiac output syndrome in 9 cases, congestive heart failure in one case, cardiac tamponade in one case, malfunction of valve in one case, cardiac rupture in one case and renal failure in one case. The 104 cases were followed up for a total 190 years and range was from 2 to 54 months [Mean*SD: 21.9*16.5 months]. During follow-up period, 2 late deaths were developed: one was due to subdural hematoma and the other was congestive heart failure combined with fulminant hepatitis. Anticoagulation therapy was done with warfarin to the level of 20 to 40% of normal prothrombin time in 53 cases, dipyridamole and aspirin in 18 cases, or ticlopidine hcl in 15 cases. The frequency of bleeding due to anticoagulation therapy was 1.0% episodes per patient-years: one was in warfarin group and another was in dipyridamole and aspirin group. Among the studied 102 cases, 93 cases [91.2%] of patients were in NYHA class I or II during follow up period.

• Tuberculosis and Respiratory Diseases
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• v.78 no.3
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• pp.289-292
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• 2015

Lemierre syndrome (LS) is a septic thrombophlebitis of the internal jugular vein (IJV) following an oropharyngeal infection. LS is commonly caused by normal anaerobic flora and treated with appropriate antibiotics and anticoagulation therapy. Although the incidence of disease is very rare, 15% cases of LS are fatal even in the antibiotic era because of disseminated septic thromboemboli. We reported a case of extensive bilateral LS due to methicillin-resistant Staphylococcus epidermidis in a 63-year-old female with lung adenocarcinoma. Initial examination revealed a retropharyngeal abscess; hence, intravenous ceftriaxone and steroid were initiated empirically. However, pulmonary thromboembolism developed and methicillin-resistant S. epidermidis was identified in the bacterial culture. Despite intensive antibiotic and anticoagulation therapies, extensive septic thrombophlebitis involving the bilateral IJV and superior vena cava developed. Adjunctive catheter-directed thrombolysis and superior vena cava stenting were performed and the patient received antibiotic therapy for an additional 4 weeks, resulting in complete recovery.

• Tuberculosis and Respiratory Diseases
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• v.82 no.4
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• pp.341-347
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• 2019

Background: Information about the epidemiology of venous thromboembolism (VTE) recurrence in Korea is lacking. The purpose of this study was to investigate VTE cumulative recurrence rates and identify risk factors for VTE recurrence among Korean adults. Methods: A retrospective cohort study was conducted on adult patients (${\geq}18years$) admitted to a university teaching hospital for pulmonary embolism (PE) from 2005 to 2013. The main outcome of interest was a recurrence of VTE. We used Cox proportional hazard regression analyses to calculate the relative risk of VTE recurrence. Results: Five-year cumulative incidence of recurrent VTE events was 21.5% (95% confidence interval [CI], 17.7-25.4) in all cases of PE; 17% after provoked and 27% after unprovoked PE. Multivariate analysis showed that body mass index (BMI) of ${\geq}25$ (hazard ratio [HR], 2.02; 95% CI, 1.17-3.46; p=0.01) and longer anticoagulation therapy duration (HR, 0.90; 95% CI, 0.84-0.96; p<0.01) were independently associated with risk of VTE recurrence. Risk factors not found to be statistically significant at the <0.05 level included history of VTE (HR, 1.81; 95% CI, 0.84-3.88; p=0.12), unprovoked PE (HR, 1.70; 95% CI, 0.89-3.25; p=0.10), symptomatic deep vein thrombosis (HR, 1.62; 95% CI, 0.89-2.94; p=0.10), and female sex (HR, 1.42; 95% CI, 0.78-2.55; p=0.24). We found that age, history of cancer, and other co-morbidities did not significantly affect the risk of VTE recurrence. Conclusion: Recurrence of VTE after PE is high. Patients with BMI ${\geq}25$ or reduced anticoagulation therapy duration have a higher risk of recurrent VTE.