• Journal of Chest Surgery
• /
• v.54 no.1
• /
• pp.25-30
• /
• 2021

Background: Life-long anticoagulant therapy is mandatory for patients who undergo heart valve replacement with implantation of a mechanical prosthesis. The aim of this study was to investigate the effects of a nurse-led patient educational program concerning oral anticoagulant therapy intake after heart valve replacement surgery on patients' knowledge of important parameters of anticoagulant administration. Methods: In this single-center study, 200 patients who underwent surgical implantation of a mechanical prosthesis were divided into 2 groups. The control group received the basic education concerning oral anticoagulants, while the intervention group received a personalized educational program. Results: Personalized education was correlated with a better regulation of therapeutic international normalized ratio (INR) levels and adequate knowledge among patients. Therapeutic levels of INR were achieved in 45% of the patients during the first month, 71% in the third month, and 89% in the sixth month after discharge in the intervention group, compared to 25%, 47%, and 76% in the control group, respectively. Patients' satisfaction with the information was higher in the intervention group than in the control group. The percentage of satisfaction reached 80% for the intervention group versus 37% for the patients of the control group. Conclusion: The implementation of the nurse-led educational programs was associated with improved clinical results and increased adherence to oral anticoagulant treatment.

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

• Restorative Dentistry and Endodontics
• /
• v.38 no.3
• /
• pp.113-118
• /
• 2013

Nowadays, oral anticoagulants are commonly prescribed to numerous patients for preventing cardiovascular accident such as thromboembolism. An important side effect of anticoagulant is anti-hemostasis. In a major surgery, the oral anticoagulant therapy (OAT) regimen must be changed before the surgery for proper post-operative bleeding control. However, in a minor dental surgery and endodontic surgery, the necessity for changing or discontinuing the OAT is open to debate. In this study, risks of the consequences were weighed and analyzed. In patients who stop the OAT, the occurrence of thromboembolic complication is rare but the result is fatal. In patients who continuing the OAT, post-operative bleeding can be controlled well with the local hemostatic measures. In the endodontic surgery, there are almost no studies about this issue. The intra-operative bleeding control is particularly important in the endodontic surgery because of its delicate and sensitive procedures such as inspection of resected root surface using dental microscope and retrograde filling. Further studies are necessary about this issue in the viewpoint of endodontic surgery.

• Archives of Pharmacal Research
• /
• v.20 no.1
• /
• pp.17-23
• /
• 1997

A saline suspension of Lumbricus rubellus earthworm powder (EWP) was administered to rats (1 g/kg/day) orally for 15 days to evaluate an oral effectiveness for thrombotic disorders. Blood was drawn at 2-day interval after the administration. Several parameters for antithrombotic, anticoagulant and fibrinolytic activities were measured, including platelet aggregation, clotting time, plasmin activity and the levels of FDP (fibrin/fibrinogen degradation products), D-dimer, and t-PA antigen. It did not affect platelet aggregation induced by ADP and collagen but anticoagulant activity (aPTT and TT) was gradually increased to two-folds for the first 5 days of administration and back to normal. Fibrinolytic activity of euglobulin fraction was highest on the 11 th day after the administration. The level of FDP was elevated to be comparable to the positve control$ (5-10 {\mu}g/ml)$ after 9-day treatment. Oral administration of the EWP could also reduce the formation of venous thrombus induced with viper venom. Complete blood count (CBC) profiles were within normal ranges except for a slight increase in white blood cells after the oral administration for 15 days. These results suggested that the EWP may be valuable for the prevention and/or treatment of thrombotic diseases.

• Journal of Chest Surgery
• /
• v.48 no.6
• /
• pp.432-434
• /
• 2015

Anticoagulation therapy is essential after cardiac valve surgery. However, spontaneous bleeding remains a major concern during anticoagulation therapy. Spontaneous gallbladder (GB) hemorrhage (hemobilia) is a rare occurrence during standard anticoagulation therapy. This report presents a case of GB hemorrhage that occurred shortly after initiating oral anticoagulant therapy in a patient who had undergone mitral valve replacement surgery.

• Biomolecules & Therapeutics
• /
• v.25 no.5
• /
• pp.461-470
• /
• 2017

Anticoagulant drugs, like vitamin K antagonists and heparin, have been the mainstay for the treatment and prevention of venous thromboembolic disease for many years. Although effective if appropriately used, traditional anticoagulants have several limitations such as unpredictable pharmacologic and pharmacokinetic responses and various adverse effects including serious bleeding complications. New oral anticoagulants have recently emerged as an alternative because of their rapid onset/offset of action, predictable linear dose-response relationships and fewer drug interactions. However, they are still associated with problems such as bleeding, lack of reversal agents and standard laboratory monitoring. In an attempt to overcome these drawbacks, key steps of the hemostatic pathway are investigated as targets for anticoagulation. Here we reviewed the traditional and new anticoagulants with respect to their targets in the coagulation cascade, along with their therapeutic advantages and disadvantages. In addition, investigational anticoagulant drugs currently in the development stages were introduced.

• Proceedings of the PSK Conference
• /
• 2002.10a
• /
• pp.276.2-276.2
• /
• 2002

Glycosaminoglycans(PT -Gag) were isolated from the porcine testis. From the PT -Gag. we obtained two different types of Gag fractions using Dowex macroporous Resin MSA-1 column. PT-Gag-1.5% NaCl and PT -Gag-16% NaCl. Various biological activities of the GAGs were examined in aspect of anticoagulant and immunomodulating activity. The anticoagulant activity of the GAGs was evaluated by activated partial thromboplastin time (aPTT ) assay and thrombin time (TT) assay. The GAGs of porcine testis markedly increased the clotting times of both of aPTT and TT. showing that PT-Gag-16% NaCl was more effective than PT-Gag-1.5% NaCl. The immunomodulating activity of the GAGs was examined in relation to regulation of cytokine production of mutine peritoneal macrophages. Treatment with the GAGs promonently enhanced the prodution of cytokines. IFN-${\gamma}$, from macrophages. Taken together. GAGs isolated from porcine testis possess biological functions such as anticoagulant and immunomodulating activity.

• Journal of Chest Surgery
• /
• v.33 no.6
• /
• pp.502-506
• /
• 2000

Background: Anticoagulant therapy can be required during pregnancy with prosthetic heart valves. Warfarin and heparin provide real protection against thromboembolic phenomena, but they also carry serious risks for the fetus and the mother. In an attempt to identify the best treatment for pregnant women with cardiac valve prostheses who are receiving anticoagulant, we studied 19 pregnancies, the warfarin was discontinued and heparin was administered every 12 hours by subcutaneous injection in doses adjusted to keep the midinterval aPTT in the therapeutic range(at least 2-2.5 control) from the conception to the 12th week of gestation and oral antiocagulant was then administered until the middle of the third trimester in the therapeutic range(at least 2 INR), and heparin therapy was restared until delivery. Also in order to avoid an anticoagulant effect during delivery, it has been our practice to instruct women to either discontinue their heparin injections with the onset of labur or to stop heparin injections 12 hours prior to the elective induction of labour. Result: The outcome of 19 pregnancies managed with above protocol was spontaneous abortion in 3 cases, voluntary termination in 2 cases, premature delivery at 35 weeks in 1 case and delivery at full-term in 14 cases. There was no maternal morbidity and moratality and fetopathy. Conclusion: We conclude that in the second and third trimester of pregnancy, warfarin provide effective protection against thromboembolism, Oral antiocagulant therapy should be avoided in 2 weeks before delivery because of the risk of serious perinatal bleeding caused by the trauma of delivery to the anticoagulated fetus. However, the substitution of heparin at first trimester and 2 weeks before delivery reduce the incidence of complications.

• The Korean journal of helicobacter and upper gastrointestinal research
• /
• v.18 no.3
• /
• pp.204-208
• /
• 2018

Spontaneous intramural hematoma is a rare complication of oral anticoagulants, and its incidence is expected to increase because of the increasing number of elderly patients undergoing anticoagulant therapy. Clinical manifestations of spontaneous intramural hematoma vary from mild abdominal pain to intestinal obstruction or acute abdomen. Early diagnosis is important because most patients can be treated successfully without surgery. The role of endoscopy in the diagnosis of intramural hematoma is not well established because almost all cases are diagnosed non-invasively with computed tomography scans. However, confirmation of the intramural hematoma through direct visualization of the involved bowel mucosa is helpful, if the imaging diagnosis is uncertain. We report a case of anticoagulant-induced spontaneous intramural hematoma, which was diagnosed using endoscopy, with relevant literature review.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.12 no.2
• /
• pp.99-104
• /
• 2012

Anticoagulation therapy with warfarin sodium is used to reduce the risk of thromboembolic events in patients with valvular heart disease, prosthetic heart valve, recurrent myocardiac infarction, etc. To keep anticoagulation state and minimize bleeding risk, patients with high risk of thromboembolism have been usually hospitalized for heparinization before oral surgery like extraction. However, this protocol requires time and high expense because of the long period of hospitalization and this is why low-molecular-weight heparin (LMWH) therapy is receiving attention in medical field as well as dentistry. LMWH has several advantages over unfractionated heparin (UFH) including predictable anticoagulant response which makes coagulation monitoring unnecessary in most patients and longer half-life than heparin which enables the patients to give themselves a subcutaneous injection once or twice daily. These advantages of LMWH make patients get oral surgery on an outpatient basis so that they can save time and cost. This case report introduces the use of LMWH in dental surgery and suggests proper use of LMWH. Though LMWH bridging therapy is widely used most of the previous studies are observational studies. Therefore randomized controlled trials are necessary to evaluate the safety and efficacy of LMWH bridging therapy.