• 한국노년학
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• v.40 no.2
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• pp.227-237
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• 2020

The purpose of this study is to understand using of antithrombotic agents in clinical settings. The number of patients receiving antithrombotic therapy is increasing in the long term due to the increased prevalence of cardiovascular disease in the elderly. There is a guideline for discontinuation of antithrombotic treatment before dental treatment, but the present study shows that there is a difference from the actual clinical situation. We used an online survey methodology to involve 1000 participants. The questionnaires were asked about general items and Clinical experience such as history of antithrombotic history, experience of complications due to antithrombotics, discontinuation of use, reasons for discontinuing use. The result is as follows. The incidence of delayed bleeding was found to be 55.1%, and discontinuation of antithrombotic therapy before withdrawal was 87.8%. Among respondents 98.3% responded that they stopped antithrombotics because of delayed bleeding and 57.4% responded that they would stop for three to five days. Korean dentists maybe cope with delayed bleeding considering the emotional problem of the patient, the relationship with the patient's physician, and the additional socioeconomic problems.

• Korean Journal of Clinical Pharmacy
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• v.27 no.1
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• pp.15-21
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• 2017

Objective: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. Methods: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. Results: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). Conclusion: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.

• Journal of Biomedical Engineering Research
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• v.15 no.1
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• pp.9-18
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• 1994

• Journal of Physiology & Pathology in Korean Medicine
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• v.17 no.4
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• pp.930-938
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• 2003

The purpose of the present study was to investigate the effects of Hyunhosaiksan (HHS) on antithrombotic actions which include blood activation, thrombus removal, warming of circulating blood, and the control of pain on abdomen and lower and upper burning spaces. HHS significantly inhibited platelet aggregation induced by ADP and epinephrine in a HHS dose-dependent manner when analyzed by the Sigmoid Emax model in WinNonlin. EC50 values of HHS were 1.71 ㎍/ml and 0.004 ㎍/ml for ADP and epinephrine respectively. In the vivo study, HHS inhibited pulmonary embolism induced by collagen and epinephrine, which was however statistically insignificant. HHS increased number of platelets, APTT and volume of fibrinogen significantly as compared with the control group in dextran-induced thrombus model. Furthermore, HHS stimulated levels of blood flow in vivo though its effect was not observed in vitro. These results suggest that Hyunhosaiksan (HHS) can be used for treating numerous diseases related with blood aggregation and circulation problems. Further systematic investigations on the synergic effects among drugs used in the oriental medicine as well as in the western medicine in relation to thrombosis therapy would provide an important insight into the potential therapeutic applications.

• Journal of Yeungnam Medical Science
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• v.20 no.1
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• pp.1-12
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• 2003

Ischemic stroke is among the principal causes of death and disability in the elderly. Although control of blood pressure, decreased cigarette smoking, and modified dietary habits are among important reasons for stroke decline, the use of antithrombotic therapy, rigorously prescribed. Several antiplatelet agents are approved to reduce the risk of recurrent stroke. Aspirin is the best-studied and most widely used antiplatelet agent for stroke prevention; it provides approximately 15% to 25% relatively risk reduction for secondary prevention of stroke or the major vascular death. Combining 2 antiplatelet agents with different mechanism of action was demonstrated to provide a substantial increase in efficacy in several studies. Anticoagulation should be considered first with potential cardiac sources of embolism. Heparin reduces development of erythrocyte-fibrin thrombi that form in regions of vascular stasis especially within the heart, in severely stenosed arteries sometimes engrafted on white thrombi, in acute arterial occlusion. Heparin should not be indiscriminately given to all acute brain ischemia patients, but may contribute to treatment of large artery occlusion and severe stenosis, cardiogenic embolism with a high acute recurrence risk, and dural sinus and cerebral venous thromobosis.

• Journal of Life Science
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• v.21 no.10
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• pp.1422-1427
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• 2011

This study was performed to develop effective antithrombotic agents from traditional herb extracts. Prunella vulgaris L. has been used traditionally as a medical resource in cancer therapy, as well as treatment of hypertension and inflammation, and as a diuretic. However, the effects of Prunella vulgaris on thrombosis and platelet activation have not been clearly understood. Antithrombotic and antiplatelet activities of oriental medicinal herbs were investigated by evaluating the effect of the aqueous extract from Prunella vulgaris on the blood coagulation, platelet aggregation and fibrinolysis. Prunella vulgaris extracts showed effective anticoagulant activity in coagulation times such as activated partial thromboplastin time (APTT) and prothrombin time (PT). Prunella vulgaris also inhibited adenosine diphosphate (ADP)- and collagen-induced platelet aggregation. In addition, evaluation of fibrinolytic activity showed that the Prunella vulgaris extracts have high solubility. From these results, it is suggested that Prunella vulgaris can be a potential candidate for anticoagulants and antiplatelets, as well as fibrinolytic agents.

• Journal of Acupuncture Research
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• v.29 no.3
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• pp.139-148
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• 2012

Objectives : The purpose of this case is to report the improvement of two patients diagnosed with eight and a half syndrome after combination therapy of oriental and western medicine. Methods : We treated the patients with combination therapy of oriental and western medicine such as acupuncture, moxibustion, herbal medication, antithrombotic agents and steroid therapy. Changes of peripheral facial paralysis were evaluated using House-Brackmann facial grading system and the degree of dizziness, tenderness and pain of upper abdomen were assessed using numerous rating scale. Changes in motor grade of upper and lower extremities were evaluated using medical research council scale. Results : We have recently experienced two cases of eight and a half syndrome - a syndrome characterized by the coexistence of one and a half syndrome, a rare ophthalmoparetic syndrome characterized by a conjugate horizontal gaze palsy in one direction and an internuclear ophthalmoplegia in the other, and cranial nerve VII palsy. The one and a half syndrome was caused by acute cerebral infarction. Two patients in this report were improved through combination therapy of oriental and western medicine. Conclusions : We report the clinical course and treatment methods of eight and a half syndrome.

• Bulletin of the Korean Chemical Society
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• v.33 no.9
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• pp.3048-3054
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• 2012

The use of aspirin is widely recommended for the prevention of heart attacks owing to its ability to inhibit platelet activation by irreversibly blocking cyclooxygenase 1. However, aspirin also affects the fibrinolytic and hemostatic pathways by mechanisms that are not well understood, causing severe hemorrhagic complications. Here, we investigated the ability of aspirin and aspirin metabolites to inhibit thrombin-activatable fibrinolysis inhibitor (TAFI), the major inhibitor of plasma fibrinolysis. TAFI is activated via proteolytic cleavage by the thrombin-thrombomodulin complex to TAFIa, a carboxypeptidase B-like enzyme. TAFIa modulates fibrinolysis by removing the C-terminal arginine and lysine residues from partially degraded fibrin, which in turn inhibits the binding of plasminogen to fibrin clots. Aspirin and its major metabolites, salicylic acid, gentisic acid, and salicyluric acid, inhibit TAFIa carboxypeptidase activity. Salicyluric acid effectively blocks activation of TAFI by thrombin-thrombomodulin; however, salicylates do not inhibit carboxypeptidase N or pancreatic carboxypeptidase B. Aspirin and other salicylates accelerated the dissolution of fibrin clots and reduced thrombus formation in an in vitro model of fibrinolysis. Inhibition of TAFI represents a novel hemostatic mechanism that contributes to aspirin's therapy-associated antithrombotic activity and hemorrhagic complications.

• Journal of Chest Surgery
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• v.11 no.3
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• pp.303-315
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• 1978

During the full 10-year period from June 1968 through June 1978, 112 consecutive patients underwent isolated or double valve replacement. A total of 130 valves were used in aortic, mitral or tricuspid positions: 63 prosthetic valves in 56 and 67 glutaraldehyde-preserved porcine aortic valves in 56 patients. There were 31 early and 9 late deaths with a cumulative mortality rate of 35.7 percent. Eighty-five patients survived longer than 10 days postoperatively were studied for the occurrence of thromboembolism and complications related to anticoagulant therapy. At the end of follow-up period, 68 patients were on Coumadin; 74 were on Persantin with or without Coumadin; 11 were off any antithrombotic drugs with 6 of them being off electively after 6 months of tissue valve replacement. Thromboembolism occurred in 7 [8.2%] of 85 patients or 10.9%/patient-year. Embolic rates were as follows: one of 18 patients anticoagulated [5.6%] or 6.1%/patient-year and 4 of 16 patients not anticoagulated [25.0%] or 17.8%/patient-year for the prosthetic valve replacement; and one of 40 patients anticoagulated [2.5%] or 7.9%/patient-year and one of 11 patients not anticoagulated [9.1%] or 7.9%/patient-year for tissue valve replacement. Three complications of major bleeding were experienced by 3 patients during the follow-up period, being related to Coumadin therapy. The importance of proper anticoagulation were stressed for the successful management of patients after cardiac valve replacement, both prosthetic and tissue valves.

• Biomedical Science Letters
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• v.19 no.3
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• pp.233-238
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• 2013

Aspirin is still the mainstay of antiplatelet therapy in the cardiovascular and cerebrovascular disease. However, some patients are not responsive to the antithrombotic action of aspirin. The aim of this study was to assess the prevalence and clinical characteristics of aspirin resistance in patients with cerebral infarction. We tested platelet function in 557 patients who had been treated with aspirin in J general hospital. Platelet function was tested using the multiple electrode platelet aggregometry (MEA). Platelet reactivity was expressed as area under the aggregation curve (AUC, U) and >30 AUC was defined as aspirin resistance. Aspirin resistance was detected in 16.2% patients. There was not any significant differences in age, gender between aspirin resistance and aspirin sensitive patients. WBC was significantly higher in patients with aspirin resistance (P < .05). HDL-cholesterol was significantly higher in patients with aspirin sensitive (P < .05). Aspirin resistance was positive correlation with platelet count (r =.314, P =.003). The prevalence of aspirin resistance in cerebral infarction was 16.2%, and platelet count were related with aspirin resistance.