• Journal of Digestive Cancer Research
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• 제1권2호
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• pp.108-110
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• 2013

전체 정맥혈색전증 환자의 20% 이상이 암과 관련이 있고, 암 환자에 있어 혈색전증은 두 번째 사망 원인으로 작용하고 있어 이에 대한 효과적인 예방과 치료가 사망률을 감소시킬 수 있는 것으로 알려져 있다. 혈색전증 진단에 있어 혈액검사로 D-dimer 측정 및 영상검사로 도플러 초음파, 전산화단층혈관 촬영술을 사용한다. 치료 약제로 경구 비타민 K 길항제가 사용되었으나, 최근에는 정기적인 모니터링이 필요하지 않은 약제들이 새롭게 사용되고 있다. 저자들은 진행성 위암환자에서 발생한 하지 심부정맥 혈전증 및 폐동맥 혈색전증에 있어 저분자량 헤파린을 투여하며, 호전된 사례를 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제59권5호
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• pp.487-496
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• 2005

연구배경 : 우심실부전 또는 쇽을 보였던 중증 폐색전증에서 혈전용해요법 혹은 항응고요법을 시행했을 때 예후의 차이에 대해 조사해 보고자 하였다. 방 법 : 1995년 1월부터 2004년 12월까지 서울아산병원에 입원했던 폐색전증 환자 중에서 우심실부전 혹은 쇽이 있었던 총 60명의 환자를 대상으로 의무기록 분석을 통해서 후향적으로 조사하였다. 결 과 : 총 57명의 환자가 혈전용해요법 또는 항응고요법을 시행 받았으며, 이 중 혈전용해제는 13명(23%)에서, 항응고제는 44명(77%)에서 사용되었다. 혈전용해요법 군과 항응고요법 군에서 APACHEII 점수나 SOFA 점수에 차이는 없었고 사망률은 각각 46% (6/13), 16% (7/44)였다(p=0.054). 쇽이 있는 19명(33%)의 환자 중 혈전용해요법은 9명(47%), 항응고요법은 10명(53%)에서 시행되었고 사망률은 각각 44% (4/9), 30% (3/10)로 차이가 없었다(p=0.650). 38명(67%)의 우심실부전 군에서 혈전용해요법은 4명(11%), 항응고요법은 34명(89%)에서 시행되었고 사망률은 50% (2/4), 24% (8/34)로 차이가 없었다(p=0.279). 중요 출혈부작용은 혈전용해요법 군과 항응고요법 군에서 23% (3/13), 5% (2/44)로 혈전용해요법이 높은 경향을 보였다(p=0.072). 결 론 : 중증 폐혈전색전증 환자에서 쇽 군과 우심실부전군을 각각 혈전용해요법과 항응고요법으로 치료했을 때, 두 군 모두에서 혈전용해요법이 항응고요법에 비해 사망률을 감소시키지 못했으며, 출혈부작용은 높은 경향을 보였다. 그러므로 우리나라에서 전향적 대규모 연구가 필요할 것으로 사료된다.

• Journal of Chest Surgery
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• 제22권6호
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• pp.980-989
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• 1989

The Hancock porcine xenograft valves had been used in Seoul National University Hospital, mainly because of their antithrombogenicity despite of the predicted failure, from March 1976 to April 1984, and a total and consecutive 163 patients were retrospectively studied for late results with the special stress on the structural failure. The hospital mortality rate [within 30 days] was 6.1 %, and the 153 early survivors were followed up for a total of 822.9 patient-years [p-y][Mean * SD 5.38 * 3.02 years]. The linealized late mortality was 1.823%/p-y. Four major complications related to the Hancock valve were: 1.822% thromboembolism/p-y; 0.729 % bleeding/p-y; 0.972% endocarditis/p-y; 3.646% overall valve failure/p-y and 2.187 % primary tissue failure [PTF]/p-y. The actuarial survival rates at 5 and 10 years were 94.90 * 1.89% and 80.58 * 5.21 %; and the probabilities of freedom from thromboembolism at 5 and 10 years were 90.93 * 2.63% and 83.35 * 7.64 9o respectively. The probabilities from PTF at 5, 10 and 12 years were 98.02 * 1.39%, 60.62 * 8.89% and 49.60 * 12.34 %. One hundred-eighteen patients [72.4%] had single MVR [age, 34.0 * 10.9 years] with the operative mortality rate of 4.2%; and 113 early survivors were followed up for a total 616.4 patient-years[5.46 * 2.96 years]. The late mortality rate was 1.460 %/p-y. The major complications were: 1.622 % thromboembolism /p-y; 0.487% bleeding/p-y; 0.649 % endocarditis/p-y; 2.920% primary valve failure/p y and 1.785% PTF/p-y. The actuarial survival rates were 97.08 * 1.67%[at 5 years] and 81.27 * 6.64%[at 10 years], and the probabilities of freedom from thromboembolism 92.44 * 2.76 %[at 5 years] and 80.89 * 11.08%[at 10 years]. The probabilities of freedom from PTF at 5 and 10 years were 98 70 * 1.29% and 65.59 * 9.78% respectively. The mean age of 11 patients of PTF was 25.7 * 8.8 years and the valve extraction period 7.16 * 1.45 years. Failure of bioprosthetic xenograft valves are reportedly known to occur earlier in young patients in an accelerated fashion. The study with two groups divided into the cumulative younger and the cumulative older patients according to the age limits of 5-year interval strongly suggested these tendency. Although PTF began to occur past postoperative 5 years and the probabilities of freedom from PTF increased as the age limits raised and the number of patients increased in the cumulative younger patients while they decreased as the age limits lowered and the number of patients increased in the cumulative older patients, the definite age limits from which the Hancock valve can be safely recommended could not be obtained. From the results, the Hancock valves are contraindicated in patients younger than 20 to 25 years and may be safely recommended in patients older than 45 years as a tentative conclusion. Further longitudinal study may define these age factors.

• Journal of Chest Surgery
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• 제44권3호
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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.

• Tuberculosis and Respiratory Diseases
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• 제54권1호
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• pp.5-14
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• 2003

연구배경 : ICOPER 보고에 의하면 급성 폐혈전색전증 발생 3개월내 사망률이 17.4%이며, 일본 조사에서는 사망률이 14%라고 보고하였다. 그러나 국내에서는 급성 폐혈전색전증의 전국 규모의 대단위 연구가 없어서, 그 현황에 대해 보고된 바 없었다. 따라서 본 학회에서는 급성 폐혈전색전증에 대한 전국 실태조사를 시행하였다. 방법 : 1998년 1월 1일부터 2000년 12월 31일까지 전국수련병원급 이상 종합병원에서 급성 폐혈전색전증으로 진단받은 환자를 대상으로 역학적 특성, 임상양상, 진단법, 위험인자, 치료, 임상경과 등을 조사하였다. 결과 : 환자들의 평균연령은 $58.3({\pm}16.3)$세 였고, 남자가 40.3%였다. 발생 위험인자로는 장기간의 부동상태, 수술, 악성종양이 각각 22.9, 19.2, 15.8% 였다. 가장 흔한 증상으로는 호흡곤란과 흉통이었다. 진단을 위한 검사방법으로는 폐관류 스캔을 시행한 경우가 가장 많았다. 흉부 방사선 검사상 정상 소견을 보인 경우가 53.5%로 가장 많았고, 이상 소견으로는 흉막 삼출액이 가장 흔하였다. 치료방법으로는 86.8%에서 헤파린 항 응고법을 시행하였고 혈전 용해요법은 시행한 경우는 12.3%였다. 사망을 예측할 수 있는 인자로는 병원내에서 이환된 경우, 폐암, 빈호흡, 쇼크, 청색증의 5가지로 분석되었고, 사망 위험도는 각각 1.88, 9.20, 3.50, 6.74, 3.45배 였다. 전체 사망률은 16.9%였고 그 중에서 급성 폐혈전색전증과 연관된 사망률은 9.0%였다. 결론 : 본 조사는 급성 폐혈전색전증에 대한 최초의 전국규모의 실태조사로서, 이 결과가 향후 국내 급성폐혈전색전증의 연구와 치료에 기여할 수 있을 것으로 사료된다.

• Journal of Chest Surgery
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• 제11권3호
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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.

• Tuberculosis and Respiratory Diseases
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• 제52권3호
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• pp.288-293
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• 2002

저자들은 객혈을 주소로 내원하여 선천성 폐동맥 부발육증으로 오인한 32세 여자환자를 폐색전증으로 진단하였고, 항응고제 투여를 통해 호전된 예를 문헌고찰과 함께 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제54권8호
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• pp.322-328
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• 2011

Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS.

• Biomolecules & Therapeutics
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• 제24권6호
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• pp.659-664
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• 2016

Lindera obtusiloba has been used in traditional herbal medicine for the treatment of blood stasis and inflammation. The leaves of Lindera obtusiloba have been reported to exhibit various physiological activities. However, there is little information available on their antiplatelet and antithrombotic activities. Thus, the present study aimed to evaluate the effect of Lindera obtusiloba leaf extract (LLE) on platelet activities, coagulation and thromboembolism. In a platelet aggregation study, LLE significantly inhibited various agonist-induced platelet aggregations in vitro and ex vivo. Furthermore, LLE significantly inhibited collagen-induced thromboxane A2 (TXA2) production in rat platelets. In addition, oral administration of LLE was protective in a mouse model of pulmonary thromboembolism induced by intravenous injection of a mixture of collagen and epinephrine. Interestingly, LLE did not significantly alter prothrombin time (PT) and activated partial thromboplastin time (aPTT). This study indicates that the antithrombotic effects of LLE might be due to its antiplatelet activities rather than anticoagulation. Taken together, these results suggest that LLE may be a candidate preventive and therapeutic agent in cardiovascular diseases associated with platelet hyperactivity.

• Journal of Chest Surgery
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• 제22권1호
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• pp.106-115
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• 1989

Clinical results with the xenograft cardiac valves were reviewed for 212 patients who underwent heart valve replacement from January 1981 to December 1987. One hundred and twenty-four Carpentier-Edwards k 88 Ionescu Shiley valves were used. Overall operative mortality was 11 out of 212[5.1%]: 5 out of 153[3.39o] for mitral valve replacement [MVR], 2 out of 34[5.9%] for aortic valve replacement [AVR], 0 out of 4[0%] for Tricuspid valve replacement [TVR], and 4 out of 21[19.1%] for double valve replacement [DVR;MVR+ AVR]. Two hundred and one operative survivors were followed up for a total of 824.3 patient-years [a mean 3.9*1.8 yrs], and the follow up was 78.1%. The linealized complication rates were 0.1% emboli / patient-year, 1.0% endocarditis/ patient-year and 2.2% overall valve failure / patient-year. A linealized rate of primary tissue failure was 0.7*/o/ patient-year. The actuarial survival rates including the operative mortality were 92*2.8% at 4 years and 85*4.3% at 7 years after surgery using the Xenograft cardiac valves. Probabilities of freedom from thromboembolism and overall valve failure were 73*11.0% and 69*2.4% at 7 years after surgery using the Xenograft cardiac valves respectively. The intrinsic durability of the Xenograft cardiac valves appears to be relatively well satisfactory over the long term [4 to 7 years] and the risk of failure appears well balanced by the advantages of a low incidence of thromboembolism and no mandatory anticoagulant therapy.