To clot, or not to clot ­ Antithrombotic therapy is the question

Haemostasis and thrombosis rely on three components namely the vascular endothelial wall, blood platelets and the coagulation cascade. Non-physiologic excessive thrombosis occurs when haemostatic processes are dysfunctional, causing undue clot formation or reduced clot lysis. Antithrombotic agents including antiplatelet, anticoagulation and fibrinolytic agents are essential for the prophylaxis and pharmacological management of venous thromboembolism and arterial thrombosis. Anticoagulation treatment options have expanded steadily over the past few decades, providing a greater number of agents. Anticoagulants that directly target the enzymatic activity of thrombin and factor Xa have recently been developed to address the inadequacies of traditional vitamin K antagonists. Appropriate use of these agents requires knowledge of their individual characteristics, risks, and benefits

Thromboembolic events in Sudanese patients with rheumatic mitral stenosis

Background: Rheumatic mitral stenosis (MS) is a common problem in the Sudanese community, usually affecting the younger population. It can be a crippling condition with many complications, thromboembolism being one of the most serious. Objective:The aim of this study is to quantify the prevalence of thromboembolism and to identify its risk factors in Sudanese patients with MS at Ahmed Gasim Cardiac Centre. Methodology:Records of patients admitted from Jan 1999-Jan 2003, were retrospectively reviewed and data from various clinical and echocardiographic variables were recorded. Results:A total of 412 patients were studied, 142 (34.5%) were males, 270 (65.5%) were females. There were no significant differences in the gender (P = 0.606) or severity of symptoms between patients with and without thromboembolism. Patients with thromboembolism were older (P < 0.016), had more frequent atrial fibrillation (P = 0.017), smaller mitral valve area (P = 0.021) and higher pulmonary artery pressure (P = 0.012) compared to patients without thromboembolism. Dilated left atrial (LA) size was significantly associated with thromboembolism (P = 0.034), spontaneous echo contrast (P = 0.048) and the presence of LA or left atrial appendage (LAA) thrombus (P = 0.029). The presence of LA/LAA thrombus was significantly associated with both thromboembolism (P = 0.05) and spontaneous echo contrast (P < 0.0001). Transoesophageal echocardiography was more sensitive in detecting both spontaneous echo contrast (P < 0.0001) and LA/LAA thrombus (P < 0.0001) than transthoracic echocardiography. Conclusion: These results highlight the clinical and echocardiographic risk factors for thromboembolism, the sensitivity of transoesophageal echo for assessment of those patients, and the need for early referral for percutaneous transvenous mitral commisurotomy (PTMC)

Epidemiological African Day for Evaluation of Patients at Risk of Venous Thrombosis in Acute Hospital Care Settings : Cardiovascular Topic

Introduction : This study aimed to identify patients at risk for venous thromboembolism (VTE) among all patients hospitalised; and to determine the proportion of at-risk hospital patients who received effective types of VTE prophylaxis in sub-Saharan Africa (SSA). Methods: A multinational; observational; cross-sectional survey was carried out on 1 583 at-risk patients throughout five SSA countries. Results: The prevalence of VTE risk was 50.4 overall; 62.3 in medical and 43.8 in surgical patients. The proportion of at-risk patients receiving prophylaxis was 51.5 overall; 36.2 in medical and 64 in surgical patients. Low-molecular weight heparin was the most frequently used prophylactic method in 40.2 overall; 23.1 in medical and 49.9 in surgical patients. Discussion: This study showed a high prevalence of VTE risk among hospitalised patients and that less than half of all at-risk patients received an American College of Clinical Pharmacy-recommended method of prophylaxis. Conclusion: Recommended VTE prophylaxis is underused in SSA

Mitral Valve Repair in Rheumatics: is it still Worthwhile?

Prosthetic valve replacement in young patients carries increased morbidity and mortality; even with recent types and models of prostheses. Fortunately; rheumatic mitral regurgitation in this young population group is amenable to repair; although the results are less favourable than those ob- served with other types of mitral valve disease and in older populations. A better knowledge of the pathology and evolution of repair techniques has improved results. Hence mitral valve repair is still worthwhile; even in rheumatic pathology and; the percentage of valves repaired; increases with the experience and the will of the surgeon to preserve the valve. Mitral valve replacement can only be justified when good repair is not feasible. It is vital that the surgeon has adequate experience which can only be gained by exposure to enough patients with this condition. Most of these patients are in developing countries and hampered by socio-economic conditions - which means 1st World surgeons get limited required exposure

Uncomplicated Caesarean Section: is Delayed Return to Oral Feeding Necessary?

OBJECTIVE: To asses the feasibility and practicability of resuming oral feeding six hours after caesarean section.METHODS: Eighty five women undergoing primary caesarean section at proprietary hospital in Lagos Nigeria were randomised into two groups of commencement of oral feeding six hours after surgery and waiting for at least 24hours for bowel sounds to return.RESULTS: In 27(64.3) of the 42 patients in the routine feeding group; normal bowel sounds were present about 24hours after the operation as against 37(86.0) of 43 in the early feeding group(X2 = 5.41;p= 0.02 ; OR = 3.43 ; 1.06 - 11.5). While 93.0(40) of the patients in early feeding group had bowel motion within 48hours ; only 69.0(29) of the patients in the routine feeding group had bowel motion within same period( X2 = 6.50 ; p = 0.01). The percentage of mothers that were ambulant within 8hours were more in the early feeding group (83.7) compared to the routine feeding group (61.9) -X2 = 5.12; p = 0.02). The overall gastrointestinal morbidity among the early feeding group was higher (18.6) compared to routine feeding group (11.9) but the difference was not statistically significant(X2 = 0.13; p = 0.72; OR = 1.54; CI = 0.38 - 6.33).Conclusion:Early oral finding is not only feasible but practicable

Etude du déficit en proteine C dans la maladie thromboembolique veineuse au CNHU de Cotonou: étude realisée chez 54 patients noirs vivant à Cotonou

L'objectif de cette etude est de depister le deficit en proteine C dans une population de patients noirs africains atteints de maladie thromboembolique veineuse. C'est une etude descriptive transversale qui a inclus systematiquement tous les patients hospitalises pour MTEV aigue ou suivis dans les suites de MTEV qui ont accepte d'y participer. Un dosage quantitatif de la proteine C a ete realise sur un equipement de type Minividas. Le prelevement sanguin a ete effectue en dehors de tout traitement antivitamine K. Un deuxieme prelevement est effectue pour confirmation au cas ou le premier dosage affirme un deficit. En cas de deficit la recherche d'une etiologie acquise est systema- tique. Pour les 54 patients retenus la sex-ratio etait de 1;08 et l'age moyen est de 52;7+/- 14;1 ans. Un deficit en proteine C a ete diagnostique chez 9;3des patients et 12;5des patients presentant des criteres de thrombophilie ( p=1). Aucune etiologie acquise n'a ete mise en evidence

Hemostase et oestro-progestatifs : a propos de 63 cas dans les centres de Planning familial du CHU et de la Formation Sanitaire de Yopougon

La thromboembolie est une complication rare mais grave pouvant survenir chez les femmes sous oestroprogestatifs. Ce danger est bien souvent meconnu des utilisatrices et a fait l'objet jusqu'a ce jour de peu d'investigations en Afrique. L'objectif de ce travail est d'evaluer le risque thromboembolique chez les utilisatrices d'oestroprogestatifs a Abidjan. C'est une etude prospective transversale multicentrique portant sur les variations de la coagulation chez 126 clientes reparties en deux groupes d'effectif egal : utilisatrices et non utilisatrices de pilules. Les parametres biologiques suivants ont ete doses: temps de Quick; taux de prothrombine; temps de cephaline active; plaquettes et fibrinemie. Les resultats n'ont pas montre de variations biologiques pathologiques concernant les facteurs precites. Cette etude n'a pas demontre de risques thromboemboliques chez les dames sous pilules contraceptives qu'il s'agisse de pilules normodosees ou minidosees. Les resultats observes suggerent les propositions suivantes : -poursuivre la recherche de l'impact des contraceptifs oraux sur la coagulation par le dosage d'autres facteurs tels que l'Antithrombine III; la proteine C; la proteine S ; -encourager la vulgarisation de la contraception orale ; -poursuivre la selection des sujets a risques vasculaires par l'interrogatoire et l'examen clinique