Analysis and management of coronary heart disease complicated by thrombocytopenia / 药学实践杂志

Objective To summarize the factors and the corresponding treatments for patients with coronary heart disease (CHD) complicated by thrombocytopenia, and provide medical advises for clinical treatment. Methods Literatures and case reports were analyzed and summarized. Results Thrombocytopenia in patient with CHD could be mainly divided into two types, one group was induced by the antithrombotic therapies for CHD, and the other group was caused by some concurrent diseases or combined non-antithrombotic medications. There were different medical decisions and prognoses according to the causes in different groups. Conclusion The treatment strategies of CHD will be considered in the CHD patients with thrombocytopenia. Identifying thrombocytopenia by monitoring the platelet counts in early stage, finding out the causes quickly and providing proper treatments are the key for the prognosis of the patients.

Mediating effect of belief about medicine on correlation between social support and adherence to anticoagulation treatment among patients with mechanical heart valve replacement / 中国实用护理杂志

Objective To explore the relationships among social support , belief about medicine and adherence to anticoagulation treatment,and mediating effect of belief about medicine on the relationship between social support and adherence to anticoagulation treatment among patients with mechanical heart valve replacement. Methods Totally 154 patients were recruited. The social support scale, the modified Chinese Version Morisky Medication Adherence Scale( MMAS-8) and belief about medicine scale were used and the information on patients were collected through clinic and telephone interviews. Results The social support was correlated with belief about medicine (r=0.441, P<0.05). The belief about medicine was correlated with adherence to anticoagulation treatment (r=0.441, P<0.05). The social support was correlated with adherence to anticoagulation treatment (r=0.300, P<0.05) . The mediator effect of the belief about medicine was tested between social support and adherence to anticoagulation treatment. In the result, with the influence of belief about medicine .The social support was not correlated with adherence to anticoagulation treatment ( B=0.020,P>0. 05). Conclusion Belief about medicine plays a completely mediating role in the relation between social support and adherence to anticoagulation treatment.

A retrospective study on patients with stroke and non-rheumatic atrial fibrillation treated with anticoagulation / 中国综合临床

Objective To investigate the current statues of anticoagulation therapy for ischemic stroke patients with atrial fibrillation(AF) and compared the difference with guidelines.Methods Three hundred and fifty-eight patients with cerebral infarction and atrial fibrillation in Xinhua Hospital Affiliated to Shanghai Jiaotong University from Jan.2008 to Jun.2012 were selected as our subjects.The data related to the antithrombotic therapy were collected and analyzed.Results Among patients with ischemic stroke,the rate of preexisting AF was 70.9％ (254/358),and warfarin taken rate was 4.3％ (11/254) before stroke onset.Of warfarin taken patients,INR were less than 1.5.Of all out hospitalized patients,20.9％ (68/326) were treated with warfarin therapy.There were the negative correlation between warfarin usage and HAS-BLED score,MRS score,antiplatelet drugs (OR =-1.974,-0.725,-4.170,P ＜ 0.05 or P ＜ 0.01).Among patients with warfarin usage in hospital,33.8％ of subjects (23/68) still remain on warfarin even out of hospital.The medium dosage was 2.5 mg (1.25-3.75 mg),and INR was controlled at ranged of 1.5-3.1.Periods of warfarin therapeutic range (TTR) was (61.6 ± 21.2)％.Conclusion The anticoagulation treatment rate and INR were lower in patients cerebral infarction with atrial fibrillation.Warfar might no be universal use due to the bleeding concerns and un-onvenience of monitoring INR.

Riesgo beneficioso del tratamiento anticoagulante oral con warfarina en una consulta especializada: Centro Cardiovascular Regional ASCARDIO / Risk benefit of oral anticoagulant therapy with warfarin in a specialized: Regional Cardiovascular Center ASCARDIO

La intensidad de la anticoagulación y mantenimiento de pacientes en rango terapéutico, son los determinantes más importantes para la seguridad y efectividad del tratamiento anticoagulante oral. El Objetivo del estudio fue evaluar el riesgo de eventos adversos frente al beneficio, en la consulta especializada de Anticoagulación del Centro Cardiovascular Regional ASCARDIO. Se realizó una revisión sistemática de historias clínicas en la base de datos de la consulta de anticoagulación - ASCARDIO (Enero 2003 - Diciembre 2007). Los eventos adversos fueron agrupados como sangrado y trombosis, y los valores de índice normalizado de la razón en rangos: Bajo (0-1,99), Adecuado (2-3) y Alto (>3). El anticoagulante oral utilizado fue warfarina sódica y el índice normalizado de la razón realizado en el Laboratorio de ASCARDIO. En 50,8% de las consultas el índice normalizado de la razón estuvo adecuado, y en 95,3% no hubo complicaciones. Al evaluar la razón de probabilidades, se reportó 2,26 veces mayor probabilidad de presentar Complicaciones Trombóticas con índice normalizado de la razón bajo en comparación con el índice normalizado de la razón adecuado. Asimismo, se reportó 3,72 veces mayor probabilidad de presentar sangrado con índice normalizado de la razón alto. La anticoagulación oral representa una importante herramienta terapéutica en prevención primaria y segundaria de múltiples patologías. El análisis de la experiencia de 5 años con más de 25000 consultas, demuestra que el tratamiento anticoagulación oral es un recurso terapéutico seguro, con un seguimiento adecuado a través de una consulta especializada. Se confirma el rango de índice normalizado de la razón: 2-3, como el de mayor protección contra eventos trombóticos con menor riesgo de sangrado.

The intensity of anticoagulation and the maintenance of patients in a therapeutic range, are the most important determinants for the security and effectiveness of Oral Anticoagulant Therapy (OAT). The objective of the study was to evaluate the risk of adverse events versus benefit, in the Specialized Anticoagulation clinic of the Regional Cardiovascular Center - ASCARDIO. A systematic reviews was undertaken of clinical histories from January 2003 to December 2007 in the database of the Specialized Anticoagulation Clinic - ASCARDIO. Adverse event were classified as bleeding and thrombosis, and INR values were categorized as: Low (0–1.99), adequate (2-3) and high (> 3). The oral anticoagulant used was sodium warfarin, and all INR determinations were made in the ASCARDIO Laboratory. In 50,8% of the visits, the INR was adequate, and in 95,3% there were no registered complications. The Odds ratio was 2,26 for the likelihood of presenting with a thrombosis and a low INR compared with an adequate INR, and 3.72 for the likelihood of bleeding when the INR was high. Oral anticoagulation is an important is a safe therapeutic treatment, given appropriate follow - up in a specialized clinic. An INR between 2 and 3 offers the best protection against thrombotic events with a lower risk of bleeding.

Anticoagulation treatment of acute pancreatitis with lower molecular weight heparin / 中华消化外科杂志

Objective To study the anticoagulation therapy of lower molecular weight heparin in the treatment of patients with acute pancreatitis.Methods Seventy-three patients with acute pancreatitis were divided into anticoagulation group(n=38)and control group(n=35).The serological indexes and prognosis of patients were detected.Results Anticoagulation treatment with lower molecular weight heparin significantly decreased the white blood cell count,increased the oxygen partial pressure in arterial blood,shoaened the duration of hospitalization,and reduced the aggravation rate,secondary operation rate and mortality of patients with acute pancreatitis.Conclusions Anticoagulation treatment with lower molecular weight heparin is safe,effective and can improve the prognosis of patients with acute pancreatitis.

Thrombolysis with anticoagulation treatment for early stage of posttraumatic and postoperative deep vein thrombosis of lower extremity / 中国普通外科杂志

Objective To explore the effect of thrombolysis with anticoagulation treatment for early stage of posttraumatic and postoperative deep vein thrombosis of lower extremity. Methods The clinical data of 38 palients with early stage of posttraumatic and postoperative deep vein thrombosis(DVT) of lower extemity treated by thrombolysis with anticoagulation and dispersion drugs were analyzed retrospectively. Results The thrombolytic effect was significant. After the treatment, the deep veins were recanalization without regorging in 71.0% of patients. The total effective rate was 100%. Only one patient had hemorrhagic complication, two patients had symptomatic pulmonary embolism,but none of the patients died. Conclusions Thrombolysis with anticoagulation is an effective and safe method for posttraumatic and postoperative DVT in the early stage.