• Journal of Korean Neurosurgical Society
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• 제55권2호
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• pp.69-72
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• 2014

Objective : There was no abundance of data on the use of anticoagulant in patients with previous high risk of thromboembolic conditions under a newly developed intracranial hemorrhage in Korean society. The purpose of this study was to evaluate the safety of discontinuance and suggest the proper time period for discontinuance of anticoagulant among these patients. Methods : We reviewed the medical records of 19 patients who took anticoagulant because of thromboembolic problems and were admitted to our department with newly developed anticoagulation associated intracranial hemorrhage (AAICH), and stopped taking medicine due to concern of rebleeding from January 2008 to December 2012. Analysis of the incidence of thromboembolic complications and proper withdrawal time of anticoagulant was performed using the Kaplan-Meier method. Results : Our patients showed high risk for thromboembolic complication. The $CHA_2DS_2$-VASc score ranged from two to five. Thromboembolic complication occurred in eight (42.1%) out of 19 patients without restarting anticoagulant since the initial hemorrhage. Among them, three patients (37.5%) died from direct thromboembolic complications. Mean time to outbreak of thromboembolic complication was $21.38{\pm}14.89$ days (range, 8-56 days). The probability of thromboembolic complications at 7, 14, and 30 days since cessation of anticoagulation was 0.00, 10.53, and 38.49%, respectively. Conclusion : Short term discontinuance of anticoagulant within seven days in patients with AAICH who are at high embolic risk ($CHA_2DS_2$-VASc score >2) appears to be relatively safe in Korean people. However, prolonged cessation (more than seven days) may result in increased incidence of catastrophic thromboembolic complications.

• Biomolecules & Therapeutics
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• 제25권5호
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• pp.461-470
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• 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.

• Clinical and Experimental Vaccine Research
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• 제12권2호
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• pp.172-175
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• 2023

Coronavirus disease 2019 (COVID-19) has become a part of our lives now and we have no more effective way of coping than a vaccine. COVID-19 is a disease that causes severe thrombosis outside the respiratory tract. Vaccines also protect us in this respect, but in some rare cases, thrombosis has been found to develop after vaccination (much less frequently than COVID-19). What was interesting in our case was that it showed how a disaster could happen under three factors that predispose to thrombosis. A 65-year-old female patient with disseminated atherosclerosis was admitted to the intensive care unit with complaints of dyspnea and dysphasia. In the evening of the day, the patient had the vaccination 2 weeks ago, she had active COVID-19. On examination, lower extremity pulses could not be detected. The patient's imaging and blood tests were performed. Multiple complications such as embolic stroke, venous and arterial thrombosis, pulmonary embolism, and pericarditis were observed in the patient. This case may give consideration to anticoagulant therapy studies. We give effective anticoagulant therapy in the presence of COVID-19 in patients at risk of thrombosis. Can anticoagulant therapy be considered after vaccination in patients at risk of thrombosis such as disseminated atherosclerosis?

• Journal of Medicine and Life Science
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• 제19권3호
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• pp.125-129
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• 2022

Patients with nephrotic syndrome (NS) are generally known to be at greater risk for thrombosis, with arterial thrombosis-related complications being relatively rare compared to venous thrombosis-related complications. This report describes a 46-year-old male with historically proven minimal change disease (MCD) complicated by acute aortoiliac thrombosis. He had been diagnosed with MCD 8 months previously and was treated successfully with steroids. He was prescribed a second course of high-dose steroids (prednisolone 1 mg/kg/day) due to a relapse of MCD at the outpatient clinic 8 days before the emergency department visit. The patient presented with severe pain in both lower limbs and was diagnosed with aortoiliac thrombosis that developed during high-dose steroid treatment. He subsequently underwent surgical thromboembolectomy. Hypoalbuminemia has the strongest association with the risk of thromboembolism. According to international clinical practice guidelines, anticoagulant therapy is recommended when serum albumin is ≤2-2.5 g/dL. However, as serum albumin levels may be relatively high in the early phase of NS, as in this case report, an individualized anticoagulation strategy for each patient should be considered, regardless of serum albumin levels.

• Childhood Kidney Diseases
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• 제28권2호
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• pp.80-85
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• 2024

Lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) is a rare entity characterized by the presence of lupus anticoagulant (LA) and prothrombin (factor II) deficiency. It may cause severe bleeding contrary to classical antiphospholipid syndrome. Here, we report a case of LAHPS presenting with a hemorrhagic ovarian cyst in a 17-year-old girl with systemic lupus erythematosus (SLE) nephritis. She had been followed up for 8 years. Her first manifestation of SLE was prolonged gingival bleeding after tooth extraction at 9 years of age. During the follow-up period, she had neither severe bleeding nor thrombotic complications despite a positive LA and a prolonged activated partial thromboplastin time (aPTT). At this visit, the patient presented with colicky abdominal pain, a hemorrhagic ovarian cyst, a prolonged prothrombin time, a prolonged aPTT, a low factor II level, and a positive LA, leading to the diagnosis of LAHPS. While a hemorrhagic ovarian cyst resolved completely in 3 months, she received oral pill, transfusions of red blood cells and plasma, and intravenous cyclophosphamide pulse therapy in combination with glucocorticoids due to persistent menorrhagia, anemia, prolonged aPTT, and lupus flaring. Thus, LAHPS needs to be considered in SLE patients with positive LA and prolonged aPTT.

• The Korean Journal of Pain
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• 제10권1호
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• pp.127-130
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• 1997

A 67-year old man with a history of cardiac disease underwent epidural catheterization for pain control of postherpetic neuralgia. Patient had severe back pain and pus discharge at catheter insertion site after dischange from medical part. Patient received anticoagulant therapy with $Aspirin^{(R)}$ and $Coumadin^{(R)}$ prescribed for 15 days in medical part. Magnetic resonance imaging(MRI) showed a diffuse $T_{4-7}$ anterior epidural mass compressing the spinal cord. Emergency surgical exploration revealed a thoracic epidural hematoma without abcess formation. Operation was successful and patient recovered satisfactory without any sequelae.

• 대한치과의사협회지
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• 제57권10호
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• pp.613-622
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• 2019

The vitamin K antagonist (VKA), cumadin, or warfarin, is the only antithrombotic drug that can be orally administered and has excellent effective for decades. However, it is cumbersome to periodically inspect the prothrombin time (PT) order to maintain adequate concentrations that do not cause bleeding, takes a few days to indicate therapeutic effects, gets affected by several factors such as food and drugs etc, and narrow in the therapeutic range. Although recently in development, the non-vitamin K antagonist anticoagulants(NOACs) exhibit a rapid onset of action and have relatively short half- lives compared to Coumadin. Because of these pharmacokinetic properties, it is possible to modify an individual's anticoagulation status quite rapidly, minimizing the period where the anticoagulation activity is therapeutically suboptimal. And the short half -lives of these drug allow for the relatively rapid reduction of their anticoagulation effects. There are currently no published clinical trials specifically assessing the bleeding risks associated with dental procedures for patients taking the NOACs. It is not necessary to interrupt NOAC medication for dental procedures that are likely to cause bleeding, but which have a low risk of bleeding complications. Because the bleeding risk for these procedures is considered to be low, the balance of effects is in favour of continuing the NOAC treatment without modification, to avoid increasing the risk of a thromboembolic event. The patients should be advised to miss(apixaban or dabigatran) or delay(rivaroxaban) a dose of their NOAC prior to dental procedures that are likely to cause bleeding and which have a higher risk of bleeding complications. Because the risk of bleeding complications for these procedures is considered to be higher, the balance effects is in favour of missing or delaying the pretreatment NOAC dose. The interruption is only for a short time to minimize the effect on thromboembolic risk.

• Journal of Chest Surgery
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• 제27권12호
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• pp.995-1001
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• 1994

The CarboMedics valve prosthesis is a relatively new. low profile bileaflet prosthesis. During a 6 year period from Aug. 1988 to July 1994. 158 patients had CarboMedics prostheses implanted in the mitral [n=94], aortic [n=25], or aortic and mitral [n=39] in National Medical Center. Hospital mortality was 9.4% and the main cause of death was low output syndrome. Follow up was 96% complete, with 365.4 patient-years and a mean follow up of 30 months [ range 1 to 72 months ] . The overall actuarial 6 year survival rate was 91.61 3.47% and actuarial 6year freedom from all valve related complications was 73.9 7.67%. The linearized incidence of vavle related complications was as follows: thromboembolism 1.37%/patient-year ; valve thrombosis 0.82%/ patient-year ; anticoagulant related hemorrhage 0.85%/patient-year ; perivalvular leakage 0.55%/paitent-year: prosthetic valve endocarditis 0.82%/patient-year ; reoperation 1.37%/patient-year. There were no instances of structural failure. We conclude that the Carbomedics valve has a low rate of complications that further improves the quality of life in patients with heart valve prostheses.

• Journal of Chest Surgery
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• 제33권6호
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• pp.502-506
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• 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.

• Journal of Chest Surgery
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• 제22권3호
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• pp.393-401
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• 1989

Between Dec. 1984, and May, 1988,96 prostheses were implanted in 80 patients at Dept. of Thoracic k Cardiovascular Surgery of National Medical Center. 43 patients had mitral valve replacement, 21 underwent aortic valve replacement, and 15 had double valve replacement [Mitral k Aortic], and 1 had tricuspid valve replacement. Seventy-one cases [88.8 %] were in NYHA Class III or IV. The mean duration of follow up was 22.1 months and follow-up information was available for 74 [92.5 %] of the patients. The overall actuarial survival rate at 45 months was 93.05 % and overall hospital mortality was 10 %, late Mortality was 5 %. The linearlized incidence of thromboembolism [2.4%/pt-yr], thrombotic valve obstruction [1.6 %/pt-yr], anticoagulant related bleeding [0.8 %/pt-yr]. There were no fatal valve related complications. The blood was studied in 40 patients 1 year after valve operation. Hgb and reticulocyte count were within normal values and Serum LDH value was slightly elevated but it was not of clinical significance. In conclusion, Monostrut Bjork-Shiley valve prosthesis to be a reliable valve substitute with an acceptable incidence of complications.