Long-term anticoagulant therapy in patients with coronary artery disease.

Secondary prevention of coronary events in coronary artery disease (CAD) patients with aspirin is generally accepted because of ease of administration, predictable safety, and proven efficacy. The use of long-term anticoagulant therapy with heparins, vitamin-K antagonists (VKAs), or thrombin inhibitors is, however, more controversial. During the last 40 years, several trials have been conducted in order to evaluate the role of anticoagulant therapy in patients with CAD as a protection against subsequent death and thrombo-embolic complications. The conducted trials are heterogeneous in many ways, concerning comparative medications, patient populations, endpoints and follow-up, which makes a standardized recommendation on the basis of these studies difficult. This review is an overview of the largest and best studies on this topic and discusses the scientific background for a possible use of VKA or an alternative anticoagulant treatment in CAD patients, looking at both the beneficial effects and the risk of bleeding.     

Presumed vestibular hemorrhage secondary to warfarin

Hemorrhage secondary to anticoagulant therapy is well documented. We report a patient who presented with acute vertigo and unilateral deafness while on warfarin and was found to have a probable hemorrhage in the labyrinth, identified on MRI.     

Effect of omeprazole on the anticoagulant activity and the pharmacokinetics of warfarin enantiomers in rats

The effect of the proton pump inhibitor omeprazole on the anticoagulation and the pharmacokinetics of warfarin enantiomers was studied in rats. Omeprazole given intraperitoneally in a daily dose of 0.67 mg/kg over 8 days had no significant effect on the absorption, distribution and the total serum clearance values of the S- and R-enantiomers of warfarin. Omeprazole did not affect the pre-treatment baseline blood coagulation and the in vitro rat serum protein binding of warfarin enantiomers. In vitro study with rat liver microsomes showed that omeprazole had an inhibitory effect on the hydroxylation of warfarin enantiomers. Results obtained from in vivo urinary excretion study revealed that omeprazole inhibited the formation clearance of both S- and R-form oxidative metabolites, but increased that of the overall reductive metabolites, and the renal clearance of S- and R-enantiomers, of warfarin. As a consequence, the total serum clearance values for warfarin enantiomers remained unchanged and the hypoprothrombinaemic response produced by warfarin was not affected.     

Regional anaesthesia in patients taking anticoagulant drugs

Many surgical patients are taking drugs that impair normal coagulation, and this causes concern about the risk of perioperative bleeding events. The anaesthetist is particularly concerned about compressive vertebral canal haematomas, which may occur after spinal or epidural anaesthetic techniques. Fortunately, the risk of this complication is very low. The major risk factors are coagulopathy or technical difficulties with the block. There is also concern about perineural haematomas, which may be associated with peripheral nerve blocks. This article attempts to put the risks of these complications into context, with reference to different classes of anticoagulant drugs.     

长期使用华法林抗凝的非瓣膜性房颤患者围手术/操作期使用NOAC桥接的抗凝方案研究

目的：探讨使用非维生素K拮抗剂的口服抗凝药物（NOAC）代替肝素类药物在围手术/操作期患者进行桥接抗凝的可行性。方法：本研究为前瞻性观察研究,2018年8月至2021年5月入选长期使用华法林抗凝的非瓣膜性房颤患者,观察患者在围手术/操作期使用NOAC桥接抗凝后,围手术/操作期以及术后30天内栓塞事件与出血事件的发生率。结果：共入选患者21例,其中4例行肠镜检查,3例行胃镜检查,8例行拔牙操作,3例行眼科相关操作,3例行皮肤科相关操作。患者的平均年龄（70.8±8.5）岁,女性有9例,平均CHA2DS2-VASc评分（3.0±1.0）分,平均HAS-BLED评分（1.4±0.7）分。21例术后30天均未出现出血事件与栓塞事件。结论：对于非瓣膜性房颤患者,采取NOAC在围手术/操作期进行桥接抗凝,具有一定的可行性。     

高危消化内镜干预对抗凝治疗患者的临床安全性研究

目的探讨高危消化内镜干预对服用华法林患者的临床安全性。方法入选服用华法林同时需行高危内镜操作的患者148例,术后分为早期抗凝组73人（术后8h内恢复抗凝治疗）和延迟抗凝组75人（术后第3 d恢复抗凝治疗）。比较两组患者出血发生率和血栓发生率。结果两组患者出血事件发生率差异无统计学意义（9.59%vs.4.00%,P=0.304）,早期恢复抗凝治疗出血风险的OR值为1.28,延迟抗凝组血栓事件发生率较高（12.00%vs.2.74%,P=0.031）,延迟抗凝血栓风险的OR值为3.83。结论对于服用华法林的患者,高危消化内镜术后8 h内恢复抗凝治疗可以降低血栓发生风险,而出血风险增加相对不明显。     

老年非瓣膜性心房纤颤并缺血性脑卒中抗凝治疗分析

目的:观察低强度华法林与阿司匹林预防老年非瓣膜性心房颤动(房颤)患者发生脑栓塞的效果和安全性.方法:将确诊为非瓣膜性房颤且年龄≥65岁的患者共190例分为2组,华法林组口服小剂量华法林治疗,按低于抗凝强度国际化标准比率(INR)(1.6～2.5).阿司匹林组每天予以阿司匹林100 mg口服.每位患者随访1 a,观察2组...     

CT联合MRI在华法林致非创伤性自发性小肠壁内血肿的临床应用

目的探讨CT联合MRI在华法林致非创伤性自发性小肠壁内血肿的临床应用。方法选取14例华法林致非创伤性自发性小肠壁内血肿患者的临床资料,分析影像学表现。结果本组14例患者CT原发征象:1)肠壁增厚;2)肠壁密度增高。CT继发征象:1)肠腔狭窄;2)肠壁积气;3)肠周改变及其他伴发征象。MRI表现:T+1黏膜下层高信号,T+2信号不同程度增高,DWI呈弥漫高或稍高信号,T₂^*呈低信号。治疗情况:未经正确治疗的3例复查均表现为原征象无改善或加重。正确治疗的11例复查,10例原征象减轻或消失。结论对正在接受抗凝治疗的患者,突发腹痛伴凝血功能异常,CT显示肠壁增厚及密度增高、腹腔积血,伴肠腔狭窄、肠梗阻、肠周和肠系膜区积血,高度提示本病可能,MRI上T₁WI呈同心环或弹簧样高信号,DWI呈弥漫高信号,T₂^*呈低信号。     

口服华法令抗凝致出血的原因分析

目的:探讨口服华法令抗凝治疗期间患者出血的相关原因。方法:收集60例因口服华法令抗凝治疗期间合并出血的急诊患者的临床资料,分析在不同凝血酶原时间(PT-INR)值范围内导致出血的相关病因。结果:60例服用华法令合并出血的病例中,24例(40.0%)所测PT-INR在2.0~3.0的目标值内,并且9例患者INR<2.0;进一步检查发现这33例患者基本都合并有不同的易促使出血的疾病。结论:服用华法令抗凝治疗期间发生出血与否并不完全取决于PT-INR值,还决定于自身潜在的疾病等相关原因;临床应用华法令时应因人而异地调整剂量并决定其抗凝强度。     

华法林钠片在健康受试者生物等效性试验中的安全性分析

目的 探讨健康受试者参加华法林钠片生物等效性试验的安全性。方法 收集2017—2020在首都医科大学宣武医院开展的4项随机、开放、四周期、交叉对照设计的华法林钠片生物等效性（BE）试验中188例受试者,比较空腹与餐后给药所发生不良事件（TEAEs）的差异及TEAEs与性别和年龄的相关性。结果 4个试验中共报告了116例次TEAEs,与试验药物相关的TEAEs 29例次,均属于轻度,主要为凝血功能指标异常（14例次）和肝功能指标异常（10例次）。餐后给药试验中肝功能指标异常的发生例次多于空腹给药试验（8∶2）,与试验药物具有相关性的TEAEs发生率出现随年龄增加而增高的趋势。结论 健康受试者参加BE试验单次口服华法林钠片的安全性良好,与试验药物相关的不良事件多与华法林的药理机制有关,年龄是不良事件发生类型和发生率的潜在影响因素。