Tag Archives: anticoagulation

Case A 63-year-old woman presented with breathlessness for a week. She had had a right mastectomy and axillary node clearance three weeks previously for breast cancer. She was known to have rheumatic heart disease and mitral stenosis with history of balloon mitral valvuloplasty 12 years ago. An echocardiogram, which was performed four months before, showed moderate mitral stenosis with valve area of 1.2 cm2, moderate aortic stenosis with peak gradient across aortic valve of 42 mmHg and mean of 22 mmHg and mild tricuspid regurgitation with normal pulmonary artery pressure. She was also known to have permanent atrial fibrillation and was on w

Nanoparticles, inhaled from sources such as vehicle exhausts, have been shown to cross from the lungs into the blood stream. They can then accumulate in areas susceptible to heart problems, according to research part-funded by the British Heart Foundation.  Previous studies have identified a correlation but not a causal link between nanoparticles and strokes or cardiovascular disease. It is not currently possible to measure environmental nanoparticles in the blood. So, researchers from the University of Edinburgh, and the National Institute for Public Health and the Environment in the Netherlands, used a variety of specialist techniques to t

Tsimane people show healthiest arteries yet studied Indigenous South Americans from the Bolivian Amazon – the Tsimane people – have the lowest recorded levels of vascular ageing A South American Tsimane person of 80 years is estimated to have the same vascular age as an American person in their mid-50s, according to a study presented at the ACC. The Tsimane people – an indigenous forager-horticulturalist population of the Bolivian Amazon – have the lowest reported levels of vascular ageing for any population, with coronary atherosclerosis being five times less common than in the USA. This has led the researchers to propose that the lo

Anticoagulant treatment after intracerebral haemorrhage in patients with AF Anticoagulant treatment may be initiated seven to eight weeks after intracerebral haemorrhage (ICH) in patients with atrial fibrillation (AF), to optimise the benefit from treatment and minimise risk, according to a nationwide observational study published recently in Stroke.1 The study aimed to provide observational data on the relationship between the timing of antithrombotic treatment and the competing risks of severe thrombotic and haemorrhagic events in a cohort of Swedish patients with AF and ICH. Patients with AF and a first-ever ICH were identified in the Swed

Introduction Warfarin is an anticoagulant commonly used in atrial fibrillation, venous thromboembolism, prosthetic cardiac valve replacement and postoperative atrial fibrillation.1 Warfarin is usually discontinued prior to cardiac surgery and subsequently re-initiated postoperatively to achieve the target therapeutic international normalised ratio (INR).2 At the cardiac surgery unit of St. Paul’s Hospital, it has been observed that the warfarin dosage needed to achieve therapeutic anticoagulation is often lower post-cardiac surgery, compared with the patient’s warfarin dose prior to cardiac surgery. Serious complications, such as postoper

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Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia with a reported worldwide prevalence of 0.6% in men and 0.4% in women.1 AF is independently associated with a five-fold increased rate of stroke, which is comparable with the risk seen in patients with three or more other stroke risk factors.2,3 Furthermore, strokes related to AF are associated with higher rates of disability and mortality than other strokes.4-6 The cost of AF-related strokes in the UK is estimated to be around £750 million per year.7 AF-related stroke is thought to be secondary to thromboembolism from the left atrium to the cerebral circulation. Ora

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Introduction Atrial fibrillation (AF) is the most common arrhythmia in the UK and is estimated to affect 2% of the general population, rising to affect 8% of individuals aged over 75 years.1 Without appropriate antithrombotic therapy, non-valvular AF confers a five-fold risk of stroke and thromboembolism.2 Oral anticoagulation effectively reduces stroke risk by two-thirds.3 Direct current (DC) cardioversion (DCCV) is one strategy to restore sinus rhythm in patients with AF (see figure 1), and has been used in clinical practice since the 1960s. This procedure has relatively high initial success rates, however, it has become increasingly evid

Yet, not all today’s physicians are keeping step with this new world. All too often adopting new ways of talking to patients or prescribing new technologies and medicines is left by the wayside in favour of keeping to tried and tested habits. Treating a common heart disorder Take the case with atrial fibrillation (AF), which affects around 800,000 people in the UK. Anticoagulation to reduce the risk of stroke is an essential part of AF management but according to the Department of Health many patients are not always appropriately anticoagulated.1 Since 2012, the National Institute for Health and Care Excellence (NICE) has approved a number