By Edited by Andrew D. Blann Edited by Gregory Y. H. Lip
Urban health facility, Birmingham, united kingdom. Discusses the explanations and outcomes of blood clots, how antithrombotic treatment works and its makes use of for sufferers. Addresses bleeding hazards, venous thromboembolism, atrial traumatic inflammation, peripheral vascular illness, center failure, and anticoagulation. ample halftone and colour illustrations. Softcover.
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Extra resources for ABC of Antithrombotic
In patients with a bioprosthesis in sinus rhythm, antithrombotic therapy with an antiplatelet drug may suffice, whereas patients with homografts in sinus rhythm may not need any antithrombotic therapy. Thromboembolic events are commoner with prosthetic mitral valves than aortic valves and in patients with double replacement valves compared with those with single replaced valves. Moreover, the risk of thromboembolic events is greatest in the first three months after implantation. Choice of antithrombotic agent Warfarin is the most used oral anticoagulant, and its dose is guided by achieving a target international normalised ratio (INR) range.
Because low dose aspirin is safe for mother and child, it may be used in conjunction with anticoagulant treatment in women at high risk of thromboembolism. However, low molecular weight heparin (which does not cross the placental barrier) may be an alternative to unfractionated heparin in this setting, although there are limited data on its efficacy or safety in pregnancy. Other pregnancy related issues are discussed in chapter 14. 5 consider giving Vitamin K1 1-2 mg orally and start low molecular weight heparin in therapeutic doses.
Cardiac disorders that predispose to stroke and unequivocally seem to benefit from anticoagulation therapy include atrial fibrillation (with additional risk factors putting patients at moderate to high risk), mitral stenosis (with or without atrial fibrillation), and mechanical valve prosthesis. In contrast, recent randomised trials (SPIRIT, WARSS) did not show advantages of warfarin over aspirin for secondary prevention of non-cardioembolic brain ischaemia. At present, warfarin should not be used routinely for patients with common causes of non-cardioembolic stroke, pending results from ongoing randomised trials.