We compared the efficacy and complications of anticoagulation with warfarin in 258 patients with prosthetic heart valves treated with regimens of "moderate intensity" (prothrombin-time ratio, 1.5; international normalized ratio, 2.65) or "high intensity" (prothrombin-time ratio, 2.5; international normalized ratio, 9) in a prospective, randomized study. The two patient groups were followed up for 421 patient-years and 436 patient-years, respectively. Eleven patients were lost to follow-up. Thromboembolism occurred with similar frequency in the two groups (4.0 and 3.7 episodes per 100 patient-years, respectively), but there was a total of 6.2 bleeding episodes per 100 patient-years in the moderate-intensity group, as compared with 12.1 episodes in the high-intensity group (P less than 0.002). There were 5.2 episodes of minor bleeding per 100 patient-years in the moderate-intensity group, as compared with 10.1 episodes in the high-intensity group (P less than 0.01). Major bleeding was also more common in the high-intensity group (2.1 episodes per 100 patient-years--including the only two fatal hemorrhages--as compared with 0.95 episode in the moderate-intensity group), but the difference was not statistically significant. We conclude that a moderate anticoagulant effect (prothrombin-time ratio, about 1.5) in patients with a mechanical prosthetic heart valve offers protection equivalent to that of more intensive therapy, but at a significantly lower risk.
Between 1981 and 1985, a total of 289 patients were seen at our anticoagulation clinic. Two hundred and fortyseven received long-term oral anticoagulation therapy because of a cardiac condition, 42 for deep vein thrombosis with or without pulmonary embolism. While on treatment, 106 patients fasted 309 Ramadan months and 183 patients elected not to fast during 594 Ramadan months. The incidence of thromboembolic events and hemorrhagic complications in the two groups was compared and no statistically significant differences were found. We conclude that Ramadan fasting, or any other form of short-term fasting, has no adverse effects on the efficacy and safety of long-term oral anticoagulation. JN Saour, JO Sieck, M Khan, L Mammo, Does Ramadan Fasting Complicate Anticoagulation Therapy. 1989; 9(6): 538-540 It is currently estimated that more than 555 million people belong to the Muslim faith.
Fifteen patients with varying diagnoses were fed via nasogastric tubes for between 7 and 41 days using a feed consisting of Caloreen (a glucose polymer) and Albumaid (a beef serum hydrolysate) with vitamin and mineral supplements. The feed proved nutritionally adequate and relatively free of complications. Diarrhoea was seen only in those patients receiving antibiotics by the nasogastric route. Codeine phosphate abolished this symptom in all patients. The constant drip method of administration proved efficient and time saving. Unlike prepacked preparations, the feed could be varied in composition to suit the clinical situation. This was of particular advantage in the intensive care context. The feed was relatively inexpensive.
The two non-suppurative post-streptococcal events, acute rheumatic fever and acute glomerulonephritis, rarely occur simultaneously. We describe such a patient, a 16-year-old male who was admitted with fever, agitation and confusion. Blood work-up showed high antistreptolysin O titre, raised serum creatinine and low complement levels. Urinalysis showed RBC casts. Echocardiographic examination demonstrated markedly impaired left ventricular systolic and diastolic function and three large thrombi in the apex. Serial echocardiographic examinations revealed improvement of cardiac function and the resolution of the thrombi and both cardiac and renal function returned to normal after 3 weeks of treatment.
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