Supra-therapeutic Anticoagulation with Warfarin: A Cross-sectional Study.

Aims: To identify the extent and associated factors for patients with prolonged prothrombin time, international normalized ratio (PT-INR), and the dosage modifications were carried out with warfarin.

Background: Studies evaluating patients on warfarin with supratherapeutic anticoagulation are limited. It is vital to understand the management strategies for patients receiving warfarin who are bleeding and those with only supratherapeutic PT-INR.

Is there a circannual variation in the anticoagulation control of warfarin?

Background: The literature regarding the seasonal variation in the therapeutic response to warfarin is somewhat contradictory, with several discrepancies. We assessed the influence of seasons on various pharmacodynamic indices of warfarin.

Methods: A retrospective study was carried out in adults receiving warfarin for at least 6 months.

Influence of CYP2C9, VKORC1, and CYP4F2 polymorphisms on the pharmacodynamic parameters of warfarin: a cross-sectional study.

Background: Warfarin is the most commonly evaluated drug in pharmacogenetic-guided dosing studies. However, gaps remain regarding the influence of the genetic polymorphisms of CYP2C9, VKORC1, and CYP4F2 on specific pharmacodynamic parameters like the warfarin sensitivity index (WSI), prothrombin time international normalized ratio (PT-INR), and log-INR variability.

Methods: A cross-sectional study was conducted in non-smoking adults receiving warfarin for at least 6 months.

Evaluation of pharmacokinetics of warfarin from validated pharmacokinetic-pharmacodynamic model.

Background: Pharmacokinetics of warfarin has not been described in our population. We derived the pharmacokinetic parameters from a validated pharmacokinetic-pharmacodynamic model.

Methods: Patients receiving warfarin for at least 6 months were recruited and their demographic characteristics, prothrombin time international normalized ratio (PT-INR), warfarin doses and concomitant drugs were collected.

Does fasting during Ramadan influence the therapeutic effect of warfarin?

What Is Known And Objectives: The changes in the therapeutic effect of warfarin during Ramadan fasting are controversial. Hence, we carried out the present study to assess if there are any alterations in the anticoagulation response to warfarin and identify the associated risk factors.

Methods: Patients receiving warfarin for at least 1 year were included in the present study.

Evaluation of inter-patient variability in the pharmacodynamic indices of warfarin.

Objectives: Warfarin exhibits huge inter-individual variability in therapeutic response. We assessed the extent and the factors affecting inter-individual variability in the anticoagulation control using pre-validated pharmacodynamic indices.

Methods: Patients receiving warfarin for at least 6 months were recruited.

Evaluation of Stable Doses of Warfarin in a Patient Cohort.

Background: Definitions for stable dose of warfarin varies in the reported studies. International warfarin pharmacogenetic consortium (IWPC) algorithm was generated from the data based on these definitions.

Objective: In the present study, we primarily evaluated whether any significant differences exist between the definitions for stable warfarin dose.

Health-related quality of life in patients receiving oral anti-coagulants: a cross-sectional study.

Objectives: Patients receiving long-term anticoagulants were reported with varied health-related quality of life (HrQoL). We assessed HrQoL in patients receiving either warfarin or dabigatran from a tertiary care hospital.

Methods: A cross-sectional study was carried out following consent from patients on oral anticoagulants.

Ventricular arrhythmia and tachycardia-induced cardiomyopathy in Gitelman syndrome, hypokalaemia is not the only culpable.

Gitelman syndrome (GS) is an autosomal recessive tubulopathy recently implicated in cases with ventricular arrhythmias (VAs), the latter being considered linked to electrolytes' imbalance. However, a direct causal relationship is considered to be an oversimplification for a complex molecular dysfunction. Recent work has suggested a degree of microvascular dysfunction in patients with GS that might be attributed as a mechanism of arrhythmia.

Left circumflex artery injury postmitral valve surgery, single center experience.

The left circumflex (LCX) artery is located close to the mitral valve (MV), making it susceptible to injury during MV surgery. We are reporting our experience in the diagnosis and management of this complication. We retrospectively reviewed our surgical and coronary angiography databases for patients with documented LCX artery injury during MV surgery between January 2000 and December 2016.

Transcatheter versus surgical valve replacement for a failed pulmonary homograft in the Ross population.

Background: Patients who undergo the Ross procedure are at increased risk of pulmonary valve (PV) homograft dysfunction. For those who require reintervention on the homograft, transcatheter PV replacement (tPVR) provides a less invasive therapeutic option than surgical PVR (sPVR). We examined the outcomes following tPVR versus sPVR in a cohort of patients who underwent the Ross procedure.

Peripartum cardiomyopathy, what if your patient plans to reconceive?

Patients with peripartum cardiomyopathy (PPCM) often express a desire to conceive again, and the risk of relapse in future pregnancies should be disclosed. No consensus is available that can determine that risk. Adequate contractile reserve, evidenced by a stress echocardiogram (exercise or dobutamine), can identify those with lower relapse risk.

Tricuspid stenosis: An emerging disease in cardiac implantable electronic devices era. Case report and literature review.

Tricuspid valve dysfunction and in particular tricuspid stenosis has recently been described secondary to cardiac implantable electronic devices. The valve is subjected to different mechanisms of injury related to the endocardial lead passing through its plane. The lead can form a loop or perforate one of the leaflets and initiate inflammatory response and fibrotic changes.

Progressive coronary aneurysms in Behçet disease, a journey through surgical and percutaneous treatment: A case report.

Behçet disease is a systemic autoimmune disease that causes inflammation within the vascular tree. Coronary arteries are rarely involved with stenosis, arteritis or aneurysm formation. Treatment is mainly directed to reduce the burden of inflammation systemically with steroid and immunosuppressive medications.

The Echocardiographic "Spike and Dome"--Obstruction It Is But Where?

Spectral Doppler interrogation of the descending thoracic and abdominal aorta provides valuable information regarding cardiac and vascular hemodynamics. An abnormal aortic Doppler profile is encountered in pathological conditions that affect the aorta and its branches, the aortic valve, the left ventricle, and the pericardium. Characteristic findings on Doppler interrogation of the aorta are often noted in individuals with obstructive atherosclerotic disease of the aorto-iliac system including severe stenosis or occlusion of the distal aorta and/or iliac arteries.

Spectral Doppler of the Hepatic Veins in Rate, Rhythm, and Conduction Disorders.

Doppler interrogation of blood flow in the hepatic veins (HVs) provides valuable information regarding a wide spectrum of pathological processes that affect the right heart. Systematic analysis of the direction, velocity, and phasicity of the HV waveforms allows one to distinguish normal from abnormal patterns and provides important diagnostic information. Abnormalities in heart rate, rhythm, and intracardiac conduction are commonly encountered during echocardiographic studies.

Spectral Doppler of the Hepatic Veins in Noncardiac Diseases: What the Echocardiographer Should Know.

In most instances, the flow profile in the hepatic veins (HVs) reflects the fluctuation of pressure within the right atrium. Thus, interrogation of blood flow in the HVs is highly useful for the evaluation of right heart hemodynamics and has become an integral part of any routine echocardiographic examination. However, flow in the HVs is also affected by the state of the liver parenchyma and by the fluctuation of pressure within the thoracic cavity.

The various hemodynamic profiles of the patent ductus arteriosus in adults.

The patent ductus arteriosus (PDA) has diverse clinical and hemodynamic manifestations depending on its size and the degree of the ensuing left-to-right shunt. A small PDA that causes minor shunting has no major hemodynamic consequences. Conversely, a large PDA with a significant left-to-right shunt may lead to various hemodynamic abnormalities.

Respiratory hemodynamics in the hepatic veins--abnormal patterns.

The flow pattern in the hepatic veins (HVs) is dependent on the cardiac cycle and right heart hemodynamics and influenced by the respiratory cycle and the liver parenchyma. Most disease states that affect the right heart alter the HV Doppler in a manner independent of the respiratory cycle. Some diseases that typically involve the pericardium, right ventricular myocardium, or respiratory system confer characteristic changes to the HV flow in a manner dependent on the respiratory cycle.

Spectral Doppler of the hepatic veins in tricuspid valve disease.

Spectral Doppler recording of the hepatic veins (HV) provides a semiquantitative assessment of tricuspid regurgitation (TR) severity. It complements findings on two-dimensional echocardiography and color Doppler imaging and helps to discriminate between hemodynamically significant and nonsignificant degree of regurgitation. In this manuscript, we discuss the usefulness of the HV Doppler for the diagnosis of tricuspid valve (TV) disease and provide examples of the various spectral Doppler patterns that assist in the quantification of TR.

Respiratory hemodynamics in the hepatic veins-normal pattern.

Doppler interrogation of blood flow in the hepatic veins (HVs) is a part of any comprehensive echocardiographic examination. Data derived from the HV Doppler provide a useful tool for the assessment of right heart function. Beyond its dependence on the cardiac cycle, right heart hemodynamics, and compliance of the liver parenchyma, blood flow in the HVs is influenced by the respiratory cycle.

Spectral Doppler interrogation of the patent foramen ovale-a window to left heart hemodynamics.

Spectral Doppler interrogation of flow across a patent foramen ovale (PFO) allows recording of the instantaneous pressure gradient between left and right atrium (RA). The assessment of RA pressure using the size and collapsibility of the inferior vena cava would thus allow estimation of left atrial (LA) pressure. In this article, we illustrate the value of spectral Doppler interrogation of flow across the PFO by transthoracic echocardiography as a novel and simple tool for the assessment of LA pressure and left cardiac hemodynamics in addition to the conventional noninvasive parameters.

Spectral Doppler of the hepatic veins in pulmonary hypertension.

Pulsed-wave Doppler interrogation of the hepatic veins (HVs) provides a window to right heart hemodynamics and function. Various pathologies that involve the right heart are manifested on the HV Doppler depending on the location and severity of the involvement and its hemodynamic consequences. Pulmonary hypertension (PHTN), a common finding on echocardiographic studies, imparts changes on the HV Doppler that are important to recognize.

Heart rate differentiates urgency and emergency in hypertensive crisis.

Objective: To study the clinical significance of presenting blood pressure parameters and heart rate in patients with hypertensive crisis.

Methods: In patients admitted with hypertensive crisis between January 2011 and May 2011, demography, mode of presentation, co-morbidities, blood pressure readings, and heart rate at presentation were documented. Further clustering of hypertensive crisis into emergency or urgency was based on the presence or absence of target organ involvement.