INDEX thromboembolism

Warfarin has been the primary oral anticoagulant used in the United States for the past 60 years. Warfarin is the anticoagulant of choice when long-term or extended anticoagulation is required. Warfarin is FDA-approved for the prevention and treatment of VTE, as well as the prevention of thromboembolic complications in patients with myocardial infarction, atrial fibrillation, and heart valve replacement. While very effective, warfarin has a narrow therapeutic index, requiring frequent dose adjustments and careful patient monitoring.15,29... 

Thrombosis in the dural sinuses or cerebral veins is much less common than cerebral arterial thromboembolism. It causes a variety of clinical syndromes, which often do not resemble stroke (Bousser and Ross Russell 1997). While ischemic arterial stroke and cerebral venous thrombosis share some causes (Southwick et al. 1986), others are specific to cerebral venous thrombosis (Table 29.1). A particularly high index of suspicion is required in women on the oral contraceptive pill (Saadatnia and Tajmirriahi 2007) and in the puerperium. In the past, cerebral venous thrombosis was strongly associated with otitis media and mastoiditis, lateral sinus thrombosis or otitic hydrocephalus, but the most common causes are now pregnancy and the puerperium, which cause 5-20% of the cerebral venous thrombosis in the developed world, the oral contraceptive pill, malignancy, dehydration, inflammatory disorders and hereditary coagulation disorders. No cause is found in around 20% of cases. 

The most widely prescribed anticoagulant in North American is warfarin sodium (Coumadin). It was discovered serendipitously in the early 1940s at the University of Wisconsin after hemorrhagic deaths occurred in cattle eating spoiled sweet clover. Warfarin is approved by the FDA for the prevention and treatment of VTE as well as for the prevention of thromboembolic complications associated with atrial fibrillation, heart valve replacement, and myocardial infarction. Because of its narrow therapeutic index, predisposition to drug and food interactions, and propensity to cause hemorrhage, warfarin requires... 

Park JH, Park YS, Park SJ, et al. Midventricular peak systolic strain and Tei index of the right ventricle correlated with decreased right ventricular systolic function in patients with acute pulmonary thromboembolism. International Journal of Cardiology 2008 125(3) 319-24. 

Marin et al. (M7) reported that patients with atrial fibrillation had lower levels of plasma MMP-1 but increased levels of TIMP-1 and prothrombin fragments FI 2 (an index of thrombogenesis) and higher ratios of TIMP-1 to MMP-1 as compared to control subjects. The authors proposed that MMP TIMP measurements in blood might be useful as markers of comorbidity that is associated with increased risk of stroke and thromboembolism in patients with atrial fibrillation. 

Cardiovascular Blood vessels A 54-year-old man with pseudoxanthoma elasticum who had vision loss because of choroidal neovascularisation due to angioid streaks underwent two intravitreal bevacizumab injections. Three days after tiie second procedure the patient was afflicted by acute stroke [19]. No significant association existed between stroke and exposure to bevacizumab (adjusted OR 0.95,0.68-1.34) [20]. A total of 21 (2.0%) case patients had received bevacizumab in the 180 days before their venous thromboembolism, and 137 (2.6%) control patients had received bevacizumab in the 180 days before tiie index date. No significant association existed between venous thromboembolism and exposure to bevacizumab (adjusted OR 0.81,0.49-1.34) [20]. 

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