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[Combined arterial bypass operation and coumarin therapy--a concept for long-term management and its conditions]
L Kühnel1, C Heinrichs, I Wache
1Zentralabteilung Hämostaseologie/Angiologie und Gefässchirurgische Klinik Berlin.
Insights
Long-term cumarin therapy, combined with strict patient compliance and adherence to WHO guidelines, improves outcomes in vascular surgery for arterial occlusion disease. This approach ensures standardized anticoagulation monitoring for better results.
Area of Science:
- Vascular Surgery
- Pharmacology
- Hematology
Background:
- Antithrombotic agents, including coumarin derivatives and antiplatelet drugs, are crucial for vascular surgical interventions in arterial occlusion disease.
- Effective anticoagulation management is essential for successful surgical outcomes and preventing complications.
Observation:
- The study highlights the preference for coumarin-type antithrombotics or those with antiplatelet effects in vascular surgery.
- Long-term coumarin therapy, when combined with specific conditions, appears to be a superior method for managing anticoagulation.
- Key conditions for success include excellent patient compliance, strict adherence to contraindications, adequate patient numbers, and experienced therapists.
Findings:
- Standardization of anticoagulation measurement using WHO expert committee recommendations, reagents, and calibration materials, expressed in International Normalized Ratio (INR), is vital.
- Influencing risk factors and fostering good patient-doctor cooperation during secondary diseases and new drug intake are integral to anticoagulation management.
- For dental surgery, a Quick test between 30-35% activity or an INR of 1.9-2.1 is preferred.
- Phenprocoumon (Falithrom, Markumar) allows for long-term anticoagulation without multiple daily applications.
- A computer-assisted program for dose prediction has been available since September 1987.
Implications:
- Optimized anticoagulation strategies, particularly long-term coumarin therapy, can significantly enhance the success rates of vascular surgical interventions.
- Standardized monitoring and individualized risk factor management contribute to improved patient safety and therapeutic efficacy.
- The integration of computer-assisted tools can further refine anticoagulation management and dose prediction, benefiting patient care.
Abstract:
Antithrombotics of cumarin type or with antiplatelet effect are preferred to obtain results from vascular surgical interventions in arterial occlusion disease. In our experience the combination with cumarin long term therapy seems to be the better method, especially if the following conditions can be achieved: very good compliance of patients respectively strict consideration of absolute and relative contraindications, a sufficient number of patients who are treated and a long enough experience of therapeutists followed by using the recommendations of the WHO expert committee for the worldwide application of standardization in measuring the anticoagulation effect, using reagents and calibration materials, and the expression of results in INR. Further in our anticoagulation behaviour we are used influencing risk factors, having a good cooperation between patients and doctors during secondary diseases and new drug intake. For dental surgery we prefer a Quick test between 30 and 35% activity or 1, 9 and 2, 1 INR. With Phenprocoumon (Falithrom, Markumar) we use the long term anticoagulation effect without several daily applications. Since September 1987 there has been the possibility of a computer assisted programme for dose prediction.