By Edited by Andrew D. Blann Edited by Gregory Y. H. Lip
Urban health facility, Birmingham, united kingdom. Discusses the motives and effects of blood clots, how antithrombotic remedy works and its makes use of for sufferers. Addresses bleeding hazards, venous thromboembolism, atrial traumatic inflammation, peripheral vascular ailment, middle failure, and anticoagulation. ample halftone and colour illustrations. Softcover.
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Additional info for ABC of Antithrombotic
J Am Coll Cardiol 2003;41:130A. The table showing ischaemic stroke in the AFFIRM study is adapted from the AFFIRM Investigators New Engl J Med 2002;347:1825-33. 0) for at least three to four weeks before and after restoration of sinus rhythm Class IIb x Cardioversion without transoesophageal echocardiography guidance during the first 48 hours after the onset of atrial fibrillation —In these cases, anticoagulation before and after cardioversion is optional, depending on assessment of risk x Anticoagulate patients with atrial flutter undergoing cardioversion in the same way as for patients with atrial fibrillation ACC/AHA Classification Class I —Conditions for which there is evidence or general agreement or both that a given procedure or treatment if useful and effective Class II —Conditions for which there is conflicting evidence or a divergence of opinion about the usefulness and efficacy of a procedure or treatment Class IIa—Weight of evidence and opinion is in favour of usefulness and efficacy ClassIIb—Usefulness and efficacy is less well established by evidence and opinion Class III —Conditions for which there is evidence or general agreement or both that the procedure or treatment is not useful and in some cases may be harmful *Data from Fuster V et al.
The dose of aspirin has been the subject of some debate, but 81-325 mg daily has been shown to be of value. Larger doses have no apparent additional benefit but increase the risk of adverse effects. Aspirin has been shown to reduce the progression of atherosclerosis in a few trials, but this remains unsubstantiated. The role of dipyridamole remains controversial. Several small studies have shown the benefit of giving it in conjunction with aspirin, but it is uncertain if dipyridamole alone is superior to aspirin.
Antiplatelet drugs, such as low dose aspirin or dipyridamole, are used in patients with bioprosthesis in sinus rhythm and in addition to anticoagulants in the high risk patients with mechanical valves. Patients with mechanical valves and those with bioprostheses and associated risk factors require lifelong anticoagulant cover. In patients with a bioprosthetic valve in sinus rhythm anticoagulant cover with warfarin for the first three postoperative months may suffice, followed by low dose aspirin treatment for life.