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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina

 

IMPORTANCE OF ADEQUATE ANTICOAGULATION IN PATIENTS WITH POLIVALVULAR DISEASE AND DYNAMICS OF POSTOPERATIVE ACHEIVEMENT OF THERAPEUTIC LEVEL OF INR
S. Pandur, M. Kulić, F. Kučukalić, S. Straus, H. Vila, E. Đonlić, E. Mujičić and I. Haxhibeqiri-Karabdić
Cardiac Surgery Clinic, Clinical Center University of Sarajevo, Bosnia and Herzegovina

Treatment of patients with polivalvular diseases complicated by atrial fibrillation requires anticoagulant medication in pre-operative phase. After diseased valve is replaced or repaired, in case where atrial fibrillation persists, use of anticoagulant drugs is mandatory in order to prevent possible thromboembolic events. We had 10 patients (8 males and 2 females) with aortic-mitral rheumatic disease with pre and postoperative disturbed thrombogenicity. Average age was 47,8 years. 3 patients had sinus rhythm (SR) and 7 patients had AF. 2 patients were treated with anticoagulants and 5 were not treated at all. Out of these 5, 1 had a stroke and 1 patient had femoral amputation because of not recognised iliaco-femoral thromboembolic event. Preoperative coagulation tests showed normal ranges of APTT and INR with increased fibrinogen values in all patients. Duration of CPB in these operations is longer. The first postoperative day the INR was increased with average level of 2,11. We started with anticoagulants according to our protocol. Oral anticoagulants were started the second postoperative day. We designed two curves. The first curve reflects the dose and the time and the second one is referring to the dynamics of the INR and the time. On that basis we extrapolated curves with safety zones for anticoagulant therapy. Prior to discharge, 9 patients had therapeutic level of the INR and one patient was close to the lower limit of the required INR.

Drugi kongres kardiologa i angiologa Bosne i Hercegovine
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