Background: Advance in cardiac intervention improved the survival of patients with congenital heart diseases (CHD). However, they may have propensity of thromboembolism and the use of antithrombotic agents was generally based on small studies and consensus opinion. Objective: To systematically review the current literature on the efficacy and safety of various antithrombotic agents in patients with CHD. Methods: Studies published in English during the period 1990 – 2012 were identified using keyword search from PubMed, Medline, EMBase, and Cochrane Library. Additional search from reference sections of the articles and clinical trial registry was performed. Data extracted included: type of studies, number of patients, follow-up period during which the patients were on the antithrombotic agents, number of thromboembolic (TE) events, and all, major and minor bleeding events. Event rate as the proportion of events of the patients and event per 100 patients-year were obtained for respective antithrombotic agent in each study. Composite event rate and event per 100 patients-year were estimated after weighting. Results: Forty studies consisted of 5144 patients were reviewed. Observation period of 8916.6 years was available in 25 studies. Diagnostic categories included: Fontan operation 15, systemic-to-pulmonary artery shunt 7, mechanical valve 8, atrial septal defect occlusion device 2, cyanotic heart 1, mixed 7. Antithrombotic prophylaxis was not used in 13 studies, warfarin in 26, aspirin alone in 22, combined aspirin and dipyridamole in 2. Clopidogrel with concomitant antithrombotic agents was reported in 5 studies. Overall composite TE event rate was 3.9% (95% CI 2.3 – 5.4%) and that of all bleeding rate was 2.8% (95% CI 0 – 5.5%), with 1.4% (95% CI 0.0 – 2.6%) for major and 2.2% (95% CI 0.0 – 4.3%) for minor bleeding. Composite TE rate for no prophylaxis (9.6%; 05% CI 3.7 – 15.5%) was significantly greater than that of warfarin (1.7%; 95% CI 0.1 – 3.3%) and aspirin (1.3%; 95% CI 0.0 – 3.0%). Both TE and all bleeding rate showed no difference between warfarin and aspirin, while major bleeding tended to be higher in warfarin than aspirin(0.9% vs 0.0%, p=0.06). Fontan patients had overall TE rate of 2.7% (95% CI 0.1 – 5.4%). Patients with no prophylaxis (10.2%; 95% CI 9.2 – 18%) had significantly greater TE rate than warfarin (1.4%; 95% CI 0.0 – 0.4%) or aspirin (1.2%; 95% CI 0.0 – 3.0%). All bleeding rate in Fontan patients was 0.5% (95% CI 0.0 – 4.3%). Both TE ad bleeding rates showed no difference between warfarin and aspirin. Overall TE rate for shunt was 7.2% (95% CI 3.7 – 14.3%), being similar between aspirin group and no antithrombotic group. Patients with mechanical valves had TE rate of 7.3% (95% CI 2.9 – 11.6%) and all bleeding rate of 7.2% (95% CI 4.2 – 10.2%). There was no statistical difference between warfarin and APA group. Patients with ASD occlusion device has TE rate of 0.1% (95% CI 0.0 – 0.2%). No bleeding event was reported in the studies. Conclusion: Patients with congenital heart diseases were at risk of developing thromboembolism which justified the use of anti-thrombotic prophylaxis. Further studies relating the thromboembolic risk profile of patients with CHD to the efficacy of anti-thrombotic agents might help in selection of anti-thrombotic agents. / published_or_final_version / Community Medicine / Master / Master of Public Health

Thesis (M. D.)--University of Hong Kong, 2008. / Includes bibliographical references (leaves 177-207) Also available in print.

Thesis (M.S.)--Oregon State University, 2009. / Printout. Includes bibliographical references (leaves 45-49). Also available on the World Wide Web.

Thesis (Ph.D.)--University of Melbourne, School of Nursing and Social Work, Dept. of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, 2009. / Typescript. Includes bibliographical references.

Thesis (M.S.)--McGill University, 1997. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (M.S.)--McGill University, 1997. / Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1948. / Typescript. Vita. With this is bound: Studies on the hemorrhagic sweet clover disease : XIII. Anticoagulant activity and structure in the 4-hydroxycoumarin group / By Ralph S. Overman ... David G. Doherty, et. al. Reprinted from Journal of biological chemistry, vol. 153, no. 1 (Apr. 1944), p. 5-24. Includes bibliographical references.

No description available.

The purpose of this study was to characterize the association between anti-prothrombin antibodies and the lupus anticoagulant (LA) in order to elucidate the antigenic site of the LA. Plasma from 8 patients with the LA had evidence of anti-prothrombin antibodies on prothrombin crossed immunoelectrophoresis as characterized by material moving slower in the first dimension of electrophoresis than normal prothrombin, i.e., a trailing shoulder. Four of 5 LA patients with a prolonged prothrombin time demonstrated the most pronounced evidence of anti-prothrombin antibodies. All patients were shown to have an essentially normal level of prothrombin antigen. Using an enzyme-linked immunosorbent assay (ELISA), six of 8 LA patients tested positive for anticardiolipin antibodies (aCL) of the IgG isotype while 7 of 8 LA patients tested positive for antiphosphatidylserine antibodies (aPS) of the IgG isotype.An anti-human Factor II (prothrombin) ELISA was developed to confirm the presence of anti-Factor II (aFII) activity in LA patients. Seven of 8 LA patients were positive for aFII activity. A strong parallel existed between the presence of aPS activity, anti-human Factor II activity, and the LA, i.e., 7 of 8 LA plasmas were aPS (+)/aFII (+). An antibovine Factor II ELISA was developed to determine if the aFII activity associated with LA patients is speciesspecific. Three of 5 LA patients positive for anti-human Factor II activity were also shown to be positive for antibovine Factor II activity. Antibodies with specificity for human prothrombin were purified from LA plasmas using a prothrombin affinity column. Three of 8 LA patient eluates were shown to be positive for aPS (IgG) while none were positive for aCL (IgG or IgM) or human aFII activity. Affinity-purified eluates were assayed for LA activity using the dilute Russell viper venom time (dRVVT). None of the LA patient eluates were shown to prolong the dRVVT when present with normal plasma in concentrations up to 100 micrograms/mL. / Department of Chemistry

Thesis (MAppSc (Medical Laboratory Science)) --University of South Australia, 1992