Publications (17)53.27 Total impact
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Article: Pulmonary arterial thrombosis in a patient with an atrial septal defect and eisenmenger syndrome.
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ABSTRACT: Pulmonary hypertension is characterized by elevated pulmonary arterial pressure and secondary right ventricular failure. A thromboembolic occlusion of the proximal or distal pulmonary vasculature results in chronic thromboembolic pulmonary hypertension. We report an uncommon case that presented to our hospital with symptoms of dyspnea on exertion over 2 years. The patient had been treated for profound pulmonary thrombosis and right ventricular failure with adequate anticoagulation and sildenafil. Our echocardiography disclosed a large atrial septal defect with severe pulmonary hypertension and right ventricular failure. A diagnosis of Eisenmenger syndrome with pulmonary artery thrombosis was made. Although Eisenmenger syndrome with pulmonary thrombosis is well described in western societies, a huge pulmonary thrombosis is seldom reported in eastern countries. Profound pulmonary thrombosis may obfuscate the actual diagnosis of pulmonary artery hypertension with underlying congenital heart disease. A physical examination and echocardiography are essential in patients with pulmonary hypertension.Korean Circulation Journal 11/2012; 42(11):772-5. -
Article: Comparison of the predictive value of EuroSCORE, SYNTAX score, and clinical SYNTAX score for outcomes of patients undergoing percutaneous coronary intervention for unprotected left main coronary artery disease.
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ABSTRACT: We aimed to assess the prognostic values of the EuroSCORE, SYNTAX score, and the novel Clinical SYNTAX score (CSS) for 30-day and 1-year outcomes in patients undergoing left main (LM) percutaneous coronary intervention (PCI). PCI has become an alternative treatment for LM coronary artery disease, and risk scoring system might be beneficial for pre-PCI risk stratification. We enrolled 198 consecutive patients with unprotected LM disease undergoing PCI (mean age 71.5 ± 10.7 years). The CSS was calculated by multiplying the SYNTAX Score to (age/left ventricular ejection fraction +1 for each 10 mL the estimated glomerular filtration rate <60 mL/min per 1.73 m(2)). The endpoints were 30-day, and 1-year all-cause death and major adverse cardiovascular events (MACE), which were defined as all-cause death, nonfatal MI, and clinical-driven target vessel revascularization. Comparing with the SYNTAX score, the predictive accuracy of CSS for 30-day and 1-year all-cause death and MACE were significantly higher (c-statistics, CSS versus SYNTAX score: P < 0.01 for 30-day and 1-year all-cause death; P < 0.05 for 30-day and 1-year MACE, respectively). Furthermore, in the multivariate Cox regression analysis, both EuroSCORE and CSS were identified as the independent predictors of 30-day and 1-year all-cause death and MACE, but the SYNTAX score was not. In the general practice among a high-risk population undergoing LM PCI, EuroSCORE and CSS might be independent predictors for 30-day and 1-year all-cause death and MACE. Furthermore, the CSS had a superior discriminatory ability in predicting the 30-day and 1-year clinical outcomes comparing with the SYNTAX score.Catheterization and Cardiovascular Interventions 02/2012; 80(2):222-30. · 2.29 Impact Factor -
Article: Association of serum bilirubin with contrast-induced nephropathy and future cardiovascular events in patients undergoing coronary intervention.
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ABSTRACT: Enhanced reactive oxygen species formation within the kidney following the administration of contrast media may play a key role in the development of contrast-induced nephropathy (CIN). Bilirubin has emerged as an important endogenous antioxidant molecule. This study was undertaken to determine whether bilirubin is associated with CIN and future cardiovascular events in patients undergoing coronary intervention. Totally, 544 consecutive patients received coronary intervention were enrolled. All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was CIN, defined as a rise in serum creatinine (SCr) of 0.5 mg/dl or a 25% increase from the baseline value within 48 hours after the procedure. The secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal myocardial infarction, and ischemic stroke. Overall, CIN occurred in 85 (15.6%) patients. All patients were stratified into 3 groups (low/normal/high) according to the serum bilirubin levels. In a multivariate logistic analysis, the odds ratio for CIN with low-bilirubin levels relative to high-bilirubin levels was 11.82 (95% CI, 3.25-43.03). By Cox regression analysis, serum bilirubin levels was an independent predictor of MACE in patients undergoing coronary intervention (low vs. high hazard ratio 2.26; 95% CI, 1.05-4.90). CIN is a serious complication of coronary intervention. Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events. The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention.PLoS ONE 01/2012; 7(8):e42594. · 4.09 Impact Factor -
Article: Application of the Sequential Organ Failure Assessment score for predicting mortality in patients with acute myocardial infarction.
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ABSTRACT: Thrombolysis in Myocardial Infarction (TIMI) score and Global Registry of Acute Coronary Events (GRACE) score have been validated as predictors of death in patients with acute myocardial infarction (AMI). This study was undertaken to determine whether the Sequential Organ Failure Assessment (SOFA) score had good accuracy for predicting mortality in AMI patients, and to compare the discriminatory performance of the 3 risk scores (RSs). This was a retrospective study. We calculated the TIMI RS, GRACE RS, and SOFA score for 726 consecutive AMI patients. The study endpoint was all-cause mortality. All patients were followed up for at least 3 years or until the occurrence of death. The area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive ability of each score at different time points. For in-hospital death, the AUC were 0.67 for TIMI RS, 0.73 for GRACE RS, and 0.79 for SOFA score (P<0.001, respectively). However, the SOFA score and GRACE RS were significantly better for predicting the 1-year (P<0.001, respectively) and 3-year (P<0.001, respectively) mortality than the TIMI RS was. Multivariate Cox regression analysis revealed that the SOFA score was an independent predictor of long-term mortality in AMI patients [hazard ratio (HR), 1.313; 95% CI, 1.191-1.447]. The SOFA score provides potentially valuable prognostic information on clinical outcome when applied to patients with AMI. Compared with TIMI RS, both SOFA score and GRACE RS provide better discrimination for long-term mortality in patients presenting with AMI.Resuscitation 12/2011; 83(5):591-5. · 3.60 Impact Factor -
Article: Effect of invasive strategy on different genders of Chinese patients with non-ST-elevation myocardial infarction.
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ABSTRACT: The aim of this study was to determine the impact of in-hospital revascularization on different genders and to compare the gender difference in short- and long-term prognosis of Chinese patients with non-ST-elevation myocardial infarction (NSTEMI). The benefit of invasive strategy between the genders of Asian ethnic populations with NSTEMI remains unclear. Methods: A total of 343 consecutive NSTEMI patients were enrolled, 104 (30%) of them were women. All patients were followed up for at least 3 years or until the occurrence of a major event. The primary end point was all-cause death. The secondary end point was the combined occurrence of death or myocardial (re-)infarction (MI). The adjusted in-hospital and long-term clinical outcomes were similar between men and women. However, in-hospital revascularization significantly reduced long-term mortality and composite endpoint in men (P < 0.001), but not in women. After risk stratification by GRACE score, there was favorable effect of invasive strategy in high-risk women. In a multivariate Cox regression analysis, GRACE score (hazard ratio; HR, 1.017; P < 0.001) and in-hospital revascularization (HR, 0.516; P = 0.008) were the independent predictors of death or MI in men. However, only GRACE score was the independent predictor of composite endpoint in women (HR, 1.012; P = 0.004). In Asian ethnic patients with NSTEMI, the in-hospital and long-term prognosis were similar between men and women. In-hospital revascularization has a benefit in men and high-risk women for reducing the all-cause death at 1 and 3 years. Our data provide evidence supporting the guideline recommendation for an invasive strategy in high-risk women.Catheterization and Cardiovascular Interventions 10/2011; 79(6):946-55. · 2.29 Impact Factor -
Article: Association of serum bilirubin levels with albuminuria in patients with essential hypertension.
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ABSTRACT: This study was undertaken to evaluate the relationship between serum bilirubin concentrations and the degree of urinary albumin excretion in hypertensive patients. A total of 120 hypertensive subjects were enrolled, in which 80 (67%) with normoalbuminuria (albumin excretion rate [AER] of <20μg/min), 30 (25%) with microalbuminuria (AER of 20-200μg/min) and 10 (8%) with macroalbuminuria (AER>200μg/min). Logarithmic (log) transformation of urinary albumin excretion was carried out before performing correlation and regression analysis. Patients with micro- or macroalbuminuria had significantly lower serum bilirubin concentrations (P=0.004). By multivariate regression analysis, serum bilirubin concentration was an independent determinant of albuminuria and had an inverse correlation with log (urinary albumin excretion) in hypertensive patients (β=-0.189, P=0.023). These findings may partly explain the pathogenetic processes that link microalbuminuria and enhanced cardiovascular risk in hypertensive patients.Clinical biochemistry 07/2011; 44(10-11):859-63. · 2.02 Impact Factor -
Article: Decreased circulating endothelial progenitor cell levels and function in essential hypertensive patients with electrocardiographic left ventricular hypertrophy.
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ABSTRACT: The aim of this study was to explore the role of circulating endothelial progenitor cells (EPCs) and endothelial apoptotic microparticles in hypertensive patients with and without electrocardiographic left ventricular hypertrophy (LVH). Flow cytometry was used to assess endothelial cell apoptosis and circulating EPC level by quantification of circulating EPC markers (defined as CD34(+)CD133(+), CD34(+)KDR(+)) and endothelial apoptotic microparticles (defined as CD31(+)/annexin V(+)) in peripheral blood samples. The LVH was defined by ECG with the Cornell voltage criteria. In total, 128 hypertensive patients (83 men and 45 women, aged 59±14 years) were enrolled in this study, in which 107 patients (84%) showed no electrocardiographic evidence of LVH, and 21 patients (16%) fulfilled the LVH criteria by ECG. There were no significant differences in basic characteristics between the two groups, but hypertensive patients with LVH had a higher urine albumin excretion rate than those without LVH (P=0.027). Furthermore, hypertensive patients with LVH were shown to have decreased circulating EPC numbers (all P<0.05) and adhesive function compared with those without LVH (LVH vs. no LVH: 14±6 vs. 30±6 cells per high-power field, P<0.001). Increased numbers of endothelial apoptotic microparticles were noted in hypertensive patients with LVH (4.2±4.9 vs. 2.4±3.4%, P=0.115), although the difference was not significant. This study showed that essential hypertensive patients with electrocardiographic LVH evidence have decreased circulating EPC numbers and adhesive function compared with those without LVH. These findings may explain the pathogenetic processes that link hypertensive LVH and endothelial injury in cardiovascular disease.Hypertension Research 06/2011; 34(9):999-1003. · 2.58 Impact Factor -
Article: Increased circulating CD31+/annexin V+ apoptotic microparticles and decreased circulating endothelial progenitor cell levels in hypertensive patients with microalbuminuria.
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ABSTRACT: Microalbuminuria is associated with an increased risk for all-cause and cardiovascular mortality, but the pathophysiologic mechanism underlying the association between urinary albumin excretion and cardiovascular disease remains unclear. Here, we tested the hypothesis that enhanced endothelial apoptotic microparticles and decreased endothelial progenitor cell (EPC) levels might contribute to the pathophysiology of microalbuminuria or macroalbuminuria in cardiovascular disease. Flow cytometry was used to assess endothelial cell apoptosis and circulating EPC levels by quantification of circulating CD31/annexin V apoptotic microparticles and EPC markers (defined as KDRCD133, CD34CD133, CD34KDR) in peripheral blood. In total, 125 patients with hypertension were enrolled in the study, of whom 80 patients (64%) were with normoalbuminuria (albumin excretion rate of <20 microg/min, overnight urine samples), 35 patients (28%) with microalbuminuria (an albumin excretion rate of 20-200 microg/min), and 10 patients (8%) with macroalbuminuria (an albumin excretion rate >200 microg/min). Compared to hypertensive patients with normoalbuminuria, patients with microalbuminuria or macroalbuminuria had significantly more diabetes (P = 0.005), higher systolic blood pressure (P = 0.018), and elevated serum creatinine levels (P < 0.001). Among the three groups, patients with microalbuminuria or macroalbuminuria had significantly increased CD31/annexin V apoptotic microparticles (1.8 +/- 2.2 versus 3.0 +/- 4.3 versus 5.2 +/- 6.2%, P = 0.044) and decreased circulating EPC numbers (P < 0.05). By multivariate analysis, CD31/annexin V apoptotic microparticle level was an independent predictor of urinary albumin excretion rate in hypertensive patients (P < 0.001). Microparticles isolated from hypertensive patients with microalbuminuria or macroalbuminuria attenuated EPC proliferation, migration, and increased H2O2 production, cellular senescence and apoptosis in comparison with those from hypertensive patients with normoalbuminuria. These findings suggest that hypertensive patients with microalbuminuria or macroalbuminuria have increased endothelial apoptotic microparticles and decreased circulating EPC levels, which may contribute to atherosclerotic disease progression and enhanced cardiovascular risk in hypertensive patients with nephropathy.Journal of hypertension 08/2010; 28(8):1655-65. · 4.02 Impact Factor -
Article: Serum bilirubin predicts long-term clinical outcomes in patients with cardiac syndrome X.
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ABSTRACT: Increased oxidative stress and vascular inflammation have been demonstrated in patients with cardiac syndrome X (CSX). Bilirubin, once considered simply the metabolic end product of haem degradation, has emerged as a potential endogenous inhibitor of atherosclerosis. This study was conducted to evaluate the prognostic role of serum bilirubin in disease progression and clinical outcome in patients with CSX. A total of 108 consecutive CSX patients were enrolled. Serum bilirubin levels were examined from blood samples collected before coronary angiography. All patients were prospectively followed up for 5 years for the composite end point of total adverse events including death and non-fatal cardiovascular events (non-fatal myocardial infarction, ischaemic stroke, rehospitalisation for unstable angina, and coronary revascularisation). There were 20 adverse events, including five deaths, five ischaemic strokes and 10 rehospitalisations for unstable angina during follow-up. Patients with adverse events had lower baseline serum bilirubin levels (p<0.001). All patients were stratified into high-bilirubin, normal-bilirubin and low-bilirubin groups. The patients in the high-bilirubin group had the lowest incidence of total adverse events (p=0.008) and non-fatal cardiovascular events (p=0.008). In a multivariate Cox regression analysis, serum bilirubin, in addition to age and basal superoxide generation of circulating mononuclear cells, was also an independent predictor of total adverse events (HR 0.002; 95% CI 0.000 to 0.520; p=0.028). In patients with CSX, baseline serum bilirubin level was associated with long-term outcomes. Serum bilirubin could be a predictive and protective biomarker for disease progression and the development of cardiovascular events in CSX patients.Heart (British Cardiac Society) 08/2010; 96(15):1227-32. · 4.22 Impact Factor -
Article: Association of adiponectin with future cardiovascular events in patients after acute myocardial infarction.
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ABSTRACT: There is uncertainty about the association between circulating concentrations of adiponectin and coronary heart disease risk, particularly in patients after acute myocardial infarction (AMI). The goal of this study was to determine whether plasma adiponectin levels could predict future cardiovascular events in patients after AMI, and to elucidate the role of adiponectin in cardioprotection. A total of 102 patients with AMI were enrolled. Plasma adiponectin levels were examined from blood samples collected 18 months after AMI. All subjects were followed-up for 43+/-12 months. The primary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including rehospitalization due to unstable angina, nonfatal MI, revascularization with percutaneous coronary intervention or coronary artery bypass grafting, ischemic stroke, and cardiovascular death. A total of 30 MACE occurred, including one case of cardiovascular death, five cases of nonfatal MI, and nine cases of ischemic stroke. Patients with MACE had lower plasma adiponectin levels (p=0.013). In addition, adiponectin was positively associated with changes in left ventricular ejection fraction (p=0.005). All patients were divided into a high-adiponectin group (>or=6.46 microg/mL) and a low-adiponectin group (<6.46 microg/mL). The incidence of MACE was significantly reduced in the high-adiponectin group (p=0.021). In multivariate Cox regression analysis that included adiponectin, classical risk factors, and medications, adiponectin was an independent predictor of MACE in patients after AMI (HR, 0.821; 95% CI, 0.691 to 0.974; p=0.024). The results indicate a potential association between plasma adiponectin levels and future cardiovascular events in patients after AMI. Moreover, plasma adiponectin concentrations appear to play a pivotal role in atherothrombosis and cardioprotection.Journal of atherosclerosis and thrombosis 02/2010; 17(3):295-303. · 2.69 Impact Factor -
Article: Acute left ventricular rupture following posterior wall myocardial infarction.
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ABSTRACT: Free wall rupture, the most fearful complication of myocardial infarction, mostly attacks anterior walls. Acute rupture is characterized by rapid development of mechanical arrest accompanied with bradyarrhythmia or electromechanical dissociation. The majority of patients succumb to death as the result of cardiac tamponade. Risk factors are advanced age, female gender, the first-time myocardial infarction, hypertension, and ST-segment elevation. We report a rare case of posterior wall myocardial infarction complicated with left ventricular rupture initially presenting with junctional escape rhythm.Internal Medicine 01/2010; 49(14):1387-90. · 0.94 Impact Factor -
Article: Images in cardiovascular medicine. Solitary pulmonary artery intima sarcoma manifesting as pulmonary embolism and subacute cor pulmonale.
Circulation 12/2009; 120(22):2269-70. · 14.74 Impact Factor -
Article: Combination of an ACE inhibitor and indapamide improves blood pressure control, but attenuates the beneficial effects of ACE inhibition on plasma adiponectin in patients with essential hypertension.
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ABSTRACT: Antihypertensive agents differentially influence the plasma adiponectin concentration and the effects of fixed-dose combination regimens remain unclear. The influence of a combination of an angiotensin-converting enzyme inhibitor (ACEI) and a thiazide-type diuretic or an ACEI alone on plasma adiponectin concentrations in patients with essential hypertension was evaluated in the present study. After a 2-week placebo run-in phase, 30 patients with essential hypertension were randomized to receive preterax (2 mg perindopril/0.625 mg indapamide) or cilazapril (2.5 mg) once daily for 12 weeks. Plasma adiponectin and insulin concentrations were measured before and after treatment. Insulin resistance was measured by homeostasis assessment index (HOMA-IR). Treatment with preterax (P=0.003) and cilazapril (P=0.031) significantly reduced systolic blood pressure (BP), but only preterax reduced diastolic BP (P=0.024). Cilazapril treatment significantly increased the plasma adiponectin concentration (P=0.025) and reduced plasma triglycerides (P=0.041), whereas preterax treatment increased the plasma insulin concentration (P=0.041) and tended to increase HOMA-IR. The combination of an ACEI and indapamide improved BP control, but attenuated the beneficial effects of ACE inhibition on plasma adiponectin in patients with essential hypertension. Such a combination may be best reserved for improved BP control rather than for metabolic protection in clinical hypertension.Circulation Journal 09/2009; 73(12):2282-7. · 3.77 Impact Factor -
Article: Plasma levels of soluble receptor for advanced glycation end products are associated with endothelial function and predict cardiovascular events in nondiabetic patients.
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ABSTRACT: We sought to test the hypothesis that decreased plasma soluble receptor for advanced glycation end products (sRAGE) levels were associated with endothelial dysfunction in nondiabetic patients. sRAGE, a C-truncated secretary isoform of the receptor protein, has been shown to neutralize vascular damage mediated by advanced glycation end products, and has been implicated in atherogenesis. However, the relation between plasma sRAGE level and endothelial function remains unclear. Plasma levels of sRAGE were examined in 180 nondiabetic participants with suspected coronary artery disease. Endothelial function was evaluated by endothelium-dependent flow-mediated vasodilation (FMD) of the brachial artery. The primary end point was the combined occurrence of major adverse cardiovascular events, including nonfatal myocardial infarction, revascularization with percutaneous coronary intervention or coronary artery bypass grafting, ischemic stroke, and cardiovascular death. All participants were divided into three groups according to the magnitude of FMD: group 1 (FMD <3%), group 2 (FMD >or=3 and <6%), group 3 (FMD >or=6%). The plasma levels of sRAGE were significantly decreased in group 1 compared with groups 2 and 3 (676+/-270, 820+/-357, and 1140+/-451 pg/ml; P<0.001). By multivariate analysis, it was shown that the plasma sRAGE level was an independent predictor of endothelium-dependent FMD (R = 0.46; P<0.001). After a 48-month follow-up period, there were 23 events (26%) in the lower sRAGE group(<or=median, 809 pg/ml) and 11 events (12%) in the higher sRAGE group (>809 pg/ml; P<0.05). By the Kaplan-Meier analysis, it was shown that enhanced plasma levels of sRAGE were associated with better major adverse cardiovascular event-free survival (P = 0.032). The results indicate that plasma sRAGE levels are positively associated with endothelial function and predict cardiovascular events in nondiabetic participants with suspected coronary artery disease, suggesting its pivotal role in atherothrombosis.Coronary artery disease 06/2009; 20(4):267-73. · 1.56 Impact Factor -
Article: Plasma heparin cofactor II activity is an independent predictor of future cardiovascular events in patients after acute myocardial infarction.
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ABSTRACT: This study tested the hypothesis that plasma heparin cofactor II (HCII) activity independently predicts cardiovascular events in patients after acute myocardial infarction (AMI) and attempted to elucidate the role of HCII in atherothrombosis. HCII inhibits thrombin activity by binding to dermatan sulfate and has been shown to be a novel and independent risk factor for atherosclerosis. However, there is limited data on the relation between plasma levels of HCII after AMI and future cardiovascular events. A total of 110 consecutive patients (aged 63+/-11 years) with AMI were followed up for 42+/-12 months. Plasma HCII activity was determined from blood samples collected immediately after hospitalization. The primary end point was the combined occurrence of major adverse cardiovascular events (MACE), including rehospitalization because of unstable angina, nonfatal MI, revascularization with either percutaneous coronary intervention or coronary artery bypass grafting, ischemic stroke, and cardiovascular death. All patients were divided into three groups: a high-HCII group (>122%, n=35), a normal-HCII group (>98% and <or=122%, n=41), and a low-HCII group (<or=98%, n=34). The high-HCII group had reduced MACE compared with the other groups, although the difference was not significant (P=0.150). Enhanced plasma HCII activity was, however, significantly associated with decreased MACE in the nondiabetic patients (P=0.034). In a Cox multivariate regression analysis that included all patients, plasma HCII activity was an independent predictor of future MACE (P=0.029). The results indicate a potential association between plasma HCII activity and future cardiovascular events after AMI. Moreover, HCII activity seems to play a pivotal role in atherothrombosis.Coronary artery disease 01/2009; 19(8):597-602. · 1.56 Impact Factor -
Article: Efficacy and safety of rosuvastatin in Taiwanese patients.
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ABSTRACT: Statins are effective in decreasing low-density lipoprotein cholesterol (LDL-C). The efficacy and safety of rosuvastatin, a newly launched statin, have not been determined in Taiwanese patients. Patients with hypercholesterolemia receiving rosuvastatin 10 mg/d in this hospital were prospectively followed and retrospectively analyzed. Men and women with primary hypercholesterolemia were eligible for inclusion in the study if they were either lipid-lowering therapy (LTT)-naive or had been receiving starting doses of other LLT that had proved ineffective in reaching goals. The primary measurement was the percentage of change in LDL-C from baseline at 12 weeks. Other measurements included: percentages of change from baseline in total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), TC/HDL ratio, percentage of patients reaching therapeutic goals, and any adverse effects at 12 weeks. Both intention-to-treat analysis and on-treatment analysis were used. A total of 447 patients, including 375 LTT-naive and 72 switched patients were enrolled. In LLT-naive patients, rosuvastatin 10 mg/d reduced LDL-C by a mean of 48.9% from baseline (p < 0.0001) by the on-treatment analysis and by a mean of 44.2% from baseline (p < 0.0001) by the intention-to-treat analysis. In switched patients, LDL-C was reduced by a mean of 26.2% from baseline (p < 0.0001) by both analyses. TC, TG, and TC/HDL ratio, but not HDL-C, were also significantly reduced. Overall, more than 75% patients reached their therapeutic goals. The safety profiles were excellent. Only 2.2% of patients complained of myalgia, 0.2% had elevation of creatine kinase > 3 x upper limit of normal (ULN), and 0.6% had an elevation of ALT > 3 x ULN. All the abnormal laboratory tests returned to pretreatment values after drug discontinuation. Only 2.7% of patients discontinued medication due to adverse effects. Rosuvastatin 10 mg/d is safe and effective in Taiwanese patients.Journal of the Chinese Medical Association 03/2008; 71(3):113-8. · 0.79 Impact Factor -
Article: Chitosan potentiation of warfarin effect.
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ABSTRACT: To report a case in which the anticoagulation effect of warfarin appeared to have been potentiated by chitosan, probably due to interference with the absorption of vitamin K. An 83-year-old male with hypertensive cardiovascular disease, type 2 diabetes mellitus, and chronic atrial fibrillation complicated by left atrial thrombus formation was maintained on warfarin 2.5 mg/day. Marked elevation of the international normalized ratio (INR) was noticed after self-medication with chitosan 1200 mg twice daily. He denied taking any other drugs, natural substances, herbal medicines, and nutritional supplements, and stated that he had not changed his dietary habits. After parenteral administration of vitamin K and discontinuation of chitosan, the INR returned to within the target range. However, the patient took chitosan again, and the INR increased to well above the target range. Following strong medical advice, the patient stopped taking chitosan, and the INR remained stable thereafter. Chitosan is a positively charged polymer that binds to the negatively charged lipids and bile acids in the gastrointestinal tract. It can affect the absorption of vitamins A, D, E, and K. Therefore, the anticoagulation effect of warfarin may be potentiated by chitosan through this mechanism. Use of the Naranjo probability scale revealed that the adverse effect was probably due to chitosan. The interaction between warfarin and chitosan has not previously been reported. Healthcare professionals should be aware of this potential interaction.Annals of Pharmacotherapy 12/2007; 41(11):1912-4. · 2.13 Impact Factor
Top co-authors
Top Journals
Institutions
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2012
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Taipei City Hospital
Taipei, Taipei, Taiwan
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2009–2012
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Taipei Veterans General Hospital
- Cardiology Division
Taipei, Taipei, Taiwan
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2007–2010
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National Yang Ming University
- Department of Internal Medicine
Taipei, Taipei, Taiwan
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