ROCHESTER, Minn. — Patients who received the anticoagulant drug warfarin after bioprosthetic aortic valve replacement had lower incidence of mortality and a decreased risk of blood clots, according to a retrospective study published in Mayo Clinic Proceedings.

The use of bioprosthetic aortic valve replacement has increased significantly during the past decade. Among its advantages is that most patients can avoid warfarin for anticoagulation treatment. Even so, research has been conflicting on whether patients would benefit from more aggressive early postoperative anticoagulation treatment.

Mayo Clinic researchers analyzed nationwide data on more than 10,000 patients who underwent bioprosthetic aortic valve replacement. Warfarin use was associated with a 32% reduction in mortality risk. Patients treated with warfarin early postoperatively also had an increased risk of major bleeding events.

"The findings support early warfarin use in appropriately selected patients, such as patients with low bleeding risk," says Hartzell Schaff, M.D., a Mayo Clinic cardiovascular surgeon who contributed to the study. "There’s often reluctance to prescribe anticoagulant treatment early after surgery due to concerns about bleeding and uncertainty about benefits. Our research finds that the small increased hazard of bleeding (4% versus 2.3%) may be an acceptable risk given the benefits in terms of mortality risk as well as reduced risk of thromboembolism."

The Mayo Clinic study analyzed deidentified patient data from 2007 to 2019 using OptumLabs Data Warehouse, which contains claims data of commercially insured and Medicare Advantage enrollees of all ages and races throughout the U.S. The study was conducted in collaboration with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

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About Mayo Clinic Proceedings
Mayo Clinic Proceedings is a monthly, peer-reviewed journal that publishes original articles and reviews on clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. The journal, sponsored by Mayo Foundation for Medical Education and Research as part of its commitment to physician education, has been published for 97 years and has a circulation of 127,000.

About Mayo Clinic College of Medicine and Science
Mayo Clinic College of Medicine and Science educates and trains more than 4,000 students, residents, and fellows a year in biomedical education. As part of the nonprofit Mayo Clinic academic medical center, the college is supported by Mayo Clinic's world-class clinical expertise, a commitment to academic excellence, and unparalleled research capabilities. The college has five schools: Mayo Clinic Alix School of Medicine, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Health Sciences, and Mayo Clinic School of Continuous Professional Development.

About Mayo Clinic  
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:

• Jay Furst, Mayo Clinic Research and Education Communications, newsbureau@mayo.edu

The post Use of anticoagulant drug after aortic valve replacement lowers mortality risk, Mayo Clinic study finds appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Direct oral anticoagulants should be considered the standard of care to treat adult patients with cancer-associated thrombosis, according to a new, ongoing study by Mayo Clinic researchers.

Thrombosis is a condition where blood clots form in blood vessels of the legs. These clots can travel to the lungs and become lodged in blood vessels, causing a pulmonary embolism. Thrombotic outcomes increase mortality in cancer patients and are the second most common cause of death after disease progression.

The study, published in Mayo Clinic Proceedings, examined the results of four randomized clinical trials involving 2,894 patients. This study found that direct oral anticoagulants significantly decreased cancer-associated venous thrombosis recurrence without significantly increasing bleeding, compared with parenteral dalteparin.

"Our meta-analysis finds that cancer patients who experience acute venous thrombosis events and were treated with direct oral anticoagulants experienced a 41% decrease in the rate of thrombosis recurrence compared with dalteparin, without significantly increasing major bleeding," says Irbaz Riaz, M.B.B.S., a Mayo Clinic hematologist and oncologist.

Dr. Riaz and Harry Fuentes Bayne, M.D., who is a Mayo Clinic medical oncologist, are co-first authors of the study.

Direct oral anticoagulants have been considered the standard of care to treat venous thrombosis in patients without cancer. "This analysis indicates the same is true for cancer patients," says Robert McBane II, M.D., a Mayo Clinic cardiologist and the study's senior author.

The systematic review led by Mayo Clinic, which also involved researchers from five other institutions, did not find differences in mortality based on the use of oral anticoagulants versus dalteparin. The authors recommend caution in using anticoagulants when treating patients at high risk of bleeding.

The researchers used a novel framework for a "living," interactive review of randomized controlled trials, beginning in September 2019. Results will be updated as more information becomes available.

"We have created interactive evidence summaries of multiple treatment options that present the benefits and harms, and evidence certainty for outcomes, and this evidence is updated as soon as new studies are published," says M. Hassan Murad, M.D., a Mayo Clinic clinical epidemiologist who leads Mayo Clinic's Evidence-Based Practice Research Program and is the study's corresponding author. "We will continue to add randomized controlled trials to this 'living' research, leading to more discoveries that produce improved outcomes for patients."

This approach was developed by a Mayo Clinic team consisting of Drs. Murad and Riaz, as well as Mayo Clinic artificial intelligence experts Huan He, Ph.D., and Hongfang Liu, Ph.D.

Dr. McBane received research funding from Bristol Myers Squibb Co. related to one of the four clinical trials reviewed. All other authors report no competing interests.

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About Mayo Clinic Proceedings
Mayo Clinic Proceedings is a monthly peer-reviewed journal that publishes original articles and reviews on clinical and laboratory medicine, clinical research, basic science research, and clinical epidemiology. The journal, sponsored by Mayo Foundation for Medical Education and Research as part of its commitment to physician education, has been published for 95 years and has a circulation of 127,000.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. For information on COVID-19, including Mayo Clinic's Coronavirus Map tracking tool, which has 14-day forecasting on COVID-19 trends, visit the Mayo Clinic COVID-19 Resource Center. 

Media contact:

• Joe Dangor, Mayo Clinic Public Affairs, newsbureau@mayo.edu

The post Direct oral anticoagulants significantly decrease recurrent venous thrombosis for adult cancer patients, Mayo Clinic study finds appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Researchers continue to study the effects of COVID-19 on the heart, including myocarditis — a focused inflammation of the heart muscle. New research from Mayo Clinic suggests that myocarditis might not be responsible for cardiac injury in many cases of COVID-19.

A small but in-depth study conducted a postmortem evaluation of the heart tissue of 15 patients with COVID-19, including the first postmortem cardiac findings of three patients who had cleared the virus. These patients were compared to a control group of patients with influenza and a control group of patients who did not have a viral infection.

One-third of patients with COVID-19 ― both active and cleared cases ― showed at least some measure of myocarditis. However, the study did not find solid evidence of SARS-CoV-2, the virus that causes COVID-19, in the heart tissue of the patients studied.

But the research revealed something else of importance in the heart of each patient with COVID-19 in the study.

"The study shows that COVID-19, unlike other viruses, seems to impact the heart's small blood vessels," says Melanie Bois, M.D., a Mayo Clinic cardiovascular pathologist and first author of the study.

Chemical staining tests revealed blood clotting in the small blood vessels of the heart tissue. These fibrous blood clots may remain even after the virus is gone, which may suggest blood-thinning therapy as a treatment for patients with COVID-19, possibly even after the virus is cleared.

Underlying heart conditions that are known to be related to worse outcomes for patients with COVID-19 also were cited in the study. Of note, more than 26% of patients with COVID-19 who were studied were found to have cardiac amyloidosis ― a cohesive buildup of abnormal proteins that interferes with the heart's ability to function. This is a much higher rate than the 3.7% occurrence of cardiac amyloidosis typically found at autopsy in patients at Mayo Clinic. It suggests that this underlying heart condition may carry a higher risk of death from COVID-19.

"This study highlights the importance of an autopsy in understanding how diseases affect the body, which helps us to explore new and potentially more effective treatments," says Joseph Maleszewski, M.D., a Mayo Clinic cardiovascular pathologist and senior author of the study.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and Mayo Clinic Facts for more information about Mayo.

Media contact:

• Terri Malloy, Mayo Clinic Public Affairs, newsbureau@mayo.edu

The post Blood clots in the heart are common in patients with COVID-19 appeared first on Mayo Clinic News Network.

Leg and foot swelling during air travel is common and typically harmless. The most likely culprit is inactivity during a flight.

Sitting with your feet on the floor for a long period causes blood to pool in your leg veins. The position of your legs when you are seated also increases pressure in your leg veins. This contributes to foot swelling by causing fluid to leave the blood and move into the surrounding soft tissues.

To relieve foot swelling during a flight:

• Wear loosefitting clothing
• Take a short walk every hour or so
• Flex and extend your ankles and knees frequently while you're seated
• Flex your calf muscles
• Shift your position in your seat as much as possible, being careful to avoid crossing your legs
• Drink plenty of fluids to prevent dehydration
• Avoid alcohol and sedatives, which could make you too sleepy or unsteady to walk around the cabin

Foot swelling isn't a serious problem if it lasts only a short time. But excessive swelling that persists for several hours after you resume activity may be due to a more serious condition, such as a blood clot in the leg (deep vein thrombosis). If you have swelling in only one leg and also have leg pain, seek prompt medical care.

If you're at increased risk of blood clots — because you recently had major surgery or you take birth control pills, for example — talk with your doctor before flying. He or she may recommend wearing compression stockings during your flight. In some cases, your doctor may prescribe a blood-thinning medication to be taken before departure.

This article is written by Dr. Sheldon G. Sheps and Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

The post Foot swelling during air travel: A concern? appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. LaTonya Hickson, a nephrologist at Mayo Clinic, will discuss treatment of chronic kidney disease. Also on the program, Dr. Rizwan Sohail, director of the Travel and Tropical Medicine Clinic at Mayo Clinic, will offer tips for avoiding blood clots during travel. And Dr. Lois Krahn, a sleep medicine specialist at Mayo Clinic, will share the findings of a study on how having dogs in the bedroom affects sleep.

Here's your Mayo Clinic Radio podcast.

The post Chronic kidney disease / avoiding blood clots / dogs in the bedroom affect sleep: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. LaTonya Hickson, a nephrologist at Mayo Clinic, will discuss treatment of chronic kidney disease. Also on the program, Dr. Rizwan Sohail, director of the Travel and Tropical Medicine Clinic at Mayo Clinic, will offer tips for avoiding blood clots during travel. And Dr. Lois Krahn, a sleep medicine specialist at Mayo Clinic, will share the findings of a study on how having dogs in the bedroom affects sleep.

To hear the program, find an affiliate in your area.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Chronic kidney disease appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. LaTonya Hickson, a nephrologist at Mayo Clinic, will discuss treatment of chronic kidney disease. Also on the program, Dr. Rizwan Sohail, director of the Travel and Tropical Medicine Clinic at Mayo Clinic, will offer tips for avoiding blood clots during travel. And Dr. Lois Krahn, a sleep medicine specialist at Mayo Clinic, will share the findings of a study on how having dogs in the bedroom affects sleep.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: Chronic kidney disease / avoiding blood clots / dogs in the bedroom affect sleep appeared first on Mayo Clinic News Network.

Laura's symptoms started earlier in 2014, when the mother of three began experiencing shortness of breath. Then her legs and ankles began to swell.

As Laura's symptoms worsened, walking became such a struggle that she began filling a cooler with snacks to keep by her bed. "At one point I couldn't walk 10 feet from my bedroom to the kitchen or living room," she says. "Putting on a pair of pants would knock me out for the rest of the day."

On Christmas day 2014, Laura was taken by ambulance to an Orlando community hospital, where she received the diagnosis of pulmonary hypertension. The diagnosis put her on a path to Mayo Clinic and regaining her life.

Difficult to diagnose

Laura was referred to Mayo Clinic's Florida campus, where she met Charles Burger, M.D., director of the Mayo Clinic Center for Pulmonary Hypertension and Vascular Diseases. The center is one of 26 designated centers recognized by the Pulmonary Hypertension Association for its integrative approach to patient care, research and education. With a team of experts, including cardiologists, pulmonologists, interventional radiologists and cardiothoracic surgeons, Mayo is one of the largest centers for treatment of pulmonary hypertension based on patient volumes.

"At one point I couldn't walk 10 feet from my bedroom to the kitchen or living room. Putting on a pair of pants would knock me out for the rest of the day." - Laura Floeckhler

"There are five different categories of pulmonary hypertension, so this can be a very difficult disease to diagnose and treat," says Dr. Burger, who likens the condition to "a kink in a water hose." That causes pressure to build, forcing the right side of the heart to work harder to increase blood flow to the lungs. Eventually, the heart enlarges and fails, Dr. Burger says.

Sadly, many patients with pulmonary hypertension are misdiagnosed because a number of conditions have similar symptoms, and the disease has often progressed by the time it is accurately identified. Because of this, some patients require a heart transplant or a heart-lung transplant.

"I didn't know how complicated pulmonary hypertension was until I got it and began researching it," says Laura, who on further testing, was found to have a subtype of the condition that causes blood clots in the lungs.

A surprising new option

Though pulmonary hypertension is a progressive disorder, some patients with Laura's specific condition are eligible for a complex procedure known as pulmonary thromboendarterectomy, where surgeons scrape the clots from the pulmonary arteries. With the procedure, doctors said Laura could essentially be healed.

Getting her active lifestyle back was within reach, but Laura feared the worst. Though she hadn't realized it before, Laura learned that another member of her family was diagnosed with the same condition at age 16 – but passed away due to complications.

Cardiothoracic surgeon Kevin Landolfo, M.D., assured Laura that technology had improved in the past 30 years. Still, thinking about Dr. Landolfo stopping her blood flow and cooling her body to 16-18 degrees Celsius to remove the clots was frightening.

"I was afraid I wouldn't wake up," Laura admits. But she opted to proceed, and in August 2015, underwent the surgery.

During the procedure, Dr. Landolfo removed the majority of blood clots and scarring from Laura's lungs. "We allowed her lungs to improve, her pressures to go down, and that allows her heart to function in a much more efficient way," says Dr. Landolfo.

Almost immediately post-surgery, Laura could tell the difference. "Just taking a breath was easier," she recalls. And she was up and walking around the hospital floor the first afternoon.

Today, Laura is thrilled to be celebrating the holidays with friends and family, taking in the sights, sounds and smells of the season. She's able to walk freely, is back at work and is looking forward to adventures with her first grandchild.

"I love Mayo Clinic and what they did for me," she says. "I feel normal … I feel like I can do it all."

Learn more about Laura's story and the surgery in the following video.

HELPFUL LINKS

• Learn more about pulmonary hypertension.
• Explore pulmonary thromboendarterectomy.
• Request an appointment.

The post Holiday Season Brighter for Pulmonary Hypertension Patient After Surgery appeared first on Mayo Clinic News Network.

• A new study by British researchers finds women who take newer formulations of oral contraceptives may have an elevated risk of developing venous thromboembolism — or blood clots in the veins — than women who take earlier generations of birth control pills. Mayo Clinic hematology expert Dr. John Heit says the study measured the risk of blood clots in veins among women receiving different types of birth control and adds that while there is a higher chance of blood clots for women taking the newer contraceptives, the risk remains very low.

Click here to read more about birth control pills.

Journalists: Video is available in the downloads. [TRT 1:27] Click here for the script.

The post Mayo Clinic News Network Headline 5/29/15 appeared first on Mayo Clinic News Network.

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