RESUMEN
Background: Prosthetic valve implantation requires postoperative prophylactic anticoagulation to preclude thrombotic events. The aim of this review is to assess the role of anticoagulation therapy in the management of valve replacement patients. Methodology: Literature from PubMed, Embase, Medline and Google Scholar were searched using the terms "valvular heart disease", "anticoagulant", "mechanical heart valve", "bioprosthesis", "bridging", "Vitamin K antagonist (VKA)", and "acenocoumarol". A committee comprising leading cardiothoracic surgeons from India was convened to review the literature and suggest key practice points. Results: Prosthetic valve implantation requires postoperative prophylactic anticoagulation to preclude thrombotic events. A paramount risk of thromboembolic events is observed during the first three months after surgery for both mechanical and bioprosthetic devices. The VKA therapy with individualized target international normalized ratio (INR) is recommended in patients after prosthetic valve replacement. Therapies for the management of prosthetic valve complications should be based on the type of complications. Special care is mandated in distinguished individuals and those with various co-morbidities. Conclusion: In patients with prosthetic valve replacement, anticoagulant therapy with VKA seems to be an effective option. The role for non-VKA oral anticoagulants in the setting of prosthetic valve replacement has yet to be established. Furthermore, whether the novel oral anticoagulants are safe and efficacious in patients after placement of a bioprosthetic valve remains unanswered.
Asunto(s)
Anticoagulantes/uso terapéutico , Implantación de Prótesis de Válvulas Cardíacas , Complicaciones Posoperatorias/prevención & control , Tromboembolia/prevención & control , Prótesis Valvulares Cardíacas , Hemorragia/inducido químicamente , Hemorragia/terapia , Humanos , Relación Normalizada Internacional , Medición de RiesgoRESUMEN
Propylene oxide (PO), propylene glycol (PG), and polyols are produced from propylene via propylene chlorohydrin. Effluents from these plants contain biological oxygen demand/chemical oxygen demand (BOD/COD) loads besides high chloride concentrations. The high salinity poses severe problem to adopt conventional methods like activated sludge processes. Presently, a simple, economically viable and versatile microbiological process has been developed to get more than 90% biodegradation in terms of BOD/COD, utilizing specially developed Pseudomonas and Aerobacter. The process can tolerate high salinity up to 10 wt% NaCl or 5 wt% CaCl2 and can withstand wide variations in pH (5.5-11.0) and temperature (15-45 degrees C). The biodegradation of glycols involves two steps. The enzymatic conversion of glycols to carboxylic and hydroxycarboxylic acids is aided by Pseudomonas. Further degradation to CO2 and H2O by carboxylic acid utilizing Aerobacter, and possible metabolic degradative pathway of glycols are discussed. Various process parameters obtained in the lab scale (50 L bioreactor) and pilot scale (20 m3 bioreactor), and unique features of our process are also discussed.