注射用血凝酶术前给药对低分子肝素抗凝患者髋关节置换术围术期出血量及凝血功能的影响

目的 探讨注射用血凝酶术前给药对低分子肝素抗凝患者髋关节置换术围术期出血量及凝血功能的影响.方法 本试验为随机、对照、单盲的临床研究.择期全麻下单侧髋关节置换术患者40例,美国麻醉医师协会(ASA)分级为Ⅰ或Ⅱ级,年龄60岁～75岁,体重45 kg ～75 kg.术前1d皮下注射低分子肝素(low-molecular-weight heparin,LMWH)4 000单位,采用随机数字表法,将患者随机分为2组(每组20例):注射用血凝酶组(H组)和生理盐水组(C组).切皮前10 min,H组静脉给予注射用血凝酶2单位(5ml生理盐水稀释),C组静脉注射等量生理盐水.记录术中出血量及术后24h引流量,记录术毕及术后24 h凝血功能的各项指标.术后第5d通过下肢深静脉彩超观察下肢深静脉血栓形成的发生情况. 结果 C组术中出血量及术后24h引流量分别为(629±97) ml和(273±87) ml,H组分别为(312±79) ml和(213±74) ml.与C组比较,H组术中出血量及术后24h引流量减少(P＜0.05).与术前比较,两组术毕、术后24h血红蛋白、红细胞、红细胞积压分别减少(P＜0.05).与术前比较,两组术毕及术后24 h凝血常规各项指标差异无统计学意义(P＞0.05).两组术后深静脉血栓形成发生率分别为13％和7％,差异无统计学意义(P＞0.05). 结论 注射用血凝酶术前给药能减少低分子肝素抗凝下髋关节置换术患者围术期出血量,并不影响患者的凝血功能.     

Thromboprophylaxis patterns,risk factors,and outcomes of care in the medically ill patient population

Introduction

Medically ill, hospitalized patients are at increased risk for venous thromboembolism (VTE) after discharge. This study aimed to examine thromboprophylaxis patterns, risk factors, and post-discharge outcomes.

Methods

This was a retrospective claims analysis involving administrative claims data and in-patient data abstracted from a sample of hospital charts. Patients aged ≥ 40 years hospitalized for ≥ 2 days for nonsurgical reasons between 2005 and 2009 were included. Hospital chart data were abstracted for a random sample of patients without evidence of anticoagulant use at 30 days post-discharge. The combined data determined whether in-patient thromboprophylaxis (anticoagulant or mechanical prophylaxis) reduces risk of VTE at 90 days post-discharge. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox proportional hazard models and logistic regression.

Results

Of 141,628 patients in the claims analysis, 3.9% received anticoagulants (3.6% warfarin). VTE, rehospitalization, and mortality rates were 1.9%, 17.2%, and 6.2%, respectively. The strongest predictors of post-discharge VTE were history of VTE (HR = 4.0, 95% confidence interval [CI]: 3.3-4.8), and rehospitalization (HR = 3.9, 95% CI: 3.6-4.3). Of 504 medical charts, 209 (41.5%) reported in-patient thromboprophylaxis. There was no statistically significant difference in post-discharge VTE rates between patients who did and did not receive in-patient thromboprophylaxis. All-cause mortality was greater among patients without use of VTE prophylaxis.

Conclusion

Utilization rates of in-hospital and post-discharge VTE prophylaxis were low. In-hospital VTE prophylaxis did not reduce the risk of post-discharge VTE in the absence of post-discharge anticoagulation. Combined in-patient and post-discharge thromboprophylaxis lowered the odds of short-term, all-cause post-discharge mortality.     

What Impact Does Venous Thromboembolism and Bleeding Have on Cancer Patients’ Quality of Life?

Background

Venous thromboembolism (VTE) is common in cancer patients and its treatment is associated with a high risk of recurrent VTE (rVTE) and bleeding.

Biological and clinical features of low-molecular-weight heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is a common adverse effect of unfractionated heparin (UFH) therapy. In contrast, only a few patients have been reported with HIT following low-molecular-weight heparin (LMWH) therapy (LMW-HIT). To define the clinical and biological characteristics of LMW-HIT, 180 patients treated for suspected HIT at 15 French centres were investigated. Clinical history was recorded and HIT was confirmed in 59 patients with positive serotonin release assay results: 57 of them had high levels of antibodies (Abs) to heparin-platelet factor 4 complexes (H/PF4) and two had Abs to interleukin 8. Eleven patients were treated exclusively with LMWH (LMW-HIT) and 48 with UFH either alone (UF-HIT, n = 34) or combined with LMWH (UF/LMW-HIT, n = 14). The LMW-HIT and UF-HIT groups were similar with respect to sex, age, platelet count before heparin therapy, frequency of bleeding and occurrence of disseminated intravascular coagulation. The interval to onset of HIT was longer in LMW-HIT patients compared with UF-HIT patients (P = 0.03). Severe thrombocytopenia (platelets < 15 x 10(9)/l) was more frequent in the LMW-HIT group (P = 0.04). Thrombosis occurred in three of 11 LMW-HIT patients, i.e. as frequently as in UF-HIT patients. LMW-HIT is potentially severe and may be observed after longer heparin treatment compared with UF-HIT. It is highly recommended, therefore, that platelet counts be monitored carefully whenever LMWH is administered.     

生骨胶囊联合低分子肝素治疗脊柱术后下肢深静脉血栓48例疗效观察

目的 观察生骨胶囊联合低分子肝素对脊柱术后下肢深静脉血栓(DVT)疗效及安全性的影响。方法 选择2015年12月至2016年11月于石家庄市第一医院行脊柱外科手术病人96例作为研究对象,采用随机数字表法将其分为观察组(48例)与对照组(48例)。对照组给予低分子肝素治疗,每天4 100 IU,皮下注射。观察组则在对照组用药治疗基础上加以口服生骨胶囊,5粒/次,3次/天。观察两组临床疗效、DVT发生率、不良反应发生情况以及治疗前后血液流变学、腘静脉内径(POPV)、股浅静脉内径(FSV)等变化情况。结果 观察组总有效95.83%高于对照组77.08%,DVT发生率4.17%低于对照组20.83%,差异有统计学意义(P＜0.05)。治疗后观察组PT、FIB、D-D指标水平较高于治疗前,差异有统计学意义(P＜0.05)。治疗后观察组FIB(4.02±0.46) g/L、D-D(385.24±26.41) μg/L指标水平较低于对照组FIB(4.63±0.51) g/L、D-D(511.61±22.29) μg/L,差异有统计学意义(P＜0.05)。治疗前两组FSV与POPV检测结果对比,差异无统计学意义(P＞0.05);治疗后观察组FSV与POPV较治疗前对比,差异无统计学意义(P＞0.05);治疗后对照组FSV(7.03±1.79) mm与POPV(7.96±1.63) mm显著低于观察组FSV(8.52±1.23) mm与POPV(9.52±1.23)mm,差异有统计学意义(P＜0.05)。治疗期间两组用药不良反应发生率差异无统计学意义(P＞0.05)。结论 生骨胶囊与低分子肝素联合治疗有助于降低脊柱术后下肢深静脉血栓发生率,加速病人术后康复,改善血液流变学,安全性良好,临床普及价值高。     

髋膝关节置换围手术期下肢深静脉血栓形成与 D-二聚体及抗凝药的关系

目的：探索髋膝关节置换围手术期下肢深静脉血栓形成与 D-二聚体升高关系及使用不同抗凝药的有效性和安全性评估。方法前瞻性分析70例行髋膝关节置换的患者,根据术后双下肢彩色多普勒超声结果,分为血栓组（11例）和非血栓组（59例）,记录两组在术前及术后D-二聚体浓度并进行统计分析。同时按照使用抗凝药不同分为低分子肝素（速碧林）预防组和利伐沙班预防组,记录并比较二者DVT发生率和术后伤口引流量关系。结果血栓组术前D-二聚体浓度与非血栓组术前D-二聚体的浓度相比较有显著性差异（P＜0.01）,血栓组较非血栓组增高。血栓组与非血栓组术后第7天的D-二聚体浓度比较则无显著性差异（P＞0.05）,血栓组与非血栓组各自组内比较,术后与术前的D-二聚体浓度比较均有显著性差异（P＜0.01）,术后浓度较术前均有增高。在使用抗凝药物情况下DVT的发病率为15.71％,利伐沙班与低分子肝素（速碧林）干预后DVT发生的情况无显著性差异（ P＞0.05）。术后伤口引流量无统计学差异（ P＞0.05）。结论研究发现D-二聚体对DVT预测不是特异性指标;髋膝关节置换术后使用抗凝药物情况下 DVT发生情况明显下降,利伐沙班与低分子肝素对于预防DVT作用上无显著性差异。     

Multicenter study of the clinical features and mutation gene spectrum of Chinese children with Dent disease

Dent disease is a rare X-linked recessive inherited tubular disease. In this multicenter study, the clinical presentation and genetic background of Chinese children with Dent disease are studied to improve the cognition and diagnostic ability of pediatricians. In this prospective cohort, we described the genotype and phenotype of a national cohort composed of 45 pediatric probands with Dent disease belonging to 45 families from 12 different regions of China recruited from 2014 to 2018 by building up the multicenter registration system. The CLCN5 gene from 32 affected families revealed 28 different mutations. The OCRL gene from 13 affected families revealed 13 different mutations. The incidence of low-molecular-weight proteinuria (LMWP) in both Dent disease type 1 populations and Dent disease type 2 populations was 100.0%; however, the incidence of other manifestations was not high, which was similar to previously reported data. Therefore, LMWP is a key clinical feature that should alert clinicians to the possibility of Dent disease. A high amount of LMWP combined with positive gene test results can be used as the diagnostic criteria for this disease. The diagnostic criteria are helpful in reducing the missed diagnosis of this disease and are beneficial for protecting the renal function of these patients through early diagnosis and early intervention.     

Recommendations on biosimilar low-molecular-weight heparins

Summary.  Based on the results of large clinical trials, several low-molecular-weight heparins (LMWHs) have been approved for prophylaxis and the treatment of venous and arterial thromboembolism. As a result of expiration or pending expiration of patent protection of the originator LMWHs, many generic or biosimilar LMWHs have been approved in some countries and more are likely to be approved elsewhere. Their greater availability may reduce the treatment costs. The Working Party on Requirements for Development of Biosimilar LMWHs of the Subcommittee on Control of Anticoagulation, Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis has reached a consensus on recommendations to ensure the quality of biosimilar LMWHs as compared with the originator LMWHs.