心脏瓣膜置换术后华法林低强度抗凝的疗效观察

目的:探讨心脏机械瓣膜置换术后华法林低强度抗凝应用于患者的安全性。方法:对109例人工机械瓣膜置换术后的患者给予华法林进行低强度抗凝治疗,观察、随访患者,记录其凝血酶原时间(PT)及国际标准化比值(INR),统计血栓及出血等不良反应的发生率。结果:本组发生血栓1例(发生率0.98%),出血8例(发生率7.8%),口服华法林剂量(3.125±0.5)mg,实际INR值(1.7±0.5)。结论:口服华法林抗凝维持国际标准化比值(INR)在1.5～2.0时,能降低血栓或出血的发生率,抗凝有效性及安全性好。     

尿激酶加序贯抗凝治疗次大面积肺栓塞疗效分析

目的:探讨尿激酶加序贯抗凝治疗次大面积肺栓塞的疗效。方法:108例次大面积肺栓塞患者随机分为两组,观察组采用尿激酶加序贯普通肝素进行溶栓治疗,对照组单纯使用低分子肝素钙行皮下注射抗凝治疗,观察两组的短期疗效。结果:研究显示,与对照组相比,观察组具有更明显的疗效(P<0.05),肺动脉压显著降低,栓子减少更明显。结论:统计分析显示,尿激酶加序贯抗凝于次大面积肺栓塞疾病的治疗方面具有更为明显的疗效,值得在临床实践中加以推广。     

Management of stable coronary artery disease and atrial fibrillation with anti-thrombotic therapy: A systematic review and meta-analysis

Introduction:Long term management of patients with stable coronary artery disease of >1 year after myocardial infarction (MI) or percutaneous coronary intervention and atrial fibrillation is unclear. Current guidelines recommend using oral anti-coagulation (OAC) alone although the recommendation is weak and there is low quality evidence. Two new randomized control trials (RCTs) were published recently. We conducted an updated meta-analysis to evaluate the effect of these studies on patient outcomesObjective:To conduct a systematic review and meta-analysis of published RCTs and observational studies to compare OAC alone versus OAC plus single anti-platelet therapy.Methods:Electronic searches were conducted using appropriate terms from 3 databases. Relevant studies included. Data extracted and analysis were performed using STATA.Measurements:Summary statistics were pooled and measured for primary and secondary outcomes of both treatment arms.Main results:Eight studies involving 10,120 patients were included for the analysis. Five thousand two hundred thirty-seven patients were on combination therapy while 4883 were on OAC alone. There was no statistically significant difference in the primary outcome of major adverse cardiac events (hazard ratio [HR] 1.067; 95% confidence interval [CI] 0.912–1.249; P value .417). There was no statistically significant difference even in the measured secondary outcomes namely all cause mortality (HR 1.048; 95% CI 0.830–1.323; P value .695), cardiovascular mortality (HR 0.863; 95% CI 0.593–1.254; P value .439). However, we found statistically significant difference between the 2 groups in the incidence of MI with higher incidence in mono therapy group (HR 1.229; 95% CI 1.011–1.495; P value .039) and higher incidence of major bleeding in the combination therapy group in the subgroup analysis (HR 0.649; 95% CI 0.464–0.907; P value .011).Conclusion:We found no reduction of major adverse cardiac event between combination therapy and mono therapy. Although mono therapy showed increased risk of major bleeding overall, subgroup analysis of the RCTs showed increased risk of major bleeding in the combination therapy group. MI was higher in the mono therapy group compared to the combination therapy group, however this outcome was not reproducible in the subgroup analysis of the RCTs.     

Inactivation of Streptokinase by Bovine Plasmin

Bovine plasma, activated by urokinase or activated spontaneously, inactivates streptokinase (SK). The process is time-consuming, and the kinetics of the process indicate that SK is digested by bovine plasmin. Various plasma protein fractions, such as bovine and human fibrinogen, human plasminogen, and even human albumin, inhibit the inactivation of SK.

Human plasmin, activated in the same manner, does not appreciably influence the stability of SK.     

新型抗凝药物研究进展

目的本文对新型抗凝血药物的研究进展进行综述,主要包括作用于组织因子/因子VIIa复合物的药物,主要阻断凝血过程的启动阶段;作用于因子IXa和因子Xa的药物,主要阻断凝血过程的发展阶段;作用于凝血酶的药物,调节纤维蛋白形成阶段的药物。     

Thrombosis and acute lymphoblastic leukaemia

Venous thrombosis is more frequent in patients treated for acute lymphoblastic leukaemia (ALL) than other malignancies and has distinctive causes, clinical features and remedies. The reported incidence varies from 1% to 36%, depending on the chemotherapy protocol and whether the reported cases are symptomatic or detected on screening radiography. The risk is thought to arise from increased thrombin generation at diagnosis combined with reduced thrombin inhibitory capacity due to depletion of circulating anti-thrombin (AT) by asparaginase. A number of patient and treatment variables have been reported to influence the risk of thrombosis including hereditary thrombophilia, early insertion of central venous catheters and exposure to a combination of steroids and asparaginase during induction. Erwinia asparaginase is associated with a lower risk of thrombosis compared with Escherichia coli asparaginase. The majority of symptomatic thromboses are related to central venous catheters and involve the upper venous system. Central nervous system thrombosis involving the cerebral venous sinuses is a unique feature of asparaginase-related thrombosis and is reported to occur in 1-3% of patients. Conclusive evidence to support the use of anti-coagulant treatment or AT concentrates for primary prevention is lacking, as is evidence for the efficacy of AT concentrates in the management of established thrombosis. Preventative strategies are hampered by conflicting data on factors that would enable identification of those at highest risk of thrombosis.     

低分子肝素与普通肝素佐治老年重症肺炎中疗效及对凝血功能的研究

目的对比低分子肝素与普通肝素辅助治疗老年重症肺炎的疗效及对凝血功能的影响,优化临床治疗方案。方法将2012年6月-2014年6月入选的105例老年重症肺炎患者随机分为低分子肝素组(LMWH组)和普通肝素组(UFH组),两组患者均给予抗感染、抗炎、解痉、氧疗、防治并发症、抗凝等综合性治疗,LMWH组抗凝治疗采用低分子肝素皮下注射,每次5000IU,每日2次,疗程7 d,UFH组皮下注射普通肝素,每次6250IU,每日2次,疗程7 d,治疗后比较两组氧合指标、APACHEⅡ评分、临床疗效、凝血指标及出血等发生率。结果 LMWH组治疗7 d后Pa O2、Sp O2数值明显高于UFH组,而Pa CO2、APACHEⅡ评分明显低于UFH组,差异有统计学意义(P0.05)。LMWH组总体有效率(50/54,92.6%)高于LMWH组(44/51,86.3%)(χ2=1.116 P=0.291);LMWH组治疗7 d内改有创通气比例(16/54,29.6%)低于UFH组(18/51,35.3%)(χ2=0.384 P=0.535);LMWH组出血发生率(6/54,11.1%)低于UFH组(13/51,25.5%)(χ2=3.659 P=0.056)。两组治疗7 d APTT、PT、PLT数值差异无统计学意义(P0.05);两组治疗后TXB2明显下降,6-keto-PGF1α明显上升,治疗后差异无统计学意义(P0.05);LMWH组治疗后CD62p水平明显低于UFH组(P0.05)。结论老年重症肺炎患者在常规治疗基础上联合使用低分子肝素较普通肝素在改善肺部氧合与降低APACHEⅡ评分方面具有显著优势,在抗凝效果与出血发生率方面具有比较优势。     

白树花多糖硫酸酯的抗凝血活性研究

目的研究白树花多糖硫酸酯的抗凝血效果及抗凝血机理,为制备合成高效、安全的多糖硫酸酯抗凝剂提供实验依据。方法将可食用的白树花真菌进行发酵,提取水溶性多糖,采用氯磺酸-吡啶法进行硫酸酯化修饰,获得水溶性的白树花多糖硫酸酯。通过测定APTT、TT、凝血因子活性对白树花硫酸酯的抗凝血效果及抗凝血机理进行评估和探讨。结果对正常人血浆进行的抗凝血实验表明,白树花多糖硫酸酯具有明显的抗凝血活性,在5 mg/L的浓度下即可发挥效果,在10 mg/L浓度时,相当于150 U肝素的抗凝血效果;抗凝血机理研究结果表明,白树花多糖硫酸酯作用于内源凝血系统,主要通过抗凝血酶Ⅲ抑制凝血因子Ⅱa和Xa的活性发挥抗凝血作用,抗凝血机理与肝素完全相同。结论通过上述研究结果,我们认为白树花多糖硫酸酯具备肝素的抗凝血特性。同时由于是可食用真菌多糖的制备产物,在防生物污染方面具备一定优势。因此,白树花多糖硫酸酯可作为理想的肝素替代品进行开发及临床应用。     

New Perspectives on Pharmacological Treatment of Atrial Fibrillation

Despite the huge development of radiofrequency catheter ablation, surgical operation, pacemaker implantation, and drug therapy remains the first line treatment of atrial fibrillation. Several new anti-arrhythmic drugs and anticoagulation drugs have come out recently, and have made the drug therapy of atrial fibrillation a more promising choice. This article provides a contemporary highlight on the new anti-arrhythmic agents of atrial fibrillation. （ S Chin J Cardiol 2009 ; 10 （4） ： 244 - 249 ）     

Pressure Diuresis and Hypertension

In seven patients who had to be dialysed between four and 13 times due to acute renal failure, low molecular weight heparin (LMWH) Fragmin was used for anticoagulation. According to dose-finding studies, 80–90 U kg^-1 body weight of LMWH as a single bolus were administered initially, producing dose-related levels of 0.3–1.5 anti-factor Xa U ml^-1 in plasma. Apart from the anti-Xa activity in the plasma, the thrombin anti-thrombin III complex (TAT complex) and a fibrin degradation product (D-dimer) were measured as parameters of a coagulation activation. A sufficient anti-coagulation during dialysis was supposed to exist at a normal range (5.0 μg l^-1 or below) of TAT complex. Pathological TAT concentrations at the end of dialysis indicated the requirement of an increased dose for the next dialysis. These concentrations reflected a need for more heparin if, for example, inflammation, indicated by increasing C-reactive protein levels (CRP), occurred. The increase of TAT complex and D-dimer during dialysis showed a good agreement (p < 0.001). Due to a single bolus application before dialysis, one measurement of TAT at the end of the dialysis was sufficient. The determination of the TAT complex concentration enabled a heparinization better adapted to the clinical situation of intensive-care patients undergoing acute dialyses, so that the coagulation system was not additionally activated by the extracorporeal circulation.