Heparin–coated circuit during cardiopulmonary bypass

A prospective randomized study was performed to investigate the effect of surface coating with covalently endpoint–attached heparin (Carmeda Bio Active Surface) and reduced general heparinization on haematological indices and complement C5 activation. Care was taken to optimize the rheological design of the system using centrifugal pump and a closed system without venting or machine suction. Twenty patients scheduled for aortocoronary bypass grafting (EF > 0.5) participated in the study. Ten patients were randomized to be treated with heparin–coated equipment (CBAS) and reduced i.v. heparin (1.5 mg kg^-1) while 10 patients treated with identical but noncoated equipment and full heparinization (3 mg–kg^-1) served in a Control group. A vacuum suction was used to collect the blood from the operating field and it was autotransfused at weaning from extracorporeal circulation (ECC). Blood samples were obtained from the venous (precircuit) and arterial (postcircuit) side. We used a new and very specific method for detection of C5a based on monoclonal antibodies. The concentration of C5a was low in both groups during the operation but a significant increase was seen on days 1 and 2. In the Control group there was an increase from 10.2 ngml^-1±1.2 to 27.5 ng ml^-1 ± 4.8 on day 2 and in the CBAS group from 10.7 ng ml^-1 ± 1.2 to 35.6 ng ml^-1 ± 11.6 on day 2 (NS between groups). The granulocytes and total leukocyte count increased at the end of ECC and was maintained at the elevated level throughout the study period. The amount of free haemoglobin was high in the autotransfused blood in both groups. The present results confirm the feasibility of reducing general heparin when using heparin–coated systems but the study does not support the superiority of such coating with regard to biocompatibility in short procedures with a Theologically optimized circuit. The potential benefit from reduced heparin and protamine has not been fully evaluated.     

肝素雾化治疗小儿哮喘性疾病的疗效观察

应用肝素雾化治疗小儿哮喘性疾病（包括以喘为主的支气管肺炎）１６例，其咳喘症状消失和肺部体征消失时间校对照组快，总显效率高。文中还就７例肝素雾化治疗前后血气结果对照，进一步阐述肝素雾化有利于改善通气功能，促进二氧化碳排出和炎症吸收，从而解除支气管痉挛的机理。具有疗效显著，安全可靠，无任何副作用的特点，值得临床推广应用。     

The effect of oral anticoagulant therapy on aptt results from a bedside coagulation monitor

Objective. The Ciba Corning 512 coagulation monitor (CC512) can be used to monitor heparin therapy by performing an activated partial thromboplastin time (APTT) at the patient’s bedside. This study was designed to compare the CC512 results to results using the laboratory system. The relative sensitivities of both systems to the effect of oral anticoagulant therapy also was investigated.Methods. Activated partial thromboplastin times were performed with both the CC512 and laboratory system on 74 specimens from patients receiving IV heparin therapy, and on 14 specimens from patients on warfarin only. Heparin assays were performed on 43 of the specimens from the heparinized patients.Results. When a patient was receiving heparin only, the APTT results of the CC512 proved to be similar to existing laboratory methods. The CC512 APTT results of patients on warfarin only were markedly prolonged, whereas the laboratory APTTs were only slightly affected.Conclusion. The CC512 results were comparable to the laboratory system. However, the CC512 APTT was more sensitive to the effect of warfarin than the laboratory APTT system used in this study. CC512 APTT results on a patient receiving both oral and intravenous anticoagulation could be misleading. The authors wish to thank D.M. O’Brien and the nursing staff of the Coronary Care Unit for providing CC512 data and laboratory specimens, and I. Smith for the preparation of graphics. We also wish to thank Australian Diagnostics Corporation, which provided consumables.     

肝素钠软膏（海普林）治疗皮质类固醇激素依赖性皮炎疗效观察

目的观察肝素钠软膏（海普林）治疗皮质类固醇激素依赖性皮炎的效果。方法随机抽取部分病例组成对照组，其余病例组成治疗组，分别使用单纯乳剂和肝素钠软膏外涂，配合相关内服药物治疗，比较治疗组和对照组疗效。结果对照组治疗有效率为24．81％，治疗组治疗有效率为52．24％，两组结果差异有非常显著性。结论应用肝素钠软膏外用治疗皮质类固醇激素依赖性皮炎取得了满意的疗效。     

Influence of heparin on fibrinogen and D-dimer plasma levels in acute myocardial infarction treated with streptokinase

The purpose of this study was to investigate whether, to whatextent, and through which mechanisms intravenous heparin, administeredbefore and after streptokinase, affects the plasma levels ofD-dimer and fibrinogen in myocardial infarction. Data concerningmortality and incidence of coronary recanalization in patientsreceiving heparin and thrombolytic therapy after acute myocardialinfarction are controversial; furthermore, the mechanisms throughwhich heparin acts in combination with thrombolytic therapyare unclear. Thirty-eight patients with acute myocardial infarctiontreated with streptokinase were considered. Nineteen of themreceived, immediately before the beginning of thrombolytic treatment,a bolus of heparin (100 U. kg¹ intravenously) and, 2 h later,intravenous heparin in doses raising the partial thromboplastintime to 2-2.5 times the normal value (Group 1); the remaining19 did not receive anticoagulant treatment (Group 2). Multipledeterminations of plasma D-dimer and fibrinogen levels wereobtained in all patients before, and in the seven days followingthrombolytic treatment. Six hours after streptokinase, fibrinogendecreased from 304 ± 34 to 61 ± 34 mg. dt¹ inGroup 1 and from 312 ± 29 to 38 ±21 mg. dt¹ inGroup 2 (P<002 versus Group 1). The same difference betweengroups persisted at the 12th and at the 18th hour. D-dimer values,from 0-5 ± 01 \ig. dl¹ in Group 1 and 04 ±01 fig.dt¹ in Group 2, increased at the 1st hour to 37.2 ± 36.5fig. dt¹ and 52.2 ± 39.8 µg. dl¹, respectively.A peak value was reached in both groups at the 6th hour, whichwas followed by a slow decrease. A significant difference betweenthe two groups (P<0.05) was observed at the 1st, 2nd, 4thand 6th hour. An inverse correlation between maximal changesof fibrinogen and of D-dimer was found in both groups (r= 0.89,P<0.001 in Group 1; r=-0.81, P<0.001 in Group 2). The relationship between D-dimer and fibrinogen variations afterstreptokinase and changes induced by heparin, support the hypothesisthat the decrease of fibrinogen, following thrombolysis, isnot only the consequence of its direct degradation, but alsothe result of its transformation by streptokinase into fibrin,fibrin cross-linked (with facilitation of thrombogenic condition)and then into the stable catabolite, D-dimer. These data confirma thrombogenic effect of streptokinase therapy; this tendencycan be limited by prompt use of high doses of heparin.     

In vivo measurements of fibrin formation and degradation in nephrotic patients

Summary Intraglomerular fibrin deposition has been implicated as an important pathogenetic mechanism in patients with glomerular diseases and the nephrotic syndrome. To investigate fibrin formation and degradation in nephrosis, we measured fibrinopeptide A by radio-immunoassay and D-dimer by enzyme-linked immunosorbent assay in the plasma of 30 consecutive adult patients with the nephrotic syndrome; in 10 the serum creatinine was more than 2 mg/dl. Both fibrinopeptide A and D-dimer were abnormally elevated in the majority of nephrotics (P<0.001 vs. healthy controls), providing evidence of increased fibrin generation and lysis “in vivo.” A positive correlation was found between fibrinopeptide A and D-dimer (correlation coefficient 0.64,P<0.001), suggesting a close relationship between fibrin formation and degradation. Calcium heparin, administered to 12 nephrotics, caused a marked decrease in plasma fibrinopeptide A, due to a reduction of in vivo thrombin activity. As enhanced thrombin activity can favor fibrin deposition within the renal parenchyma, as well as vascular complications, it is reasonable to assume that an antithrombotic treatment aimed at controlling thrombin generation may ameliorate the natural history of nephrosis.     

低分子肝素治疗不稳定型心绞痛41例临床观察

目的:探讨低分子肝素治疗不稳定型心绞痛(UA)的临床疗效。方法:对41例不稳定型心绞痛病例,治疗前均常规治疗。在此基础上低分子肝素(体重≤60 kg为5 000 U,体重>60 kg为7 500 U),12 h 1次皮下注射,连用7~14 d,分别于用药前30 min,用药后48 h采血测定活化部分凝血活酶时间(APTT),凝血酶原时间(PT)。结果:显效9例,有效24例,总有效率80.5%。结论:低分子肝素具有高比例的抗因子Xa和抗因子Ⅱa活性,由于其分子量小,与血浆蛋白和内皮细胞结合减少,所以生物利用度高,血浆半衰期长。疗效可取得与肝素同样甚至更高抗凝血酶效果,并且有发生严重出血事件低的优点。     

抗凝治疗肺心病血栓前状态的临床研究

目的探讨肺心病患者的血栓前状态，观察并分析低分子肝素抗凝干预的疗效。方法将54倒肺心病患者分为低分子肝素治疗组和常规治疗组各27例。分别检测治疗前后血浆血管性假血友病因子(VWF)、血浆凝血酶片段1 2(F1 2)、纤堆蛋白原(Fg)、血小板颗粒膜蛋白(GMP-140)和D-二聚体(DD)。结果肺心病患者VWF、F1 2、Fg、GMP-140、DD血浆浓度显著高于对照组；肺心病治疗组经LMWH治疗后上述各凝血分子标记物及PaCO2明显降低。而PaO2显著增高。常规组虽血气指标略有改善。但凝血分子标记物未见改善。结论尽早检测肺心病血栓前状态，及时给予低分子肝素抗凝干预，有望从根本上改善肺心病惠性加重期患者的不良预后。     

Immunology: High fecundity rates following in- vitro fertilization and embryo transfer in antiphospholipid antibody seropositive women treated with heparin and aspirin

This study was undertaken to explore whether intervention withheparin and aspirin (H/A) in selected patients undergoing in-vitrofertilization (TVF) and embryo transfer could improve fecundityrates. Specifically, it explored the possibility that womendiagnosed with organic pelvic disease who demonstrated antiphospholipidantibodies (APA) could benefit from H/A administration in asimilar manner to that used in patients with recurrent pregnancyloss. We used an enzyme–linked immunosorbent assay forsix different phospholipids to identify patients who expressedAPA before they underwent IVF/embryo transfer. This study wasconfined to the first IVF/embryo transfer cycle that followedassessment of APA status and accordingly, the number of IVF/embryotransfer cycles corresponds with the number of patients treated.APA seropositive patients were treated with aspirin, 81 mg orallyq.d., and heparin 5000 IU s.c. b.i.d., beginning on day 1 ofcontrolled ovarian stimulation. The endpoint for success wasa live birth or an ultrasound confirming fetal cardiac activity(a viable pregnancy). The prevalence of APA in patients diagnosedwith organic pelvic disease (53%) was much higher than in thosewithout female pathology (14%). The administration of H/A toAPA seropositive patients significantly (P < 0.05) improvedthe viable pregnancy rate (49%) compared to the untreated APAseropositive group (16%). The viable pregnancy rate for APAseropositive women treated with H/A was also significantly (P< 0.001) higher than for untreated APA seronegative patients(27%). We conclude that all women undergoing IVF/embryo transfershould be tested for APA prior to initiating ovarian stimulation,and those with APA seropositivity should be treated with H/A.     

低分子肝素治疗肺心病继发红细胞增多症21例临床分析

目的观察低分子肝素治疗肺心病继发红细胞增多症的临床疗效。方法将42例慢性肺源性心脏病继发红细胞增多症患者随机分为治疗组21例,对照组21例。对照组给予常规治疗(氧疗、控制感染、扩张血管、纠正止心衰、纠正酸碱失衡及电解质紊乱)。治疗组在常规治疗的基础上加用低分子肝素5 000 IU腹壁皮下注射,1次/12 h,10~14 d为1疗程。结果治疗组:显效13例,有效7例,无效l例,总有效率95.2%;对照组:显效10例,有效5例,无效6例,总有效率71.4%。两组比较有显著差异(P<0.05)。结论低分子肝素佐治慢性肺源性心脏病继发红细胞增多症安全有效。