Endoscopy-Related Bleeding and Thromboembolic Events in Patients on Direct Oral Anticoagulants or Vitamin K Antagonists

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Pediatric valve replacement, 15 years experience in Oman

Background Despite improving surgical techniques, treatment of heart valve disease in children remains controversial. Somatic growth and adequate anticoagulation are of concern when children undergo valve replacement. We conducted this study to evaluate the performance of valves in this age group. Methods 42 children under the age of 13 years who underwent valve replacement were included in this study. Totally, 50 valves were implanted in 42 patients: 48 were mechanical prostheses, two were bioprosthetic both in pulmonary position. 37 (74%) valves were implanted in mitral position, 10 (20%) in aortic position, 1 (2%) in tricuspid position and 2 (4%) in pulmonary position. Preoperatively, 14 (33,3%) patients were in New York Heart Association (NYHA) class IV, while 27 (64.2%) were in NYHA class III. Results There were 2 (4.7%) hospital deaths and 2 (4.7%) late deaths while 2 (4.7%) patients were lost to follow up. The mean follow up period was 9.4 yrs. 35 (83.3%) patients are in NYHA Class I and free of all medications except warfarin. 3 (7.1%) patients have undergone 5 successful pregnancies. The median INR was 2.23. Major thrombo-embolic episode occurred in 1 (2.3%) patient. Conclusions In view of the problems of sizing, anticoagulation and need for re-operation at an early age, there is a reluctance to replace valves in children. This study shows that despite these problems, valve replacement can be undertaken safely and successfully in children, when repair has failed or not technically feasible.     

两种工艺类肝素抗凝和降脂作用的比较

实验表明类肝素碱性处理者在抗凝与降脂上明显优于中性处理者;对小鼠的抗凝作用及TritonWR-1339诱发的大鼠高胆固醇血症的降胆固醇作用,二者在所试剂量范围内随剂量增加作用增强,但对TritonWR-1339性高甘油三酯血症,二者的作用强度未见此效应。     

腹部手术后并发下肢深静脉血栓16例分析

目的　探讨腹部手术后并发下肢深静脉血栓形成 (DVT)的原因、诊治要点和预防措施。方法　回顾性分析 1 6例腹部手术后并发DVT病人的临床特点及诊断、治疗方法。结果　发生DVT的高危因素是复合创伤、恶性肿瘤、血粘度增高、老年病人、合并高血压病、糖尿病及术后常规应用止血药等。本组 1 6例均治愈 ,无一例发生肺栓塞等严重后果。结论　腹部手术后并发DVT者要积极早期治疗 ,对发生DVT的高危人群术前、术后应采取预防措施     

肠系膜静脉血栓形成七例临床分析

为探讨肠系膜静脉血栓形成的临床诊治经验，作者从病理生理、病因、致病因素、临床表现、诊断及治疗等方面对肠系膜静脉血栓形成进行了探讨。作者１９８４年至１９９６年收治了肠系膜静脉血栓形成患者７例，全部经手术治疗并经病理证实。本组７例患者经手术及抗凝治疗，其中５例治愈，２例死亡。作者认为此病大多数以急腹症就诊，术前要做出正确诊断有一定难度。对可疑病例必须进行严密观察及适时开腹探查。为降低死亡率，必须彻底切除包括外观正常但含有血栓系膜的肠袢，此外应早期、足量给予抗凝治疗。     

嗜酸性粒细胞阳离子蛋白测定的影响因素探讨

目的探讨温度、抗凝剂(EDTA-K2)对血嗜酸性粒细胞阳离子蛋白(ECP)水平的影响。方法采用固相双位点酶放大化学发光法,分别对22例健康体检者在两种不同温度(25℃和37℃)的血清标本,以及在相同温度(37℃)下,加抗凝剂和不加抗凝剂的血标本进行ECP水平测定。结果25℃组和37℃组血清ECP水平分别为8.92±6.45μg/L(x±s)和19.87±12.16μg/L(x±s),两组有显著性差异(P<0.01);37℃温度下加抗凝剂和不加抗凝剂血标本的ECP水平分别为5.26±2.60μg/L(x±s)和19.87±12.16μg/L(x±s),两组也有显著性差异(P<0.001)。结论温度和抗凝剂(EDTA-K2)对血标本的ECP水平测定有不同程度的影响。     

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.     

A low molecular weight heparin in hemodialysis

Summary The purpose of our study was to check whether the dosage recommended for the low molecular weight heparin tested here, i.e., 50% of the corresponding unfractionated heparin dose, is adequate to prevent clot formation in the extracorporeal system. Sixteen dialysis treatments of 4–5 h were given to each of six chronic dialysis patients. In dialyses 1, 2, 15 and 16 unfractionated heparin (initial dose 35 IU/kg, continuous dose 20 IU/kg/h) was given, and in dialyses 3–14 low molecular weight heparin (initial dose 17.5 anti-Xa U/kg, continuous dose 10 anti-X U/kg/h). At these dose levels of low molecular weight heparin, clot formation occurred in the extracorporeal system in five of the six patients, despite the fact that the plasma anti-Xa level of 0.5 U/ml recommended by the manufacturer had been attained. For this reason the continuous dose of low molecular weight heparin had to be raised to approx. 80% of the corresponding continuous dose of unfractionated heparin. A plasma anti-Xa level of 0.7 U/ml is necessary to prevent extracorporeal clot formation.Abbreviations anti-Xa U Anti-factor Xa unit - aPTT Activated partial thromboplastin time - AT III Antithrombin III - IU International unit - LMWH Low molecular weight heparin - UFH Unfractionated heparin     

ACD - A solution as anticoagulant during continuous renal replacement therapy in high risk bleeding patients

Objective To assess the efficacy and safety of ACD-A solution as anticoagulant during continuous renal replacement therapy (CRRT) in high risk of bleeding patients. MethodsForty high risk bleeding patients on continuous veno - venous hemofiltration (CVVH) were randomly divided into two groups: ACD-A group (22 patients, 61 cases) and heparin-free group (18 patients, 47 cases). Serum creatinine, function of the coagulation system, electrolyte and acid-base were monitored pre - and post - CVVH. The vital signs of the patients during treatment, dialyser clotting and the incidence of bleeding episodes were recorded. Results(1) The serum level of creatinine decreased significantly after treatment in both groups, but the rate of decrease was obviously higher in ACD-A group than that in heparin - free group[(55.4±10.2)% vs (42.0±5.2)%, P＝0.031]. (2) The average duration of CVVH treatment was (17.3±3.8) h in ACD-A group and (9.7±4.5) h in heparin-free group. There was significant difference between them (P＝0.019). The frequency of dialyzer clotting was much higher in heparin-free group than that in ACD-A group (88% vs 4.9%, P＜0.001). (3) There was no significant difference in the function of the coagulation system between pre- and post-CVVH in either group (P＞0.05). (4) Electrolyte, acid-base and glucose tended to be stable during the treatment in ACD -A group. (5) The vital signs were kept stable and no bleeding episodes were found in all patients of two groups. ConclusionsAnticoagulation with ACD-A is safe, effective and convenient for CRRT in critically ill patients at high risk of bleeding. The occurrence of complications can be reduced by configurating appropriate replacement fluid and close laboratory monitoring.