基于DEA方法的华法林抗凝分级管理模式的效率评价

目的:通过小范围的临床实践,使用数据包络分析(data envelopment analysis,DEA)方法对基于全程化抗栓药学服务模式的华法林抗凝管理工作效率进行评价。方法:选取2021年7-12月南京大学医学院附属鼓楼医院心胸外科瓣膜置换术后使用华法林抗凝的患者。将患者分为实验组和对照组,实验组由临床药师利用基于分级管理的全程化抗栓药学服务模式进行抗凝管理和药学监护,对照组由临床药师按照无差别监护模式进行抗凝管理和监护,记录2种模式下药师工作内容和工作成效,通过DEA方法分析比较2种抗凝管理模式的效率。结果:研究最终纳入服用华法林的患者233人(实验组116人,对照组117人),实验组的单位患者管理时间显著减少[(27.8±9.7)min vs.(34.8±11.4)min]。经模型计算后,实验组的总体效率值为1,说明其投入和产出最优,且效率高于对照组。结论:全程化抗栓药学服务模式下药师管理单位抗凝患者需要的时间更少,管理效率更高。     

Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar

Stroke is a leading cause of permanent disability. Therefore, primary prevention of first stroke and secondary prevention of recurrent stroke are a high priority. Primary prevention of ischemic stroke includes lifestyle modification and diet, treatment of risk factors including hypertension, diabetes mellitus and lipid disorders, antiplatelet therapy for high vascular risk patients, and anticoagulation in atrial fibrillation. Secondary prevention of ischemic stroke includes additional carotid surgery or stenting in selected symptomatic patients, closure of patent foramen ovale after cryptogenic stroke, treatment of insulin resistance, and best medical treatment of intracranial stenosis. The most important preventive strategies in the primary and secondary prevention of cerebral hemorrhage include the treatment of hypertension, reduction in alcohol intake, and occlusion of the left atrial appendage in patients with atrial fibrillation and permanent contraindications for oral anticoagulation.     

The Essence Trial: Efficacy and Safety of Subcutaneous Enoxaparin in Unstable Angina and Non-Q-Wave MI: A Double-Blind,Randomized, Parallel-Group,Multicenter Study Comparing Enoxaparin and Intravenous Unfractionated Heparin: Methods and Design

Antithrombotic therapy reduces the risk of recurrent ischemic events in patients with unstable angina. The primary aim of the ESSENCE trial is to evaluate the efficacy of enoxaparin (low molecular weight heparin) versus unfractionated heparin, plus aspirin, in patients with rest angina or non-Q-wave infarction. This is a randomized, double-blind, placebo-controlled study of 3180 patients comparing enoxaparin, 1 mg/kg sc bid, with unfractionated heparin via continuous iv infusion to maintain the aPTT at 2 × control. Patients within 24 hours of the onset of acute myocardial ischemia without ST elevation are eligible, and trial therapy is administered for a minimum of 48 hours to a maximum of 8 days. Primary endpoints analyzed are death, myocardial infarction (MI), or recurrent angina at 14 days. Currently 3019 patients have been randomized in 10 countries. The mean age is 64 years, 33% are female, and 46% have had a prior MI. The overall event rates at 14 days are 1.7% mortality, 5.9% subsequent MI, and 17% recurrent angina. The composite triple endpoint rate is 23.6%. Recruitment should be complete by June 1996. The methods and design of the study are presented in this article.     

中药豨莶草的化学成分及其药理作用研究进展

目的探讨菊科植物豨莶草化学成分及其近年来药理作用研究进展。方法检索、整理、归纳国内外有关豨莶草化学成分及其药理作用研究文献。结果与结论豨莶草主要含有二萜类、倍半萜类、黄酮类等化学成分,豨莶草提取物及化学成分具有抗炎镇痛、抗过敏、心血管保护等生物活性。     

Strawberry extract presents antiplatelet activity by inhibition of inflammatory mediator of atherosclerosis (sP-selectin,sCD40L,RANTES, and IL-1β) and thrombus formation

Cardiovascular disease prevention is of high priority in developed countries. Healthy eating habits including the regular intake of an antithrombotic diet (fruit and vegetables) may contribute to prevention. Platelet function is a critical factor in arterial thrombosis and the effect strawberries have is still unclear. Therefore, the aim of this study was to systematically examine the action of strawberries in preventing platelet activation and thrombus formation. Strawberry extract concentration-dependently (0.1–1?mg/ml) inhibited platelet aggregation induced by ADP and arachidonic acid. At the same concentrations as strawberry inhibits platelet aggregation, it significantly decreased sP-selectin, sCD40L, RANTES, and IL-1β levels. The strawberry may exert significant protective effects on thromboembolic-related disorders by inhibiting platelet aggregation. Also, this suggests that antithrombotic activity may have novel anti-inflammatory effects.