Once-Daily Enoxaparin in The Outpatient Setting Versus Unfractionated Heparin in Hospital for the Treatment of Symptomatic Deep-Vein Thrombosis

Background: Once- and twice-daily low-molecular-weight heparin administered in hospital have been shown to be effective and safe for treating deep-vein thrombosis. The aim of this study was to compare the efficacy and safety of deep-vein thrombosis treatment using once-daily subcutaneous enoxaparin in the outpatient setting with intravenous unfractionated heparin in hospital.Methods: This randomized, parallel-group, open-label study was conducted in 18 centers in 4 countries. In total, 298 patients with symptomatic deep-vein thrombosis who were eligible for home treatment were randomized to treatment with enoxaparin in the outpatient setting (1.5 mg/kg subcutaneously once-daily) or unfractionated heparin in hospital (5000 IU bolus and 1250 IU/hour intravenous infusion) for ≥5 days. Clinical endpoints were assessed during a 6-month follow-up period.Results: Among all patients treated with enoxaparin, there was a trend towards fewer recurrent deep-vein thromboses (1.3% vs. 5.4%; p = 0.060) and pulmonary emboli (1.3% vs. 4.1%; p = 0.17) compared with patients treated with unfractionated heparin. When considering a post-hoc combined endpoint of deep-vein thrombosis and pulmonary embolism, significantly fewer events occurred in the enoxaparin group than in the unfractionated-heparin group (2.7% vs. 8.8%; p = 0.026). The incidences of bleeding events and adverse events in the enoxaparin and unfractionated-heparin groups were similar.Conclusions: Once-daily subcutaneous enoxaparin in the outpatient setting is at least as effective and as well tolerated as in-hospital intravenous unfractionated heparin for treatment of deep-vein thrombosis.     

Outpatient management of DVT using low molecular weight heparin and a hospital outreach service

In recent years there have been several studies comparing the efficacy and safety of low molecular weight (LMW) and unfractionated heparin for the treatment of deep venous thrombosis (DVT), showing them in the clinical trial setting to be equal in these regards. LMWH has the advantage of once daily subcutaneous injection and daily monitoring of levels is not usually required. This has led many centres to develop outpatient treatment strategies for these patients but evidence for the safety of this approach is scarce. In 1997 we developed a hospital outreach service for the treatment of patients with DVT and, in a retrospective study, have compared the outcome in 172 patients treated at home with 172 age, sex and thrombotic risk factor matched inpatients treated at our institution with unfractionated heparin. Five patients in the home treatment group suffered a haemorrhagic event, compared with six patients in the hospital group. One patient in the home treatment group had a recurrent DVT within the first 3 months of treatment; in the hospital-treated group, six patients had recurrent DVTs and nine developed pulmonary emboli. At 3 months, there were three deaths in the home treatment group, compared with five deaths in the hospital group. There was no difference in re-admission rate at 3 months: 23 in the home treatment group, 24 in the hospital-treated group. Average length of hospital stay for the home-treatment group was 2.1 days and 12 days for the hospital group. Warfarin control was found to be significantly better in those patients treated at home, and only 18% of patients treated in hospital received heparin according to hospital guidelines. In conclusion, outpatient management of patients with DVT using LMWH is as safe as hospitalization and continuous infusion of unfractionated heparin. The complication rate was lower in the home treatment group and, in particular, the incidence of recurrent thrombosis was significantly less in the home treatment group. In addition, warfarin control was better when managed by specialist nurses. Patients expressed a preference for home treatment.     

Heparin and low molecular weight heparin for treatment of acute pulmonary embolism.

Pulmonary embolism occurs in more than 175,000 patients each year in the United States. The objectives of treatment are to prevent death from the existing embolus, to prevent death and morbidity from recurrent pulmonary embolism, and to prevent morbidity from recurrent deep-vein thrombosis. For patients with adequate cardiorespiratory reserve, the primary objective is to prevent recurrent pulmonary embolism. Anticoagulant therapy with intravenous unfractionated heparin or subcutaneous low molecular weight heparin followed by oral anticoagulant treatment for at least 3 months is the treatment of choice for most of these patients. Clinical trials indicate that the effectiveness of intravenous heparin depends on achieving an adequate heparin effect (activated partial thromboplastin time above lower limit) during the initial 24 hours. A validated protocol for intravenous heparin should be used to lessen the likelihood of delayed heparinization. Low molecular weight heparin given subcutaneously either once or twice daily is as effective as intravenous heparin for the treatment of patients with deep-vein thrombosis and submassive pulmonary embolism. Low molecular weight heparin enables many patients with uncomplicated deep-vein thrombosis to be treated in an outpatient setting.     

Pulmonary Embolism in Medical Patients: Improved Diagnosis and the Role of Low-Molecular-Weight Heparin in Prevention and Treatment

Pulmonary embolism is the major complication of deep-vein thrombosis (DVT) and has been shown in autopsy studies to account for 5–10% of hospital deaths. Approximately 75% of fatal pulmonary emboli (PE) occur in medical patients, a clinically heterogeneous group of patients. Ten percent of deaths due to PE occur within the first hour of the acute thrombotic event. Unfortunately, only 25% of all PE are diagnosed and receive appropriate treatment. The major focus for preventing this complication in medically ill hospitalized patients is to provide venous thromboembolism (VTE) prophylaxis. Unfractionated heparin (UFH) was the mainstay for preventing VTE in hospitalized medical patients. However, over the past few years, low-molecular-weight heparins (LMWHs) have been shown to be at least as effective and safer in preventing VTE in this population. Although highly effective in preventing VTE, there remains a small incidence of thrombotic events. Therefore, clinicians must be attentive to the symptoms and signs that would indicate a PE. If a PE is confirmed, then appropriate treatment based on the clinical status of the patient with either LMWH or body-weight dose-adjusted UFH is indicated.     

Treatment of pulmonary embolism with full-dose heparin, streptokinase or embolectomy--results and indications

The results of treatment of pulmonary embolism with heparin (n = 34), streptokinase (n = 28) or embolectomy (n = 25) are presented. The treatment groups represented different degrees of embolization with acute embolic scores (possible maximum: 20, mean +/- SD): 5 +/- 4, 9 +/- 3 and 13 +/- 3, respectively (p less than 0.0001). The post-treatment embolic score (mean +/- SD) for patients with acute massive central emboli (score greater than or equal to 9) was: 6 +/- 4 (n = 7) and 3 +/- 2 (n = 15) in the streptokinase and embolectomy groups, respectively, (p less than 0.01). The hospital mortality was 6% (n = 2), 21% (n = 6) and 20% (n = 5) in the heparin, streptokinase and embolectomy groups, respectively (p less than 0.05). The 5-year cumulative survival (+/- SE) was 68% +/- 10, 64% +/- 10 and 80% +/- 8, respectively (p: NS). The relative survival (hospital and late deaths, observed/expected) stratified according to acute embolic score showed the best results in the embolectomy group. Systolic pulmonary artery pressure greater than 60 mmHg was found in cases with a duration of symptoms greater than 7 days and/or with greater than or equal to 25 anamnestic recurrent embolic episodes before diagnosis, indicative of a gradual increase in pulmonary artery pressure and of partly organized non-lyseable emboli. Embolectomy carried a low risk of complications (8% with cerebral reduction). Streptokinase treatment was associated with serious complications (18% with cerebral reduction/fatal hemorrhage). Pulmonary embolectomy should be recommended in all cases with emboli in the main branches of the pulmonary artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Outpatient treatment of patients with deep-vein thrombosis or pulmonary embolism

There have been a large number of randomized trials comparing standard unfractionated intravenous heparin with low-molecular-weight heparin for the treatment of deep-vein thrombosis, but only two of these have looked at outpatient therapy. There have been only two randomized trials including patients with symptomatic pulmonary embolism, and neither of these provided outpatient therapy. Postmortem and clinical studies have shown a strong association between pulmonary embolism and the presence of venous thrombosis in the lower limbs. Based on similar rates of venous thromboembolic recurrence and death, these studies suggest that initial treatment should be the same for deep-vein thrombosis and pulmonary embolism. The feasibility of providing outpatient care to many patients seeking treatment for deep-vein thrombosis or acute pulmonary embolism at certain tertiary care hospitals has become evident, but the data suggest that the proportion of eligible patients is institution dependent and may vary from 18% to 91%. In the author's institution, approximately 50% of patients with pulmonary embolism could be treated as outpatients, but there have been no other reports on outpatient therapy for patients with pulmonary embolism. If patients with pulmonary embolism meet criteria demonstrated to result in a higher risk of death, it is, of course, reasonable to not treat such patients on an outpatient basis. Low-molecular-weight heparin followed by oral anticoagulant therapy provides adequate therapy in most patients with deep-vein thrombosis or pulmonary embolism, and many patients can be treated as outpatients.     

Thrombolysis vs heparin in the treatment of pulmonary embolism: a clinical outcome-based meta-analysis

BACKGROUND: In patients with acute pulmonary embolism, thrombolysis results in a more rapid resolution of pulmonary emboli than heparin treatment. Whether this advantage results in an improved clinical outcome is unclear. We sought to perform a clinical outcome-based meta-analysis of studies comparing thrombolytic and heparin treatment in patients with pulmonary embolism. METHODS: Data concerning adverse outcome events (death, recurrent pulmonary embolism, and major bleeding events) were extracted from the identified randomized studies. RESULTS: A total of 56 (23.2%) of 241 patients treated with thrombolytic agents in 9 randomized trials experienced an adverse outcome event compared with 57 (25.9%) of 220 patients treated with heparin (relative risk [RR], 0.9; 95% confidence interval [CI], 0.57-1.32). In the thrombolysis group, 11 patients (4.6%) died compared with 17 (7.7%) in the heparin group (RR, 0.59; 95% CI, 0.27-1.25). Thirty-one patients (12.9%) undergoing thrombolysis had a major bleeding episode compared with 19 patients (8.6%) treated with heparin (RR, 1.49; 95% CI, 0.85-2.81). Five fatal bleeding episodes (2.1%) occurred in the thrombolysis group and none in the heparin group. Six studies provided data on recurrent pulmonary embolism. A recurrence occurred in 14 (6.6%) of 214 patients treated with thrombolytic agents and in 22 (10.9%) of 201 patients treated with heparin (RR, 0.60; 95% CI, 0.29-1.15). Recurrence and/or death occurred in 25 (10.4%) of 241 and in 38 (17.3%) of 220 patients treated with thrombolytic agents and heparin, respectively (RR, 0.55; 95% CI, 0.33-0.96; P =.03). CONCLUSIONS: In patients with pulmonary embolism, thrombolysis had a lower composite end point of death/recurrence than heparin treatment. Excessive bleeding is the trade-off for improved efficacy. A comparative clinical outcome trial of thrombolysis and heparin treatment is warranted in patients with pulmonary embolism and selected for high risk of death and/or recurrence and low risk of bleeding.     

Treatment of proximal deep-vein thrombosis using subcutaneously administered calcium heparin: comparison with intravenous sodium heparin.

In a prospective, randomized clinical trial we compared the efficacy of subcutaneously (SC) administered (every 8 h) calcium heparin to intravenous (IV) sodium heparin in the treatment of proximal deep-vein thrombosis (DVT). A secondary objective was to give enough heparin to achieve a therapeutic anticoagulant effect by the end of the first 24 h. Five of 36 patients (14%) in the SC heparin group failed to achieve a therapeutic anticoagulant effect by the end of the first 24 h compared to 2 of 23 patients (9%) in the IV group (p = NS; 95% CI for true difference = -11.7% to 22.1%). Two of 31 patients (6.5%) in the SC group had venographic evidence of clot propagation compared to 1 of 19 patients (5.3%) in the IV group (p = NS; 95% CI for true difference = -12.4% to 14.8%). The rate of major hemorrhagic complications was similar in each group (approximately 15%). We conclude: (1) using a large initial dose of SC heparin, a therapeutic anticoagulant effect can be readily achieved within 24 h, and (2) combining the results of this trial with previous studies, the efficacy of SC administered calcium appears to be comparable to IV sodium heparin.     

低分子肝素钙联合普米克令舒吸入治疗AECOPD98例临床观察

目的观察低分子肝素钙与普米克令舒联合吸入治疗慢性阻塞性肺疾病急性加重期（AECOPD）的疗效。方法 AECOPD病人98例,按随机数分配法分为治疗组52例,对照组46例,两组病人均给予常规治疗,治疗组在常规治疗的基础上加用低分子肝素钙联合普米克令舒吸入治疗。观察治疗前后以及组间临床症状改善情况,各项指标的变化。结果两组临床症状评分、平均住院日比较差异有统计学意义（P均〈0.05）,治疗组临床疗效明显优于对照组,差异有统计学意义（u=2.692,P=0.007）。治疗后两组血气分析、肺功能均比治疗前改善,差异有统计学意义（P〈0.01）,治疗组改善程度大于对照组,差异有统计学意义（P〈0.05）。结论低分子肝素钙与普米克令舒联合吸入治疗AECOPD,临床疗效确切,值得推广应用。     

静滴川芎嗪并雾化吸入低分子肝素钙治疗慢性肺心病疗效观察

目的探讨静滴川芎嗪并雾化吸入低分子肝素钙治疗慢性肺源性心脏病（简称肺心病）的价值。方法 60例肺心病急性加重期住院患者,随机分为治疗组与对照组,对照组给予常规治疗,治疗组在常规治疗的基础上,加用川芎嗪静滴并低分子肝素钙雾化吸入。结果治疗10天后,治疗组较对照组血液流变学指标明显改善,PaO2明显上升,PaCO2明显下降。治疗组临床总有效率93.3%,明显高于对照组76.7%（P〈0.05）。结论静滴川芎嗪并雾化吸入低分子肝素钙可明显改善肺心病患者的血液粘稠度和肺通气功能,提高临床总有效率,给药方便、安全有效。     

Comparison of low-molecular-weight heparin, administered primarily at home, with unfractionated heparin, administered in hospital, and subcutaneous heparin, administered at home for deep-vein thrombosis.

In this study, 294 patients with acute proximal DVT (deep venous thrombosis) were randomly assigned to receive intravenous standard heparin in the hospital (98 patients) or low-molecular-weight heparin (LMWH) (nadroparin 0.1 mL [equivalent to 100 AXa IU] per kg of body weight subcutaneously twice daily) administered primarily at home (outpatients) or alternatively in hospital (97 patients) or subcutaneous calcium heparin (SCHep) (99 patients, 0.5 mL bid) administered directly at home. The study design allowed outpatients taking LMWH heparin to go home immediately and hospitalized patients taking LMWH to be discharged early. Patients treated with standard heparin or LMWH received the oral anticoagulant starting on the second day, and heparin was discontinued when the therapeutic range (INR 2-3) had been reached. Anticoagulant treatment was maintained for 3 months. Patients treated with SCHep were injected twice daily for 3 months without oral anticoagulants. Patients were evaluated for inclusion and follow-up with color duplex scanning. Venography was not used. In case of suspected pulmonary embolism (PE) a ventilatory-perfusional lung scan was performed. Endpoints of the study were recurrent or extension of DVT, bleeding, the number of days spent in hospital, and costs of treatments. Of the 325 patients included, 294 completed the study. Dropouts totaled 31 (10.5%); six of the 325 included patients (1.8%) died from the related, neoplastic illness. Recurrence or extension of DVT was observed in 6.1% of patients in the LMWH group, in 6.2% in the standard heparin group, and in 7.1% in the SCHep group. Most recurrences (11/17) were in the first month in all groups. Bleedings were all minor, mostly during hospital stay. Hospital stay in patients treated with LMWH was 1.2+/-1.4 days in comparison with 5.4+/-1.2 in those treated with standard heparin. There was no hospital stay in the SCHep group. Average treatment costs in 3 months in the standard heparin group (US $2,760) were considered to be 100%; in comparison costs in the LMWH group was 28% of the standard heparin and 8% in the SCHep group. This study indicated that LMWH and SCHep can be used safely and effectively to treat patients with proximal DVT at home at a lower cost.     

Beneficial effect of heparin in the management of patients with APL

115 patients with acute promyelocytic leukaemia (APL) were studied retrospectively to evaluate prognostic factors and assess therapeutic approaches, particularly the use of heparin in the management of disseminated intravascular coagulation (DIC). The remission rate was 86% (30/35 patients) in those who received heparin and 49% (39/80 patients) in those who received no heparin (P = 0.0002). This difference in remission rates was accounted for by a marked decrease in the number of haemorrhagic deaths, especially those due to intracranial haemorrhage (ICH), in the heparin treated group. Other factors associated with a poor remission rate were prothrombin ratio (PTR) greater than 1.3 (P = 0.008), fibrinogen less than 1.5 g/l (P = 0.02) and WCC greater than 2.0 x 10(9)/l (P = 0.03).     

尿激酶联合低分子肝素钙治疗急性心肌梗死的疗效观察

目的观察尿激酶联合低分子肝素钙治疗急性心肌梗死的临床效果。方法将我院收治的急性心肌梗死患者40例随机分为治疗组和对照组,各20例。治疗组给予尿激酶联合低分子肝素钙治疗,对照组单独给予尿激酶治疗,均连续治疗5～7d,比较两组患者临床效果。结果治疗组血管再通率为100%,对照组血管再通率为72%,两组比较差异有统计学意义(P<0.05);经过一段时间的溶栓治疗后,治疗组出血率为10%,对照组出血率为35%,两组出血率比较,差异有统计学意义(P<0.05)。结论尿激酶联合低分子肝素钙治疗急性心肌梗死的临床效果较好,是安全有效的溶栓药物,值得临床推广应用。     

An audit of the clinical and sub-clinical changes in the first year following an acute deep vein thrombosis.

BACKGROUND: An audit of 100 proximal (above knee) deep vein thromboses (DVT) was carried out to document the dynamic status of the condition during the first year. METHODS: Duplex ultrasound was used to diagnose the presence of an acute deep vein thrombosis in a consecutive series of patients. Follow-up bilateral ultrasound scans were performed at one week, one month, six months and at one year and clot retraction, lysis or extension were recorded. The patients' treatment regime and symptoms were also recorded at each follow-up examination. RESULTS: There were 100 proximal DVT's from 89 patients (11 bilateral thromboses). The patient population included those with a previous history of DVT or in the end stages of a major illness and those with reversible risk factors. The mortality rate over the one-year period was 14 percent, most of the deaths occurring in the first month. The majority of deaths occurred as a result of an underlying primary disease (e.g. cancer) and 3 percent died from a pulmonary embolism. All patients were treated initially with either intravenous (IV) heparin or subcutaneous low molecular weight (SCLMW) heparin. Following heparin all patients were treated with warfarin. The duration of anticoagulant therapy varied with most physicians treating the patient for six months. Symptomatic and asymptomatic events (pulmonary emboli, extension of thrombi, new DVT's) were recorded in the follow-up period especially in the initial and late phase. CONCLUSIONS: The audit concluded that the diagnosis and treatment of DVT continues to be a major clinical problem with uncertainty as to the type and length of treatment required. The mobility of the patient was not considered in the choice of initial heparin treatment. Anticoagulants were generally continued for a period of up to six months regardless of the patient's risk factors. Little consideration was given to asymptomatic events with physicians still depending on unreliable clinical symptoms to determine if recurrences had occurred. Generally, no consideration was given to the long-term consequences of a post-thrombotic limb at the initial stage of treatment of a DVT.     

急性心肌梗塞肝素加阿司匹林抗凝治疗对梗塞相关冠状动脉内血栓自溶的影响

为探讨急性心肌梗塞肝素加阿司匹林抗凝治疗对梗塞相关冠状动脉内血栓自溶的影响,我们观察了45例急性心肌梗塞肝素加阿司匹林抗凝治疗,22例尿激酶溶栓治疗和21例心肌梗塞常规治疗冠状动脉造影情况,其结果为:急性心肌梗塞肝素加阿司匹林抗凝治疗对梗塞相关冠状动脉血栓自溶率为42.2%,溶栓治疗梗塞相关冠脉再通率为68.2%,常规治疗梗塞相关冠状动脉内血栓自溶再通率为14.3%.三组间有显著差异(X~2=12.78,P<0.01).结论是肝素加阿司匹林抗凝治疗急性心肌梗塞能促进冠状动脉内血栓自溶,提高梗塞相关冠脉再通率,但血栓自溶缓慢,冠脉再通延迟,对挽救梗塞区域心肌坏死作用不大.然而,对改善心肌电稳定性和心肌缺血区域的供血有积极的临床意义.     

CONTROLLED TRIAL OF TWO REGIMENS OF SUBCUTANEOUS HEPARIN IN PREVENTION OF POSTOPERATIVE DEEP-VEIN THROMBOSIS

To investigate the efficiency of two regimens of subcutaneous heparin in the prevention of postoperative deep-vein thrombosis, a prospective random trial was carried out on 150 patients, all aged over forty years, who were undergoing various major operations. The patients were divided into three groups: (1) controls, (2) those receiving three twelve-hourly doses of 5000 I.U. heparin, and (3) those receiving 5000 I.U. heparin twelve-hourly for five days. In groups 2 and 3 the initial dose of heparin was given an hour before operation. Deep-vein thrombosis was diagnosed by the ¹²⁵I-fibrinogen technique. The incidence of deep-vein thrombosis was 42% in the controls, 13·5% in group 2, and 8·3% in group 3. The difference in the incidence between the treated groups and the controls was statistically significant, and there was no statistical significance in the difference between the two treatment groups. Short-term therapy (group 2) gave no significant protection against deep-vein thrombosis in patients with malignant disease.     

Prevention of deep venous thrombosis of the leg by a very low molecular weight heparin fraction (CY 222) in patients with hemiplegia following cerebral infarction: a randomized pilot study (30 patients)

The effectiveness and safety of a very low molecular weight heparin fraction were evaluated in the prevention of deep-vein thrombosis in patients confined to bed due to hemiplegia consecutive to a recent cerebral infarction. CY 222 was administered within 48 hours of the stroke by one single daily subcutaneous injection of 0.6 ml (= 15,000 U AXa IC) during 14 days. This randomized pilot study involved 30 patients. The effects of CY 222 were assessed in a group of 15 patients compared with a control group of 15 untreated patients. No deep-vein thrombosis was detected by the labelled fibrinogen test in the treated group, as against 12 patients in the control group. Six patients (3 in each group) died during the study. One case of lethal pulmonary embolism was observed and confirmed at autopsy in the control group. In the remaining 5 patients, no systematic autopsy which would have asserted the absence of pulmonary embolism or drug-induced haemorrhage was performed. Numerous standard laboratory tests confirmed that CY 222 was well tolerated.     

肝素治疗不稳定心绞痛临床观察

对１８０例不稳定心绞痛随机单盲分为常规治疗（对照组）及常规＋肝素治疗（肝素组）。结果显示，肝素组１周显效率４４．８％，总有效率６７．８％；２周总有效率９３．２％，高于对照组（Ｐ＜０．０５）。２周显效率８７．３％，明显高于对照组（Ｐ＜０，０１）。住院期间心肌梗塞发生率：肝素组３．５％，对照组７．５％（Ｐ＞０．０５）。在院期间病死率：肝素组２．３％，对照组３．２％（Ｐ＞０．０５）。肝素治疗未见明显不良反应。认为肝素与常规药物并用治疗不稳定心绞痛，能迅速控制心绞痛，对降低心肌梗塞发生可能有益。     

Adjusted subcutaneous heparin or continuous intravenous heparin in patients with acute deep vein thrombosis. A randomized trial

Study Objective: To determine the efficacy and safety of adjusted subcutaneous calcium heparin compared with continuous intravenous calcium heparin as the initial treatment for acute deep vein thrombosis. Design: Randomized control trial. Setting: University-affiliated general hospital. Patients: Of 111 consecutive patients considered, 103 had acute proximal or calf vein thrombosis confirmed by ascending venography and met all other eligibility criteria. Interventions: Patients were randomly assigned to receive subcutaneous or intravenous heparin. The subcutaneous regimen consisted of an initial dose of 15,000 U, adjusted thereafter to prolong the activated partial thromboplastin time to 50 to 70 seconds. The continuous intravenous regimen was begun as a bolus injection of 5000 U, followed by an infusion of 1250 U/h, adjusted to maintain the activated partial thromboplastin time at 50 to 70 seconds. Measurements and Main Results: There was no significant difference in the rate of new pulmonary embolism between the two groups, as defined by new high-probability defect on repeat ventilation-perfusion scintigrams of the lung in 96 (93%) of the patients after 7 to 10 days of treatment. Five of forty-seven patients in the subcutaneous group and 5 of 49 in the intravenous group developed pulmonary embolism (95% confidence interval [CI] for the difference, -13.1% to 12.2%). Similarly, there was no significant difference in the frequency of hemorrhagic complications. Five of fifty-one patients in the subcutaneous group and 5 of 52 in the intravenous group had hemorrhagic complications (95% CI for the difference, -11.2% to 11.6%). Conclusion: Adjusted subcutaneous calcium heparin may be an effective and safe alternative to continuous intravenous calcium heparin in the initial treatment of acute proximal deep vein thrombosis.     

低分子肝素治疗癌症相关急性肺血栓栓塞症的疗效

目的评价低分子肝素单药抗凝治疗癌症相关急性肺血栓栓塞症的疗效和预后。方法选择于我院就诊的60例癌症相关急性肺血栓栓塞症患者,分为试验组30例和对照组30例,对照组给予常规华法林抗凝治疗,试验组则采用低分子肝素单药抗凝治疗。观察两组患者动脉血氧分压(Pa O2)改善情况,治疗前后D-二聚体和纤维蛋白原(FIB)改善情况,预后情况。结果两组患者治疗后临床症状均有显著缓解,Pa O2、D-二聚体和纤维蛋白原(FIB)比较(P0.05),且试验组患者的改善情况显著优于对照组患者(P0.05),两组患者的病死率及血小板减少发生率均无显著差异(P0.05),但试验组患者的再栓塞率及出血事件发生率显著低于对照组患者(P0.05)。试验组患者的疾病控制率为96.7%高于对照组患者80.0%(χ2=4.0431,P=0.0444)。结论低分子肝素单药抗凝治疗癌症相关急性肺血栓栓塞症的临床疗效显著,可以有效降低再栓塞发生率及出血风险。