Prospective randomized clinical study in general surgery comparing a new low molecular weight heparin with unfractionated heparin in the prevention of thrombosis

A prospective, randomized, controlled clinical trial was performed comparing the antithrombotic efficacy of the low molecular weight heparin LMWH 21–23, (Braun) with an unfractionated heparin in elective general surgical patients over an observation period of 7 postoperative days. A total of 230 patients were admitted: 103 (group I) received low molecular weight heparin and 100 (group II) low-dose unfractionated heparin treatment given subcutaneously. In group I 41 patients (46%) were operated on for malignant disease and in group II 54 patients (54%). Due to the large amount of great abdominal procedures the intra- and perioperative application of hydroxyethyl starch was allowed for volume substitution. None of the patients died due to fatal pulmonary embolism. In group I four patients revealed positive ¹²⁵I-labeled fibrinogen uptake (3.9%); two patients belonged to the hydroxyethyl starch subgroup. In group II five patients displayed a positive fibrinogen uptake (5%); two belonged to the hydroxyethyl starch subgroup. The results of the hemostaseological investigations (e.g., prothrombin time, activated partial thromboplastin time, thrombin clotting time, fibrinogen, antithrombin III, protein C, plasminogen, ₂-antiplasmin , tissue-type plasminogen activator, plasminogen activator inhibitor) revealed no statistically significant differences between groups I and II or their subgroups, although a tendency to prolonged clotting times was observed. The antifactor Xa activity values, however, displayed a statistically significant difference between the two groups (P < 0.05). The antifactor Xa activity measured up to 0.16 U/ml for the low molecular weight heparin (group I) and 0.05 U/ml for the unfractionated heparin (group II) in the postoperative period. Major bleeding complications were not encountered in this study. Fundamental for the low incidence of thrombosis, the additive administration of hydroxyethyl starch appeared in almost one-third of the patients in both study groups.Abbreviations APTT activated partial thromboplastin time - aXa anti-factor Xa - DVT deep venous thrombosis - FUT ¹²⁵I-labeled fibrinogen uptake test - HES hydroxyethyl starch - LMWH low molecular weight heparin - PE pulmonary embolism - UFH unfractioned heparin     

The effects of various anticoagulants on blood coagulation: with special reference to false positive lupus anticoagulants

We studied the effects of heparin, dextran sulphate (MDS), gabexate mesilate (FOY), nafamostat mesilate (FUT-175) and argipidine (MD-805) on APTT, PT, thrombin time (TT) and kaolin-activated PTT (KPTT) with various concentrations of phospholipid for screening of lupus anticoagulants (LA). Heparin, MDS and FUT-175 had a greater effect on APTT than PT. On the contrary, MD-805 had a similar effect on both APTT and PT, which suggests that MD-805 inhibits thrombin generation equally on intrinsic and extrinsic coagulation pathways. Heparin and MD-805 were more effective on TT than MDS, FUT-175 and FOY at high concentrations significantly prolonged TT. But, at even higher concentrations of FUT-175, prolongation of TT was reduced contrary to our expectation. With FOY TT became less prolonged with a passage of time, suggesting time-dependent reduction of its anticoagulant activity. Heparin (0.1-0.2 U/ml) and MDS (0.1-0.3 mg/ml) did not have any effect on KPTT with high concentration of phospholipid, but did FUT-175. It suggests that phospholipid inhibits anticoagulant activity of heparin and MDS. Anti-phospholipid activity of heparin and MDS is similar to that of LA. We concluded that the differentiation of LA from heparin-like inhibitors is needed.     

A comparison of the sensitivity of APTT reagents to the effects of enoxaparin, a low-molecular weight heparin

Low-molecular weight heparin (LMWH) is the product of enzymatic or chemical degradation of unfractionated heparin (UFH). It has been found to have better bio-availibility, more predictable dose response and can be used as an alternative to UFH for prophylaxis and treatment of thrombotic disorders. It is claimed that no laboratory monitoring is necessary for LMWH therapy; however, for the aged, renal impaired, obese or grossly underweight, monitoring of dose effect with anti-Xa assay is recommended. The activated partial thromboplastin time (APTT), which is the test of choice for UFH monitoring, is believed to be insensitive to the effect of LMWH. The sensitivity of the APTT to heparin lies in the APTT reagent used. In this study, eight different APTT reagents were used to compare the APTT with anti-Xa activity in ex vivo plasma from patients who were on enoxaparin (LMWH, Clexane) therapy. It was found that, as with UFH, APTT reagents show variable sensitivity to LMWH. The APTTs from all eight reagents were found to have a linear relationship to anti-Xa activity. The APTT results using three of the reagents gave an indication of the use of LMWH therapy. It was also found that patients who were lupus anticoagulant (LA)-positive had much more prolonged APTTs when on LMWH therapy; however, a linear correlation between APTT and anti-Xa was not present in these patients.     

Clinical efficacy of low molecular weight heparin in postoperative thrombosis prophylaxis

Summary In a randomized controlled clinical trial, the efficacy and safety of two low molecular weight heparin (LMWH) fractions in the prophylaxis of deep vein thrombosis (DVT) were assessed. One hundred twenty-six patients undergoing major abdominal surgery received alternatively 2,500 APTT units b.i.d. of two LMWH fractions or 5,000 APTT units b.i.d. of an unfractionated sodium mucosal heparin (UFH). LMWH 2 differed from LMWH 1 by presenting a lower mean molecular weight and a higher anti-Xa/APTT ratio in vitro. Patients were randomly allocated to the three groups, and the development of DVT was studied with the¹²⁵I-fibrinogen uptake test (RFUT).The study was interrupted and the code broken prematurely because of otherwise unexplainable bleeding events.While no thrombosis and no severe bleeding were detected in the UFH group, three (7%) RFUT-positive DVT and two (5%) hemorrhagic complications occurred in the LMWH 1 group. No thrombosis and nine (22%) cases of severe bleeding were observed in the LMWH 2 group. Thus, the latter group differed significantly from the control group with regard to subjective and objective criteria for postoperative bleeding.Although these results do not allow general conclusions as to the value of LMWH fractions in the prevention of DVT, they indicate that these preparations just as ordinary heparin have a limited therapeutic range.Supported by a grant (Schm 345/4-2) from the Deutsche Forschungsgemeinschaft     

一个纤维蛋白原γ链Arg275His突变导致的遗传性异常纤维蛋白原血症家系

目的　对一个遗传性异常纤维蛋白原血症家系进行表型和基因型分析。方法　采集家系3代5人外周血,吸取上层血浆用血凝仪检测活化部分凝血酶原时间、凝血酶原时间、凝血酶时间、蛋白C活性、蛋白S活性和抗凝血酶活性,纤维蛋白原活性和抗原分别用Clauss法和免疫比浊法进行检测。以常规酚-氯仿法抽提家系所有成员外周血基因组DNA,PCR扩增纤维蛋白原基因FGA、FGB和FGG所有外显子及其侧翼序列,PCR产物纯化后直接测序以检测基因突变。结果　先证者活化部分凝血酶原时间、凝血酶原时间正常,凝血酶时间超出正常上限值2倍以上,纤维蛋白原活性明显下降,抗原也低于正常范围,且活性显著低于抗原;其母表型检测结果与之相似。基因分析显示先证者呈纤维蛋白原FGG基因第8外显子g.5 6 78G>A杂合碱基置换,导致Arg2 75 His错义突变,该突变来源于母系。结论　纤维蛋白原γ链Arg2 75 His杂合错义突变是引起该家系异常纤维蛋白原血症的原因。     

Interaction of blood components with heparin-immobilized polyurethanes prepared by plasma glow discharge

The blood compatibility of poly(ethylene oxide) (PEO)-grafted and heparin (Hep) immobilized polyurethanes was investigated using in vitro plasma recalcification time (PRT), activated partial thromboplastin time (APTT), platelet adhesion and activation, and peripheral blood mononuclear cell (PBMC) adhesion and activation. In the experiment with plasma proteins, the PRT of the polyurethane (PU) surface was prolonged by PEO grafting and further prolonged by heparin immobilization. The APTT was prolonged on PU-Hep, suggesting the binding of immobilized heparin to antithrombin III. The percentage of platelet adhesion on PU was not much different from that on acrylic acid- and PEO-grafted PUs (PU-C, PU-6, PU-33), yet was substantially decreased by heparin immobilization (PU-6-Hep, PU-33-Hep). The release of serotonin from adhering platelets was slightly suppressed on PEO-grafted PUs yet significantly suppressed on heparin-immobilized PUs. In the PBMC experiments, the adhesion and activation of the cells were significantly suppressed on heparin-immobilized PUs, and the amount of interleukin-6 (IL-6) released from PBMCs stimulated with surface-modified PUs decreased with a decrease in PBMC adhesion.     

Anwendung von niedermolekularem Heparin bei Hämodialysepatienten

Summary Low-molecular-weight (LMW) heparin has been compared to standard unfractionated (UF) heparin in a total of 49 patients on hemodialysis and hemofiltration in order to determine the necessary therapeutic dose and its effect on the coagulation system. A LMW heparin dose corresponding to 50% of the normal UF heparin dose was found to produce similar plasma heparin levels (anti-FXa-U/ml) in particular on minimal heparinization. At higher doses, UF heparin produced a more marked increase in plasma-heparin than did LMW heparin. Highly significant differences were found between UF and LMW heparin in their effects on PTT and thrombin time. Partial thromboplastin time (PTT) increased under UF heparin by an average of 120 s whereas LMW heparin only produced an increase of 5–7 s. Thrombin time was increased by 250–280 s under UF heparin and by 5–8 s under LMW heparin. With this LMW heparin dose of 50% of the UF heparin dose, no thrombosis of the extracorporal system occurred and no macroscopic detectable thrombotic material was found in the dialyzers or filters. No significant differences were observed between the effects of UF and LMW heparin on Factor VIII activity and fibrin monomers, so that a difference in coagulation activation between the two heparins can be excluded. Furthermore, there were no changes in thromboplastin time according to Quick, fibrinogen, antithrombin III, plasminogen, and a₂-antiplasmin. Thus effective Anti-FXa levels and by similar antithrombotic activity, LMW heparin will probably present less of a bleeding risk because of its reduced effect on PTT and thrombin time. LMW heparin therefore appears to be a good alternative to UF heparin for patients with renal insufficiency requiring dialysis. LMW heparin is indicated in particular in patients at bleeding risk, with diabetic retinopathy, on therapy with oral anticoagulants or platelet aggregation inhibitors, and with thrombocytopenia.

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Abkürzungsverzeichnis F Faktor - FFA Free Fatty Acids=freie Fettsäuren - LMW-Heparin Low Molecular Weight Heparin=niedermolekulares Heparin - LPL Lipoprotein-Lipase - PTT Partial Thromboplastin Time=Partielle Thromboplastinzeit - UF-Heparin unfraktioniertes Heparin     

Safety and Cost-Effectiveness of Bridge Therapies for Invasive Dental Procedures in Patients with Mechanical Heart Valves

Purpose

Bridge anticoagulation therapy is mostly utilized in patients with mechanical heart valves (MHV) receiving warfarin therapy during invasive dental procedures because of the risk of excessive bleeding related to highly vascular supporting dental structures. Bridge therapy using low molecular weight heparin may be an attractive option for invasive dental procedures; however, its safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain.

Materials and Methods

This study investigated the safety and cost-effectiveness of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients (57±11 years, 35% men) with MHV who underwent invasive dental procedures.

Results

This study included 75 patients treated with UFH-based bridge therapy (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between the UFH group and the enoxaparin group. However, total medical costs were significantly lower in the enoxaparin group than in the UFH group (p<0.001). After multivariate adjustment, old age (≥65 years) was significantly associated with an increased risk of total bleeding independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (β=-0.694, p<0.001) and major bleeding (β=0.296, p=0.045) were significantly associated with the medical costs within 30 days after dental procedures.

Conclusion

Considering the benefit of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH for bridge therapy in patients with MHV who required invasive dental procedures.     

Preparation,characterization and in vitro anticoagulant activity of corn stover xylan sulfates

A new anticoagulant agent was prepared by introducing sulfate groups into corn stover xylan through homogeneous reactions. Three organic solvents, N, N-dimethylformamide (DMF), dimethyl sulfoxide (DMSO) and formamide (FA), were adopted as reaction media, with the assistance of LiCl. Structural characterization by FT-IR and ¹³CNMR showed that xylan sulfate (XS) could be successfully synthesized with SO₃?Pyridine (SO₃?Py) complexes sulfation reagent in the three media. The effect of sulfation temperature, sulfation time, media type and molar ratio of ?SO₃/?OH on the degree of substitution (DS) and degree of the polymerization (DP) were studied. DMF/LiCl were more effective than DMSO/LiCl and FA/LiCl in preparation of xylan sulfate with high DS. The optimal conditions for sulfation were obtained when SO₃?Py complex was added to DMF/LiCl with ?SO₃/?OH ratio of 1.5:1 and maintained at 50 °C for 3 h. Degree of polymerization of xylan was decreased during the sulfation process and DMF/LiCl offered the least xylan degradation as compared with DMSO/LiCl or FA/LiCl. Anticoagulant activities of the resultant xylan sulfates with different DS were evaluated by using activated partial thromboplastin time (APTT), thrombin time (TT), and prothrombin time (PT). Results indicated that the introducing of sulfate groups into xylan did endow the polysaccharides with anticoagulant activity. The APTT and TT of XS with DS of 1.20 reached 141 and 45.3 s at a dosage of 20 μg/mL, while the APTT and TT values for the blank sample were only 35.5 and 15.6 s. Furthermore, coagulation time was prolonged with the increase of DS and the concentration of XS. Our findings provide new insights into the value-added utilization of agricultural biomass.     

Prothrombinase-induced clotting time assay for determination of the anticoagulant effects of unfractionated and low-molecular-weight heparins, fondaparinux, and thrombin inhibitors

The prothrombinase-induced clotting time assay (PiCT, Pentapharm, Basel, Switzerland) is a clotting assay sensitive to factor Xa and factor IIa inhibitors. It is based on the addition of factor Xa and snake venom RVV-V (Russell viper venom factor V activator) specifically activating factor V and phospholipids to platelet-poor plasma. Following an incubation time, the mixture is recalcified and the clotting time is determined. An almost linear dose-response and high sensitivity of the assay for unfractionated heparin (UFH), low-molecular-weight heparins (LMWHs), r-hirudin, and argatroban was found. Fondaparinux showed a nonlinear dose-response. By using ex vivo samples, the following Pearson correlation coefficients were found: r=0.85 between amidolytic anti-Xa and PiCT for 120 LMWH and 24 control samples; r=0.86 between amidolytic anti-Xa activity and PiCT for 68 UFH and 24 control samples; and r=0.94 between ECT and PiCT for 38 hirudin samples. Thus, PiCT is a promising assay for the monitoring of anticoagulants inhibiting factor Xa and/or factor IIa.     

Comparative anticoagulant activity and influence on thrombin generation of dextran derivatives and of a fucoidan fraction

CMDBS compounds are synthetic dextran derivatives with a random distribution of glucosyl units substituted with carboxymethyl, benzylamide, sulfonate, and sulfate groups. Fucoidans are sulfated polysaccharides extracted from brown seaweeds. CMDBS and fucoidans exhibit anticoagulant activity which depends on their chemical composition and molecular weight. Tested with purified proteins, these compounds catalyse thrombin (EC 3.4.21.5) inhibition mainly via heparin cofactor II (HCII). We investigated the mechanism involved in the anticoagulant activity of these polysaccharides relative to that of heparin. Three CMDBS with different chemical compositions were studied to evaluate the effect of sulfate and sulfonate groups on the anticoagulant activity. The fucoidan fraction was extracted from the brown seaweed Ascophylum nodosum. The clotting assays (activated partial thromboplastin time, thrombin time, prothrombin time) were significantly prolonged in the presence of CMDBS and fucoidan, which were less active than heparin. To investigate the action mechanism of these polysaccharides, thrombin generation tests (TGT) were performed on human plasma in the presence of several CMDBS and a fucoidan fraction. The results showed an inhibition of thrombin generation in contact-activated plasma in the presence of both polysaccharides, with a prolonged lag phase preceding the burst of thrombin generation. In thromboplastin-activated plasma, thrombin generation was inhibited by CMDBS and fucoidan, with a prolonged lag phase only in the presence of CMDBS. The data obtained with each polysaccharide, compared to those obtained with heparin (our study) and hirudin (published data), led to hypothesize that fucoidan could act, like heparin, by forming complexes with the inhibitor (although antithrombin (AT) in the case of heparin, and HCII for fucoidan), while CMDBS could act, like hirudin, by forming complexes with thrombin.     

低分子肝素治疗胎儿生长受限的临床疗效分析

目的 分析低分子肝素治疗胎儿生长受限的临床疗效。方法 选取2012年1月~2018年12月我院收治的60例胎儿生长受限（FGR）孕妇作为研究对象。根据治疗方案不同,分为对照组和实验组,各30例。对照组采用复方氨基酸及低分子右旋糖酐等治疗,实验组在对照组治疗的基础上给予低分子肝素,比较两组治疗前后孕周、胎儿生长指标、脐血流指标、羊水指标,实验组治疗前后D-D二聚体、血小板（PLT）、部分凝血活酶时间（APTT）、凝血酶原时间（PT）。结果 两组在治疗前后孕周差值比较,差异无统计学意义（P＞0.05）;两组胎儿生长指标、S/D比值、羊水指数、羊水最大前后径比较,差异无统计学意义（P＞0.05）;实验组治疗后APTT时间延长,与治疗前比较,差异有统计学意义（P＜0.05）,D-D二聚体、PLT、PT与治疗前比较,差异无统计学意义（P＞0.05）。结论 低分子肝素对胎儿生长受限与传统治疗相比并没有明显优势,临床使用尚存在争议。     

Development of Laboratory Parameters-Based Formulas in Predicting Short Outcomes for Adult Hemophagocytic Lymphohistiocytosis Patients with Different Underlying Diseases

Purpose

Hemophagocytic lymphohistiocytosis (HLH) is a severe disease with high mortality. The purpose of this investigation was to build models to predict 30-day death in total and subgroup HLH patients based on available and cheap laboratory parameters.

Method

The research contained 431 adults HLH patients from January 2015 to September 2021 in the hospital. Logistic regression and receiver operating characteristic (ROC) were utilized to build models.

Results

Results suggested that age, ferritin, lymphocyte (LY), international normalized ratio (INR), thrombin time (TT), globulin, uric acid (UA), chloride, activated partial thromboplastin time (APTT), aspartate aminotransferase (AST), triglycerides (TG), total bilirubin (TB), and indirect bilirubin (IB) were independent factors in HLH and subgroups. Then, models adapted to patients with different underlying diseases were established based on these factors. Area under curve (AUC) of these models was excellent: HLH patients: 0.838 (p < 0.001); infection-associated HLH (I-HLH) patients: 0.913 (p < 0.001); malignancy-associated HLH (M-HLH): 0.921 (p < 0.001) and 0.809 (p < 0.001) for two or more different etiologies-associated HLH (Mix-HLH patients). In addition, UA, TT, and chloride were firstly confirmed as independent factors in adult HLH.

Conclusion

Four models depending on biomarkers that available and affordable in clinical practice were built. With these models, high-risk patients with different underlying diseases could be easily identified.

     

初发和复发性脑梗死患者凝血功能指标分析

目的:分析初发和复发性脑梗死患者凝血功能指标的变化。方法:采集46例初发脑梗死患者(初发脑梗死组)和57例复发脑梗死患者(复发脑梗死组)的血液标本,应用CA7000全自动凝血仪检测血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)以及D-二聚体(D-Dimer)5项凝血指标,并与97例健康人群(健康对照组)对照分析。结果:与健康对照组比较,脑梗死患者PT、APTT、TT时间明显缩短(P<0.05或P<0.01),FIB和D-Dimer水平显著升高(P<0.05或P<0.01);复发脑梗死与初发脑梗死组PT、TT差异无统计学意义(P>0.05),但复发脑梗死患者APTT明显缩短(P<0.01),FIB和D-Dimer水平显著升高(P<0.01)。结论:脑梗死患者PT、APTT、TT、FIB、D-Dimer水平明显异常,复发脑梗死较初发脑梗死更严重。     

Haemostatic mechanisms of the armadillo Chaetophractus villosus (Xenarthra, Dasypodidae)

Haemostatic mechanisms in humans are formed by two activation pathways, named tissular factor pathway and contact system pathway, and a common pathway, that promotes the formation of the fibrin clot. These mechanisms have also been identified in other mammals. In this work we evaluate their presence in the armadillo Chaetophractus villosus, a mammal of the neotropical Xenarthra Order. Twenty animals (ten males and ten females), previously adapted to captivity, were used. Fibrinogen (Fbg) was measured at the beginning and at the end of the experimental period; prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) were measured at the same time during the experience. Neither Fbg nor the other parameters evaluated showed sex-related differences, but Fbg diminished during the experimental period. TT related to PT and APTT showed longer times and larger dispersion of the individual values. Compared to the human beings, PT and TT were longer and APTT was shorter. Considering those results, we conclude that C. villosus has the same basic coagulation system as human beings. However, in this species the contact system pathway seems to play a greater role in the activation of the coagulation system than it does in man, and the common pathway appears to limit the velocity of the system.     

Inactivation of thrombin in heparin-PVA coated tubes

Heparin, immobilized to polyvinyl alcohol by reaction with glutaraldehyde (heparin-PVA), retained its ability to accelerate the antithrombin III inactivation of thrombin, in a recirculating flow loop using heparin-PVA coated polyethylene tubes. The extent of inactivation, for a constant flow time, was approximately constant over ten cycles of exposure to thrombin and antithrombin III, suggesting that the immobilized heparin was reusable, as expected from the catalytic nature of non-immobilized heparin. Assessment of the chromogenic substrate activity of adsorbed thrombin and the extent of displacement were less conclusive with the implication that thrombin is adsorbed to heparin-PVA or PVA without heparin in multiple states.     

Evaluation of coagulation tests in mouse plasma

The coagulation variables thrombin time (TT), activated partial thrombin time (APTT) and prothrombin time (PT), were investigated in mouse plasma. TT and APTT clotting times were determined using a KC10 coagulation analyser and test kits Dia Thrombin (bovine thrombin diluted to a concentration of 2.5 U/l) and Dia Celin-L (rabbit brain cephaloplastin, activated with complexed Kaolin), respectively. PT was determined with IL Test™ Hepatocomplex (rabbit brain thromboplastin and calcium ions) using an ACL 200. Furthermore, the test procedures were also used to assess the anticoagulant status of mice treated orally with Melagatran, a thrombin inhibitor. The results showed that the kits could be used successfully on mouse plasma to measure the effect of a thrombin inhibitor on haemostasis.     

Interaction of blood components with heparin-immobilized polyurethanes prepared by plasma glow discharge

The blood compatibility of poly(ethylene oxide) (PEO)-grafted and heparin (Hep) immobilized polyurethanes was investigated using in vitro plasma recalcification time (PRT), activated partial thromboplastin time (APTT), platelet adhesion and activation, and peripheral blood mononuclear cell (PBMC) adhesion and activation. In the experiment with plasma proteins, the PRT of the polyurethane (PU) surface was prolonged by PEO grafting and further prolonged by heparin immobilization. The APTT was prolonged on PU-Hep, suggesting the binding of immobilized heparin to antithrombin III. The percentage of platelet adhesion on PU was not much different from that on acrylic acid- and PEO-grafted PUs (PU-C, PU-6, PU-33), yet was substantially decreased by heparin immobilization (PU-6-Hep, PU-33-Hep). The release of serotonin from adhering platelets was slightly suppressed on PEO-grafted PUs yet significantly suppressed on heparin-immobilized PUs. In the PBMC experiments, the adhesion and activation of the cells were significantly suppressed on heparin-immobilized PUs, and the amount of interleukin-6 (IL-6) released from PBMCs stimulated with surface-modified PUs decreased with a decrease in PBMC adhesion.     

机采血小板联合冷沉淀输注对颅脑外伤大出血患者凝血功能的影响

目的 探讨机采血小板联合冷沉淀输注对颅脑外伤大出血患者凝血功能的影响。方法 选取2017年1月~2018年10月我院收治的90例重型颅脑外伤患者，随机分为A、B、C三组，各30例。A组输注血小板治疗，B组输注冷沉淀治疗，C组输注血小板和冷沉淀治疗。比较三组输注血制品前后的凝血功能变化。结果 输注前1 h三组血小板（Plt）、纤维蛋白原（FIB）、凝血酶时间（TT）、活化部分凝血酶原时间（APTT）、凝血酶原时间（PT）比较，差异无统计学意义（P＞0.05）；输注24 h后三组Plt、FIB均高于输注前1 h，TT、APTT、PT均低于输注前1 h，且C组PLT、TT、APTT、PT优于A组、B组，差异均有统计学意义（P＜0.05）。结论 对于颅脑外伤大出血患者，联合输注血小板和冷沉淀对其凝血功能的改善优于单独输注血小板和冷沉淀。     

Anticoagulant Activity of Fucoidan from Brown Algae Fucus evanescens of the Okhotsk Sea

In vitro and in vivo experiments showed that anticoagulant activity of sulfated polysaccharide from Fucus evanescens (brown algae of the Okhotsk Sea) was similar to that of heparin. Anticoagulant properties of fucoidan are determined by thrombin inhibition mediated via plasma antithrombin III.