Main comedications associated with major bleeding during anticoagulant therapy with coumarins

Objective To study the main comedications associated with major bleeding during anticoagulant therapy with coumarins in a non-selected population under everyday circumstances.Methods The study population for this retrospective cohort study included all new users of phenprocoumon or acenocoumarol aged 40–80 years, during the period 1992–2000 in the PHARMO Record Linkage System. All patients were followed until the last dispensing of phenprocoumon or acenocoumarol, the first bleeding complication requiring hospitalization, death, or the end of the study period. The number of days on coumarins alone and the number of days on coumarins in combination with several potentially interactive drugs during follow-up were determined for each patient. Results The inclusion criteria of this study were met by 19,935 new users of phenprocoumon or acenocoumarol. During follow-up, 552 patients were hospitalized for bleeding. Of all potentially interactive drugs started during anticoagulant therapy by at least 50 patients and with at least five bleedings, antibacterial drugs were associated with a four to seven times increased risk of bleeding. Among non-steroidal anti-inflammatory drugs, naproxen had the highest relative risk. Antithrombotic salicylates and tramadol were associated with a three times increased risk of bleeding.Conclusion Antibacterial drugs, non-steroidal anti-inflammatory drugs, antithrombotic salicylates and tramadol were the main potentially interactive drugs associated with major bleeding during anticoagulant therapy with coumarins under everyday circumstances.     

Medication compliance in long term phenprocoumon therapy

Medication compliance was assessed by a cross-sectional study of 225 patients, chosen at random from the records of a thrombosis service. The serum phenprocoumon concentration, in relation to the prescribed dose, was found to be unacceptably low in eleven patients. It is concluded that non-compliance occurs only infrequently. Thrombotest values were of little help in detecting non-compliance.     

音乐治疗对长期住院精神分裂症患者焦虑情绪的影响

目的：探索音乐治疗对长期住院精神分裂症患者伴有的焦虑情绪的疗效。方法对82例伴有焦虑情绪长期住院的精神分裂症患者随机分为两组，对照组予以常规应用抗精神病药物治疗及护理，研究组在此基础上加用音乐治疗3个月，治疗前后分别采用焦虑自评量表（SAS）进行评定。结果在研究末，组间比较显示研究组SAS评分明显低于对照组，差异有统计学意义（P＜0.05）；组内比较研究组治疗后SAS评分明显低于治疗前，差异有统计学意义（P＜0.05），而对照组治疗前后无差异。结论音乐治疗能有效改善长期住院精神分裂症患者伴有的焦虑情绪，可在临床试用。     

冠脉搭桥术后抗血小板药物治疗远期出血事件发生的相关预测指标

目的:预测冠脉搭桥术后抗血小板治疗远期发生出血事件的预测参数及界值。方法:对冠脉搭桥术后双联抗血小板治疗且行血栓弹力图检测的90例患者随访1年,记录患者是否发生事先预定的出血事件。结果:体重指数[OR=1.276,CI(1.025,1.589),P<0.05]与远期出血事件发生呈正相关,体重指数27.04 kg·m-2[ROC曲线下面积0.661,CI(0.498,0.825),灵敏度0.385,特异度0.922]是预测界值。结论 :应控制体重指数不超过27.04 kg·m-2以减少冠脉搭桥术后远期发生出血事件的可能性,本实验未得到血栓弹力图指标对其的预测价值,存在与以往研究得到的PCI术后患者的预测指标和界值不一致的可能性。     

Is sulphonylurea therapy effective long term? A 3-year study with gliclazide

Fifty non-insulin-dependent diabetic patients, aged 59.06 +/- 1.37 years and overweight (119.3% of ideal body weight), with an impaired daily glycaemic profile despite a carbohydrate restrictive diet were treated with gliclazide (40 to 320 mg per day) for 36 months. Forty-four patients completed the full study (3 drop-outs for secondary failure, 3 others for reasons not related to the treatment). Mean daily plasma glucose levels (fasting, 10.00, 12.00 and 16.00 hours) decreased significantly from 15.2 +/- 0.7 to 6.9 +/- 0.2 mmol/l after 36 months. Mean fasting plasma glucose level decreased significantly from 12.7 +/- 0.5 to 8.2 +/- 0.2 mmol/l after 3 months and continued to decrease to 6.9 +/- 0.3 mmol/l after 36 months (p less than 0.01). Fatty acids, cholesterol, and triglycerides plasma levels also decreased significantly from 0.53 +/- 0.06 mmol/l, 6.3 +/- 0.2 mmol/l and 1.9 +/- 0.2 mmol/l, respectively to 0.32 +/- 0.01 mmol/l, 5.8 +/- 0.1 mmol/l and 1.6 +/- 0.1 mmol/l, respectively. No weight gain was observed: mean body weight decreased significantly from 68.2 +/- 1.7 to 64.0 +/- 1.4 kg, indicating that gliclazide did not interfere with diet-induced weight loss. Importantly, platelet adhesiveness, abnormal before treatment 77.2 +/- 1.3% (normal less than 70%), improved throughout the study to 57.8 +/- 1.3% after 36 months of gliclazide. Treatment was well tolerated and no hypoglycaemic attacks or other side-effects were reported.     

Pharmacokinetics of fluocortolone in long term therapy of patients with rheumatic and hematologic diseases

The pharmacokinetics of fluocortolone (Ultralan oral) and its effect on plasma cortisol levels were investigated during long-term treatment of patients with rheumatic and haematological diseases with different doses of fluocortolone. Fluocortolone was administered in the morning and plasma levels of fluocortolone and cortisol were measured in samples obtained 1.5, 3, 4, and 5 h p. adm. by means of specific radioimmunoassays. Maximum concentrations of fluocortolone in plasma (Cmax) and areas under the fluocortolone plasma level curves (AUC) increased linearly with the dose. The peak time (tmax = 2.04 +/- 0.85 h) and the plasma half-life (t1/2 = 1.53 +/- 0.52 h) were independent of the dose administered. Cortisol suppression as indicated by morning cortisol levels below 50 ng/ml plasma was not observed with doses below 10 mg/d.     

住院病人抗凝治疗后下肢静脉血栓形成的危险因素分析

目的了解住院病人抗凝治疗后静脉血栓栓塞症(venous thromboembolism,VTE)的危险因素,为对其的治疗和预防提供依据。方法收集中国人民解放军总医院2010年2月—2011年6月期间各科室经过系统抗凝治疗的住院患者320名,其中80例为经过系统抗凝治疗后仍发展为VTE的患者,设为病例组。按个体1∶3的配比比例,按年龄(差别小于5岁内)、性别、病种匹配等相同的配比原则,选取同期抗凝治疗后未发生VTE的240例患者设为对照组。应用单因素和多因素Logistic回归模型进行相关危险因素筛查。结果我们发现尽管给予系统的抗凝治疗,颅脑损伤、重症监护以及中心静脉置管三种因素仍为独立危险因素。结论即使给予系统抗凝治疗,颅脑损伤、重症监护、中心静脉置管三种危险因素是住院病人VTE的发生的独立危险因素。临床上提高对这类危险因素的警惕并提前给予抗凝治疗将有助于降低发生VTE的风险。     

长期低剂量大环内酯类抗生素的抗哮喘作用

以红霉素为代表的大环内酯类抗生素在感染性疾病中应用相当广泛,疗效确切。经过长期的药理研究和临床实践,人们发现此类抗生素除具有抗感染作用外,对支气管哮喘亦有一定作用。近年来国内外对其研究逐渐增多,笔者就大环内酯类抗生素在哮喘治疗中的机理及疗效作一综述。     

Pemoline pharmacokinetics and long term therapy in children with attention deficit disorder and hyperactivity

The pharmacokinetic behaviour of pemoline was studied in 28 children, aged 5 to 12 years, diagnosed as having the attention deficit disorder with hyperactivity. The mean elimination half-life of pemoline in these children was approximately 7 hours, which is considerably shorter than the half-life of 11 to 13 hours previously reported in adults. The tendency of the half-life to increase with age may be explained by the statistically significant decrease in total body clearance with age. The increasing half-life of pemoline with age should be considered during long term drug therapy. In this study no tolerance to the beneficial effects of pemoline was observed over 6 months. The apparent therapeutic serum concentration range for these children was attained after doses of 37.5 to 131.25 mg pemoline daily. Since the optimum serum concentration shows wide variation, the dosing regimen must be determined individually. Routine monitoring of the pemoline serum concentrations is not useful because of this apparent variation in optimum serum concentration and because of the linear relationship between dose and concentration.