血塞通软胶囊联合低分子肝素治疗冠心病不稳定型心绞痛

目的 观察血塞通软胶囊联合低分子肝素治疗冠心病不稳定型心绞痛的疗效及安全性。方法 将104例不稳定型心绞痛病人随机分为两组，对照组采用西药常规治疗；治疗组在常规西药治疗基础上加服血塞通软胶囊，每次120mg，每日2次口服，2周后改为每次60mg，每日2次口服，同时低分子肝素钙6 150U，皮下注射，每12h1次。两组疗程均为4周。结果 治疗组显效率为67．3％，总有效率为92．3％，对照组分别为26．9％、69．2％，两组比较有统计学意义（P〈0．05）。治疗后治疗组心绞痛发生率、心电图均较对照组有明显改善（P〈0．01），且无严重不良反应发生。结论 血塞通软胶囊联合低分子肝素治疗冠心病不稳定型心绞痛，疗效确切且无严重不良反应。     

低分子肝素钙、辛伐他汀联合治疗不稳定型心绞痛疗效观察

目的 观察低分子肝素钙（博璞青）、辛伐他汀联合治疗不稳定型心绞痛的治疗疗效。方法 62例不稳定型心绞痛病人随机分成治疗组和对照组。两组均进行严格内科药物治疗，治疗组在药物治疗基础上用低分子肝素钙0．4～0．6ml，皮下注射，每日2次，疗程为1周，同时口服辛伐他汀20mg，每晚1次，长期服用。观察两组心绞痛发作及心电图变化。结果 治疗组显效率62．5％，总有效率93．8％，对照组显效率30％，总有效率70％。两组比较显效率及总有效率有显著差异（P〈0．05）。结论 低分子肝素钙、辛伐他汀联合应用，能有效减少心绞痛发作，可降低心肌梗死发生率。     

低分子肝素治疗不稳定型心绞痛疗效观察

目的：观察低分子肝素（LMWH）治疗不稳定型心绞痛（UAP）的疗效及安全性。方法：58例UAP患被随机分为2组：在常规抗心绞痛药物基础上，A组加用LMWH，B组加用安慰剂生理盐水。结果：A组近期心绞痛发作次数、持续时间， 心电图ST－T改善方面明显优于B组（P＜0．01），且A组治疗后血液流变学的主要指标较之B组有明显改善（P＜0．05）。A组2例出现注射部位瘀斑。结论：LMWH治疗UAP疗效好，不良反应少，安全、可靠，值得推广。     

疏血通注射液治疗冠心病不稳定型心绞痛的临床观察

目的评价临床应用疏血通治疗冠心病不稳定型心绞痛（UA）的安全性及有效性。方法将95例UA病人随机分为疏血通与低分子肝素组。两组均采用常规治疗。疏血通组在常规治疗的基础上，给予静脉输注，疏血通注射液10mL／d，连续7d，低分子肝素组在常规治疗的基础上．给予低分子肝素0．4mL每日2次皮下注射，连续7d。比较两组的疗效及不良反应。结果疏血通组和低分子肝素组总有效率分别为84．62％、83．72％，两组比较无统计学意义（P〉0．05）。两组病人均未发生心肌梗死、心源性死亡、消化道出血及脑出血等不良反应。结论疏血通注射液治疗冠心病安全有效。     

低分子肝素联合小剂量尿激酶抗凝治疗不稳定型心绞痛的临床观察

目的观察低分子肝素与小剂量尿激酶联合治疗不稳定型心绞痛的临床疗效。方法将223例不稳定型心绞痛患者随机分为两组。观察组118例,采用常规治疗加尿激酶3×10^3U／d静脉输注和低分子肝素钙5000U皮下注射,每12h1次;对照组105例,采用常规治疗加普通肝素100mg／d静脉输注,疗程均为7d,观察心绞痛发生与心电图改变。结果心绞痛缓解显效率观察组高于对照组（82．2％vs67．7％,P〈0．05）;心电图改善观察组明显高于对照组（83．0％vs71．4％,P〈0．05）。结论低分子肝素与小剂量尿激酶联合治疗不稳定型心绞痛可明显缓解心绞痛症状,改善心肌缺血,减低出血并发症及心脏事件的发生率。     

低分子肝素辅助治疗不稳定型心绞痛临床观察

目的：观察低分子肝素辅助治疗不稳定型心绞痛（UAP）的临床疗效。方法：将符合纳入标准的82例UAP患者随机分为治疗组42例和对照组40例,两组患者均接受硝酸酯类、β受体阻滞剂、血管紧张素转换酶抑制剂、他汀类药物、阿司匹林等治疗,治疗组患者另予以低分子肝素5000U／a皮下注射,连续7d,两组患者均连续治疗半月后评定疗效。结果：治疗组总有效率达88．1％,对照组总有效率为77．5％,两组患者疗效差异没有统计学意义（P〉0．05）,两组患者心绞痛发作情况均有明显好转,且治疗组患者心绞痛日发作次数和发作持续时间均低于对照组（P〈0．05和P〈0．01）。结论：低分子肝素辅助治疗不稳定型心绞痛疗效确切,安全可靠,值得临床推广。     

冠心病介入治疗中应用低分子肝素与普通肝素的随机对照研究

目的探讨冠心病患者经皮冠状动脉介入治疗（PCI）中应用低分子肝素（LMWH）替代普通肝素（UFH）的安全性和有效性。方法自2003年10月至2005年2月共入选966例申请一次性行PCI的患者,所有患者均签署了知情同意书。966例患者中最终完成PCI治疗者455例[包括283例为非ST段抬高急性冠脉综合征（ACS）者]。未接受PCI治疗者511例。研究采用随机对照方法,将入选患者分为LMWH组和静脉UFH组,LMWH组484例,静脉UFH组482例。LMWH组采用依诺肝素（enoxaparin）,按1mg／kg的剂量于PCI手术前至少给予2次皮下注射（每12h一次）,PCI手术在最后1次皮下注射30min后开始。完成冠状动脉造影或PCI后,立即拔出鞘管。静脉UFH组的患者于手术前即刻先给予普通肝素25rIlg静脉推注,如果造影显示适合PCI时,再追加65mg。完成PCI后4h左右拔出鞘管。LMWH组和静脉UFH组中最终行PCI者各为227例和228例。结果（1）LMWH组中1例于PCI术中发生急性血栓形成致急性心肌梗死（AMI）,PCI术后及住院期间未见急性和亚急性血栓形成。静脉UFH组术中和住院期间无急性和亚急性血栓形成。住院期间心脏事件发生率（死亡、AMI和再次血管重建）在LMWH组为0．44％,静脉UFH组为0;（2）LMWH组均于术后即刻拔出鞘管,穿刺局部发生血肿8例,静脉UFH组于术后4h左右拔出鞘管,穿刺局部发生血肿20例,前者血肿发生率明显低于后者,差异有统计学意义（P〈0．05）;（3）随访1个月LMWH组心脏事件发生率为0,静脉UFH组1例于院外发生亚急性血栓致AMI,再次行PCI成功,随访期间心脏事件发生率为0．43％。结论本研究结果提示对于拟行PCI的冠心病患者或非sT段抬高ACS患者术前给予至少2次依诺肝素皮下注射（1mg／kg,每12h一次）,并于最后1次皮下注射的8h内行PCI是安全和有效的,术前和术中不需要给予静脉UFH,术后可即刻拔出鞘管。     

低分子肝素钙治疗急性心肌梗死临床观察

目的观察低分子肝素钙对急性心肌梗死的疗效,并与肝素钠的疗效进行对比。方法随机将急性心肌梗死（AMI）患者分为观察组和对照组各40例,在常规治疗基础上,观察组用低分子肝素钙0．4ml腹部皮下注射,1次／12h,对照组用肝素钠注射液100mg,持续静脉滴注,5d为1个疗程。结果观察组显效率、总有效率均高于对照组,差异有统计学意义（X^2=8．41,7．16,P〈0．01）。观察组梗死后心绞痛发作率11．8％,对照组34．5％,两组比较差异有统计学意义（P〈0．05）。结论低分于肝素钙比肝素钠治疗AMI患者更安全、有效、方便。     

通心络联合低分子肝素治疗不稳定型心绞痛

目的探讨通心络与低分子肝素联合治疗不稳定型心绞痛的疗效。方法将124例不稳定型心绞痛病人随机分为两组。对照组采用常规治疗；治疗组在常规治疗基础上加用低分子肝素钙5000U皮下注射，每12h1次，通心络每次4粒，每目3次，疗程为4周。结果治疗组总有效率为86．7％，对照组总有效率为70．3％，两组比较有统计学意义（P〈0．05）。结论通心络与低分子肝素合用治疗不稳定型心绞痛优于常规治疗。     

低分子量肝素、肝素钙对不稳定性心绞痛患者凝血系统影响的对比研究

目的：比较不稳定性心绞痛患不同分子量肝素治疗后体内凝血系统的变化。方法：63例不稳定性心绞痛患随机分为皮下注射低分子量肝素组（A组，依诺肝素组）33例和皮下普通肝素组（B组，肝素钙组）30例，疗程为5d，观察临床效果、不良反应及凝血指标。结果：治疗后A、B组缓解心绞痛总有效率分别为97％和80％（P＜0．05），出血发生率显性差异（P＞0．05）。治疗5d后两组血浆抗因子Xa活性（anti-Xa）、抗因子IIa活性（anti-IIa）均明显升高（P＜0．01），anti-Xa活性A组明显高于B组（P＜0．01），而anti-IIa活性B组明显高于A组（P＜0．05）。血浆抗凝血酶Ⅲ（AT－Ⅲ）活性在A组无明显变化（P＞0．05），B组明显下降（P＜0．01）。血浆凝血酶原片段1＋2（F1＋2）水平两组均明显下降（P＜0．01）。血浆激活部分凝血活酶时间（APTT）A、B组均明显延长（P＜0．01），第5天时B组APTT稍长于A组（P＝0．05）。结论：治疗5d后，普通肝素以抗因子IIa为主，低分子量肝素以抗因子Xa为主；普通肝素导致血浆AT－Ⅲ活性明显下降，而低分子肝素则无此不良作用；低分子量肝素抑制凝血酶产生的作用明显优于普通肝素。低分子量肝素组心绞痛的缓解率明显高于肝素钙组，与凝血系统的变化相符合，两组出血倾向差异无显性。     

Haemorrhagic Effect of Enoxaparin,a Low Molecular Weight Heparin: Comparison with Unfractionated Heparin in Humans

The haemorrhagic effects of unfractionated heparin (UFH) and the low molecular weight heparin (LMWH) enoxaparin were investigated and compared in the gastric mucosa (haemorrhage induced by biopsy) and skin (haemorrhage induced by Simplate) of 12 healthy volunteers. Administration of UFH and LMWH (given in a dose of 75 anti-Xa U/kg intravenously) increased median gastric bleeding time (3.5 min) and geometric mean blood loss (11.5 l) to 19 min (p = 0.00003) and 54.1 l (p = 0.0021) after UFH and to 13 min (p = 0.008) and 29.0 l (p = 0.275) after LMWH. Median skin bleeding time (4.25 min) increased to 6.0 min after UFH (p = 0.003) and to 6.75 min after LMWH (p = 0.0008). Mean heparin activity in plasma was 20% higher after LMWH than after UFH. The calculated gastric bleeding time to heparin activity ratio was significantly lower for LMWH than for UFH (0.05).     

低分子肝素治疗不稳定型心绞痛的疗效及其对内皮功能的影响

目的 研究低分子肝素（LMWH）治疗不稳定型心绞痛（UA）的疗效及其对血管内皮功能的影响。方法 将44例UA患者随机分为A、B两组，B组予常规治疗，A组在其基础上加用LMWH5000IU,1次／12h，腹部皮下注射，疗程为一周。观察心绞痛缓解、缺血性心电图改善及血浆内皮素（ET）、血管性假血友病因子（vWF)的变化。结果 缓解心绞痛的疗效A组优于B组（P＜0.05)；治疗前两组ET、vWF含量比较，差异无显著性（P＞0.05)，但均高于对照组（P＜0.001)，治疗后两组ET、vWF含量均下降，A组降低程度较B组显著（P＜0.05)。结论 LMWH缓解UA患者的心绞痛症状与血管内皮功能改善有一定关系。     

辛伐他汀联合低分子肝素治疗不稳定型心绞痛的疗效观察

目的观察辛伐他汀联合低分子肝素治疗不稳定型心绞痛（UA）的疗效。方法选择2008年6月—2010年6月来我院就诊的不稳定心绞痛的患者93例。随机分为治疗组和对照组。对照组给予β受体阻滞剂、硝酸酯类药物、血管紧张素转换酶抑制剂（ACEI）;治疗组在对照组治疗基础上加用辛伐他汀同时给予低分子肝素。结果治疗组总有效率为93.75%,对照组总有效率为66.67%,治疗组总有效率明显高于对照组,差异有统计学意义（P〈0.05）。结论辛伐他汀和低分子肝素联合治疗不稳定型心绞痛疗效显著。     

Low Molecular Weight Heparin and Unfractionated Heparin in the Early Pharmacologic Management of Acute Coronary Syndromes: A Meta-analysis of Randomized Clinical Trials

Background: The standard of care in Acute Coronary Syndromes (ACS) includes a full complement of antischemic and antithrombotic therapy. Although aspirin is used widely and concomitant anticoagulation is recommended, the comparative benefits of low molecular weight heparin (LMWH) and unfractionated heparin (UFH) have not been defined. Methods/Results: A meta-analysis including all randomized clinical trials comparing LMWH and UFH for the treatment of non-ST segment elevation acute coronary syndromes was performed. Risk ratios (RR), using the DerSimonian-Laird Model, were calculated from a total of 13,320 patients. Death (RR 0.98, 95% CI 0.73–1.31), death and myocardial infarction (MI) (RR 0.86, 95% CI 0.74–1.01), death, MI, recurrent angina or revascularization (RR 0.89, 95% CI 0.74–1.07) and major hemorrhage (RR 1.01, 95% CI 0.81–1.25) occurred with similar frequencies for the anticoagulant-based strategies. Conclusions: Fixed dose LMWH therapy given subcutaneously compares favorably with UFH titrated to a target level of anticoagulation and should be considered a safe, effective, and clinically acceptable alternative in the early management of patients with non-ST segment elevation ACS. The superiority of LMWH preparations characterized by high in vitro factor Xa to thrombin inhibitory capacity is supported by clinic trial data but requires further investigation.     

Low-Molecular-Weight Heparin Should Replace Unfractionated Heparin in the Management of Acute Coronary Syndromes

Acute coronary syndromes (unstable angina and non–Q-wave myocardial infarction) are caused by the rupture of an atherosclerotic plaque, platelet activation, and fibrin deposition, resulting in thrombosis. Aspirin and unfractionated heparin (UFH) have traditionally been the treatment of choice in patients with acute coronary syndromes. Low-molecular-weight heparins (LMWHs) offer potential advantages over UFH and have been shown to be equally effective as UFH for the treatment and prevention of many venous thromboembolic processes. Results of prospective, randomized, controlled trials evaluating the role of LMWH in the management of patients with unstable angina or non–Q-wave myocardial infarction have indicated improved outcomes when compared with UFH. In addition, despite the increased acquisition cost of LMWH compared with UFH, an overall cost saving was associated with LMWH use, primarily as a result of a reduction in cardiovascular events. The available evidence supports improved clinical outcomes, favorable safety profile, and cost savings associated with LMWH use in the management of unstable angina and non–Q-wave myocardial infarction. Thus, LMWH should replace UFH as the antithrombotic agent of first choice in the management of acute coronary syndromes.     

低分子肝素钙治疗不稳定型心绞痛疗效观察

目的 :观察低分子肝素钙治疗不稳定型心绞痛的疗效。方法 :选择不稳定型心绞痛住院病人 3 5例 ,随机分成两组 ,A组 15例给予常规抗心绞痛治疗 ;B组 2 0例给予常规抗心绞痛治疗同时加低分子肝素钙 5 0 0 0AXaIU ,皮下注射 ,每 12h 1次 ,7d为一疗程。观察治疗前后临床症状、心电图变化 ,并于用药前后测定凝血时间(TT)、凝血酶原时间 (PT)、部分凝血酶时间 (APTT )。结果 :A、B两组病人的临床疗效分别为 5 3 %和 90 %(P <0 .0 1) ,B组TT、PT、APTT较治疗前延长 (P <0 .0 5 ) ,无明显出血的不良反应。结论 :低分子肝素钙对控制不稳定型心绞痛效果显著 ,而且使用安全方便。     

血栓通注射液与低分子肝素钙联合治疗不稳定型心绞痛的临床观察

目的观察血栓通注射液联合低分子肝素钙治疗不稳定型心绞痛的临床疗效。方法将100例病人随机分为两组,对照组在常规治疗的基础上加用低分子肝素钙治疗,治疗组在上述治疗的基础上,加用血栓通治疗。观察治疗前后心绞痛发作次数、心绞痛持续时间、发作间隔时间、24h Holter缺血总时间等变化。结果治疗组总有效率为94%,优于对照组的86%（P〈0.05）,且治疗组在心绞痛发作次数、持续时间、发作间隔时间及24h Holter缺血总时间改善方面优于对照组（P〈0.05）。结论血栓通联合低分子肝素钙治疗不稳定型心绞痛疗效确切。     

Incidence and clinical relevance of heparin-induced antibodies in patients with deep vein thrombosis treated with unfractionated or low-molecular-weight heparin

The frequency of heparin-induced thrombocytopenia (HIT) varies between different clinical treatment settings and remains unknown for patients treated with unfractionated (UFH) or low-molecular-weight heparin (LMWH) because of deep vein thrombosis. In this multicentre, open-label study, 1137 patients with deep vein thrombosis were randomly assigned to UFH for 5-7 d, reviparin, a LMWH, for 5-7 d (short-treated group) or reviparin for 28 d (long-treated group). Heparin-platelet factor 4 antibodies (HPF4-A) were determined on d 5-7 and d 21. Heparin-induced thrombocytopenia was defined by clinical evaluation. Two patients in the UFH group (incidence: 0.53%, 95% confidence interval (CI): 0.06-1.91) and two patients in the long-treated LMWH group (incidence: 0.53%, 95% CI: 0.06-1.92) had HIT, while no HIT was observed in the short-treated LMWH group. Pulmonary embolism developed in one of the HIT-patients, who had HPF4-A and was treated with UFH. On d 5-7 the incidence of HPF4-A was 9.1% in the UFH group, 2.8% in the short-treated LMWH group and 3.7% in the long-treated LMWH group, with a significant increase to 20.7% in the UFH group and to 7.5% in the long-treated LMWH group on d 21. Therefore the incidence of HPF4-A and heparin-induced thrombocytopenia was lower in patients treated with LMWH compared with UFH for the same duration of treatment.     

Inhibition of coagulation and platelet adhesion to extracellular matrix by unfractionated heparin and a low molecular weight heparin

Summary In 7 healthy volunteers, the effect of a single i.v. injection of 52 mg (7,500 IU) of an unfractionated heparin (UFH) and of 52.5 mg (5,000 anti XaU) of a low molecular weight heparin (LMWH) on coagulation parameters and platelet function has been studied. Thrombininduced platelet aggregation was inhibited after the injection of both heparins. There was no significant change of ADP or collagen-induced aggregation after LMWH or UFH. Platelet adhesion to bovine extracellular matrix was not inhibited by UFH but was significantly reduced after addition in vitro and ex vivo after administration of LMWH. Further investigation should establish the time course of LMWH effects on platelet adhesion. A long duration of this effect could be partially correlated with the antithrombotic effects of LMWH.