低分子肝素钙治疗不稳定型心绞痛临床疗效观察

目的观察低分子肝素钙治疗不稳定型心绞痛的疗效。方法选择我院不稳定型心绞痛患者58例,在常规抗心绞痛治疗同时加用低分子肝素钙4100U,皮下注射1次/12h,7d为1个疗程,观察治疗前、后临床症状,心电图变化,用药前、后测定凝血时间（TT）,凝血酶原时间（PT）,部分凝血酶原时间（AFTT）。结果治疗后显效35例（60．3%）,有效18例（31．0%）,总有效率达91．3%,各型心绞痛治疗前、后心电图ST段间差异均有非常显著性意义（P＜0．01）。54例患者治疗前、后TT、APTT、PT间差异均有显著性意义（P＜0．05）。无明显出血等不良反应。结论低分肝素钙治疗不稳定型心绞痛疗效显著,使用安全、方便。     

降纤酶和速碧林治疗劳力性不稳定型心绞痛对比分析

目的 观察降纤酶与速碧林（低分子肝素钙）治疗劳力性不稳定型心绞痛（UA）的疗效。方法 将340例UA患者随机分为降纤酶组（150例）和速碧林组（190例），降纤酶组给予降纤酶5u静滴，隔日1次，共5次；速碧林组给予速碧林0．4ml，皮下注射，每天2次，共10天。同时记录心绞痛分级，心电图NST、∑ST及部分凝血指标（ACT、PT、APTT、Fib）。结果 降纤酶组的显效率及总有效率显著高于速碧林组（P〈0．01），治疗后的NST、∑ST和Fib均显著少于速碧林组（P〈0．01）。结论 降纤酶治疗劳力性不稳定型心绞痛疗效显著。     

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。     

低分子肝素钙治疗不稳定型心绞痛38例临床观察

目的 观察低分子肝素钙在治疗不稳定型心绞痛（UAP）中临床疗效及预后判定。方法 根据WHO的UAP诊断标准，对38例UAP患者应用低分子肝素钙进行抗凝治疗。以心绞痛的发作次数、持续时间、常规心电图改变，进行临床观察。结果 应用低分子肝索钙治疗不稳定型心绞痛，通过观察心电图的变化、临床症状的改善，对UAP患者的治疗有肯定的疗效。结论 治疗不稳定型心绞痛应用抗凝方法（经t检验，P〈0．005）疗效显著，明显控制了心绞痛发作频率及时间，并有效预防和防止了心肌梗死（AMI）的发生及心脏猝死。     

低分子肝素联合疏血通治疗不稳定型心绞痛的疗效及安全性

目的观察低分子肝素联合疏血通治疗不稳定型心绞痛的临床疗效及安全性。方法将72例不稳定型心绞痛患者随机分成两组,对照组（36例）为常规治疗加低分子肝素,治疗组（36例）在对照组的基础上加用疏血通,观察两组治疗前后心绞痛症状及凝血指标的变化。结果对照组显效16例,有效14例,无效6例;治疗组显效20例,有效13例,无效3例,两组疗效间差异有统计学意义（T=0.556,P〈0.05）。对照组症状缓解时间为（4.9±1.1）d,治疗组症状缓解时间为（3.5±0.5）d,差异有统计学意义（t=6.952,P〈0.05）。治疗前两组患者的凝血酶原时间、活化部分凝血活酶时间及纤维蛋白原含量间差异均无统计学意义（P〉0.05）;治疗后两组纤维蛋白原含量间差异有统计学意义（P〈0.05）,而凝血酶原时间、活化部分凝血活酶时间间差异无统计学意义（P〉0.05）。两组均无明显的不良反应。结论低分子肝素联合疏血通治疗不稳定型心绞痛疗效好,安全性高。     

低分子肝素治疗不稳定型心绞痛83例疗效观察

目的观察低分子肝素治疗对不稳定型心绞痛心血管事件、出血风险及预后的影响。方法选择我院不稳定型心绞痛患者151例,随机分为观察组83例和对照组68例。两组患者均于入院后常规予以吸氧、卧床休息,肠溶阿司匹林75～150mg/d口服,根据病情选用β-受体阻滞剂、硝酸酯类、钙拮抗剂及控制血压、血糖,调脂药物等。观察组患者给予低分子肝素0．6ml/次（如体重＜60kg为0．4m1）,2次/d,皮下注射,连续7d;对照组首先给予普通肝素5000U静脉推注,接着约1000U/h静脉滴入,维持活化部分凝血酶时间（APTT）于60～85s或活化凝血时间（ACT）于250～300s,连续7d。观察两组患者治疗前、后心绞痛缓解、心电图改善情况及心血管事件发生率。结果两组患者治疗前、后心绞痛发作次数、持续时间、24h缺血总时间、ST段下移间差异均有显著性意义（P＜0．05）,且两组患者治疗后上述各项间差异亦均有显著性意义（P＜0．05）。两组患者心脏性猝死、轻度出血、服硝酸甘油情况间差异均有显著性意义（P＜0．05）。结论低分子肝素可明显缓解不稳定型心绞痛,改善心肌缺血,减少心血管事件的发生,且更少发生出血事件,应用方便、安全。     

低分子肝素治疗老年不稳定型心绞痛疗效观察

目的：研究低分子肝素加阿斯匹林治疗老年不稳定型心绞痛的疗效。方法：采用随机、单盲对照试验,研究治疗前后心绞痛发作及心电图、动态心电图所示心肌缺血改善状况。结果：低分子肝素加阿斯匹林治疗后,心绞痛发作频率减少;间隔时间延长;心电图ＳＴ段下移恢复明显;动态心电图心肌缺血总时间缩短,与对照组比较均存在明显差异（Ｐ〈０．０１）。结论：低分子肝素加阿斯匹林较单用阿斯匹林对老年不稳定型心绞痛治疗更有效,无明显     

低分子肝素钙治疗老年不稳定型心绞痛临床观察

为观察低分子肝素钙治疗老年不稳定型心绞痛的临床疗效,将老年不稳定型心绞痛51例随机分成2组,分别予以常规药物加低分子肝素钙和常规药物加普通肝素钠,比较两组心绞痛的缓解情况、心肌梗死和猝死发生情况、常规和动态心电图变化、凝血功能和不良反应.结果表明低分子肝素钙治疗老年不稳定型心绞痛有明显疗效,对凝血功能影响小,不良反应少.     

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。     

低分子肝素联合阿司匹林治疗老年不稳定型心绞痛的临床观察

目的观察低分子肝素联合、阿司匹林治疗老年不稳定型心绞痛的临床疗效及安全性。方法将156例不稳定型心绞痛的老年病人,随机分为低分子肝素加阿司匹林组、低分子肝素组、阿司匹林组3组,探讨不同治疗方案对不稳定型心绞痛的抗凝治疗疗效。结果低分子肝素加阿司匹林组总有效率为95.8%,低分子肝素组80.8%,阿司匹林组58.9%;低分子肝素加阿司匹林组无一例恶化为急性心肌梗死,低分子肝素加阿司匹林组和低分子肝素组疗效明显优于阿司匹林组（P〈0.01）,而低分子肝素加阿司匹林组较低分子肝素钠组更有效（P〈0.05）。结论低分子肝素同时合用阿司匹林加强抗凝治疗老年不稳定型心绞痛的临床疗效显著且安全。     

The use of pulsed Doppler in the evaluation of diastolic function in acute ischemic cardiopathy

We report the alterations of the left ventricular diastolic function studied with pulsed Doppler echocardiography. We measured different parameters of the transvalvular mitral blood flow in four patients with Unstable Angina Pectoris and six patients with Acute Myocardial Infarction. The results of these patients were compared with the results of a control group of twelve normal subjects. All subjects of study had no previous history of cardiovascular disease. The studied parameters were the acceleration and deceleration half times (t1(2a)/t1(2d), respectively), the diastolic deceleration slope (PD), the maximum velocity of the atrial filling and rapid filling quotient (A/E), and the first third diastolic fraction (FD). We found significant difference in the mean value of the A/E and the FD between the normal subjects and 80% of the patients with Ischemic Heart Disease. We also found significant difference in the other studied parameters between the normal and Unstable Angina groups. We concluded that Acute Ischemic Heart Disease causes significant anomalies of the left ventricular diastolic function and that pulsed Doppler echocardiography is a good method to demonstrate it.     

Clinical trials of unfractionated heparin and low-molecular-weight heparin in addition to aspirin for the treatment of unstable angina pectoris: do the results apply to all patients?

We sought to determine how the results of available randomized controlled trials of intravenous unfractionated heparin (UH) and low-molecular weight heparin (LMWH) apply to unselected patients with unstable angina pectoris (UAP). Although UH is widely used in addition to aspirin for treatment of UAP, the evidence is weak for a net benefit over aspirin alone. LMWH preparations may confer a net benefit over UH for the treatment of UAP in clinical trials. It is not clear, however, how trial results are generalized to unselected patients with UAP. Using criteria from the Agency for Health Care Policy and Research Unstable Angina Clinical Practice Guideline, we identified 277 consecutive patients with primary UAP. Exclusion criteria were applied from 6 trials of UH in addition to aspirin and 5 trials of LMWH in addition to aspirin for the treatment of UAP. Clinical outcomes were compared among ineligible and eligible patients for trial enrollment. Patients meeting exclusion criteria were older and had more extensive coexisting medical illness than eligible patients for trial enrollment. Thirty-eight percent to 42% of our study population met > or = 1 exclusion criteria for each of the 6 trials of UH, and 14% to 46% met > or = 1 exclusion criteria for each of the 5 LMWH trials. The 1-year all-cause death rate was higher in UH ineligible patients compared with UH eligible patients (16% vs 4%, p = 0.003) and in LMWH ineligible patients compared with LMWH eligible patients (16% vs 7%, p = 0.005). Thus, clinical trials of UH and LMWH may have limited generalizability to unselected patients with UAP, many of whom have characteristics that would exclude them from trial enrollment and put them at risk for adverse outcomes.     

麝香保心丸治疗不稳定型心绞痛的系统评价和Meta分析

目的从循证医学的角度系统评价麝香保心丸治疗不稳定型心绞痛的疗效和安全性。方法广泛搜集麝香保心丸治疗不稳定型心绞痛的随机对照试验,运用Cochrane图书馆系统评价方法,对纳入研究进行质量评价和Meta分析。结果 9个随机对照试验纳入系统评价,均为Jadad评分〈2的低质量研究。Meta分析结果提示麝香保心丸联合常规治疗在整体临床症状和心电图的改善方面均优于单纯使用常规治疗。整体临床疗效比较OR值为2.76,95%IC为（1.83,4.15）;心电图改善情况比较OR值为2.51,95%IC为（1.68,3.76）。5个研究报告了应用麝香保心丸带来的轻度不良反应。结论麝香保心丸联合常规治疗用于不稳定型心绞痛可能取得较单纯常规治疗更好的效果,且安全性良好,但由于纳入的研究方法学质量低,存在发生偏倚的高度可能性,需更多设计合理的高质量的临床试验加以验证。     

Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

AIM: To compare the incidence of early portal or splenic vein thrombosis (PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.METHODS: We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010. Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation, respectively. Group A (153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin (LMWH) irregularly. Group B (148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery, followed by oral warfarin and aspirin for one month regularly. The target prothrombin time/international normalized ratio (PT/INR) was 1.25-1.50. Platelet and PT/INR were monitored. Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.RESULTS: The patients’ data were collected and analyzed retrospectively. Among the patients, 94 developed early postoperative mural PSVT, including 63 patients in group A (63/153, 41.17%) and 31 patients in group B (31/148, 20.94%). There were 50 (32.67%) patients in group A and 27 (18.24%) in group B with mural PSVT in the main trunk of portal vein. After the administration of thrombolytic, anticoagulant and anti-aggregation therapy, complete or partial thrombus dissolution achieved in 50 (79.37%) in group A and 26 (83.87%) in group B.CONCLUSION: Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization, and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy. Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.     

连续性肾替代治疗对危重患者凝血功能的影响

目的：评价连续性肾替代治疗方法对危重患者的安全性。方法：回顾性统计60例行连续性肾替代治疗患者的病历资料,按治疗累计总时间将患者分为〈72h组和〉72h组,比较治疗前、后血小板及凝血指标的变化和出血发生率。结果：〈72h组在治疗24h后与治疗前比较PLT、纤维蛋白原（FIB）下降,PT、APTT延长（P〈0．05）;〉72h组在24h、72h后各项指标有同样变化,且72h后PLT、FIB下降更多（P〈0．01）,PT、APTT延长更明显（P〈0．05、P〈0．01）。〉72h组继发出血情况较〈72h组严重（P〈0．01）。结论：连续性肾替代治疗连续多次治疗后可引起血小板减少、凝血时间延长,出血发生率增加。治疗期间应加强凝血功能监测,治疗次数和时间控制在一定范围,病情改善及时停止治疗,避免增加出血几率。     

Secondary prevention of venous thromboembolism: A role for low-molecular-weight heparin.

BACKGROUND: After a short initial course of heparin therapy, patients with venous thrombo-embolism (VTE) require continuing anticoagulant therapy for several months after hospital discharge. At present, two small-scale studies have compared the efficacy and safety of low-molecular-weight heparin (LMWH) with warfarin in the secondary prevention of VTE. PATIENTS AND METHODS: We studied 654 consecutive patients, 202 with pulmonary embolism (PE) and 452 patients with deep vein thrombosis (DVT) of the lower limbs. 220/654 patients (34%) were considered to have some contraindications to coumarin, and were discharged on LMWH (dalteparin, Fragmin((R)), 10, 000 IU s.c. once daily). The remaining 434/654 patients were asked to choose between either coumarin or LMWH: 190 patients preferred LMWH and 244 coumarin. Patients were followed up for a 3-month (DVT patients) or 6-month (PE patients) period. RESULTS: 14/654 patients (2%) developed recurrent VTE while on anticoagulant therapy. One in every three recurrent episodes was PE (which was fatal in 2/5 patients), and half of the recurrent DVT were located in the contralateral leg. We failed to find any differences between patients receiving LMWH and those on coumarin therapy, but recurrences were more common in patients with cancer (hazard ratio: 17.15; 95% CI: 4.0-73.5; p < 0.001). 21 patients (3.3%) bled (major bleeding 5 patients; minor bleeding 16). Bleeding was more common in patients on coumarin therapy (hazard ratio: 3.14; 95% CI: 1.20-8.22; p = 0.02). CONCLUSIONS: Long-term LMWH therapy proved to be both effective and safe in the long-term treatment of VTE. Thus, we suggest long-term LMWH therapy should be considered for patients with contraindications to coumarin, or those with difficulties in coming to laboratory control.     

The safety and effectiveness of salvianolate in preventing perioperative venous thromboembolism in China: A PRISMA-compliant meta-analysis based on RCTs

Background:Salvianolate, a common drug for stabilizing heart disease and Angina Pectoris, is considered to be off-label for preventing venous thromboembolism (VTE) or anticoagulation at present. However, many clinical studies have showed that salvianolate can effectively inhibit the deep-vein thrombosis (DVT) incidence, and prevent VTE of perioperative patients in the real world in China.Objective:This analysis aimed to evaluate the effectiveness and safety of salvianolate in preventing VTE in perioperative patients.Methods:Databases of PubMed, Cochrane Library, Embase, CNKI, Wanfang and VIP were searched until July 2019. Literature retrieval, data extraction and quality assessment were independently completed by two researchers and checked with each other. Review Manager 5.2 software was applied for meta-analysis.Results:A total of 429 studies were retrieved, including 11 randomized controlled trials (RCTs) with a total of 1149 subjects. Compared with low molecular weight heparin (LMWH) group alone, salvianolate combined LMWH group had lower DVT incidence in preventing perioperative thrombosis (2.75% and 14.23%, OR: 0.21, 95% CI:[0.08,0.53]; P = .0009). The incidence of adverse reactions of experimental group was similar to that of control group (1.79% and 2.31%, OR: 0.65, 95% CI:[0.18,2.35]. P = .51). Compared with the control group, D-dimer level (D-D), platelet count (PLT), fibrinogen (FIB), whole blood high shear viscosity (WBHSV), and whole blood low shear viscosity (WBLSV) were all significantly decreased (P < .01), and prothrombin time (PT) was significantly increased (P < .05).Conclusion:Salvianolate combined LMWH has better effectiveness and the same safety in preventing venous thromboembolism in perioperative patients. However, due to the small number of included literatures, large sample studies are still needed to further verify this conclusion.     

Periprocedural bridging therapy with low-molecular-weight heparin in chronically anticoagulated patients with prosthetic mechanical heart valves: experience in 116 patients from the prospective BRAVE registry

BACKGROUND AND AIM of the study: The study aim was to determine the safety and feasibility of a standardized bridging regimen in patients with mechanical heart valves at high thromboembolic risk, using low-molecular-weight heparin (LMWH). METHODS: Since the year 2000, all patients at the authors' institution, with mechanical heart valves and a need for periprocedural interruption of oral anticoagulation (OAC), were prospectively enrolled in this registry. Patients were treated with enoxaparin following a pre-specified, standardized bridging regimen. The main outcome measures were the incidence of hemorrhagic or thromboembolic events. The follow up period was 30 days after hospital discharge. RESULTS: A total of 116 patients was included (31 with mitral valve replacement, 76 aortic valve replacement, nine double valve replacement). Patients underwent either major surgery (n = 25), minor surgery (n = 36), pacemaker implantation (n = 21), or coronary catheterization (n = 34). Bridging therapy with enoxaparin was administered for a mean of 7.0 +/- 4.6 days. Eighteen patients (15.5%) were treated as outpatients. In 35 patients (34%) with renal impairment (creatinine clearance <50 ml/min), LMWH dosage was halved. No thromboembolic (95% CI 0-3.1%) and only one major bleeding complication occurred (0.86%; 95% CI 0.02-4.7%); minor bleeding occurred in 10 patients (8.6%; 95% CI 4.2-15.3%). The hemorrhages arose after a mean of 5.4 +/- 1.4 days LMWH therapy. CONCLUSION: Bridging therapy following a standardized LMWH-based regimen with enoxaparin was effective and relatively safe in a large cohort of patients with mechanical heart valves. Extended duration of LMWH therapy seems to promote the incidence of hemorrhage. Neither dose reduction in patients with renal impairment nor outpatient treatment affected the safety and efficacy of this bridging regimen. These findings warrant that more extensive studies be conducted to investigate the safety of this approach.     

脑梗死患者凝血、抗凝、纤溶指标改变及低分子肝素治疗研究

目的　观察脑梗死患者血浆凝血、抗凝、纤溶指标凝血酶元时间 (PT)、白陶土部分凝血活酶时间 (KPTT)、抗凝血酶Ⅲ (ATⅢ )、组织型纤溶酶元激活物 (tPA)及其抑制物 (PAI)变化和低分子肝素 (LMWH)对其影响及疗效评定。方法　将 80例脑梗死患者随机分为两组 ,分别给予LMWH和常规药物治疗 ,检测治疗前后上述指标改变并评定LMWH疗效。结果　脑梗死患者较正常对照KPTT缩短 (P <0 .0 5 ) ,ATⅢ、tPA显著下降 (P <0 .0 1) ,PAI显著升高 (P <0 .0 1) ;LMWH治疗后tPA较治疗前显著升高 (P <0 .0 5 ) ,ATⅢ升高及PAI下降较常规治疗组有显著差异(P <0 .0 5及P <0 .0 1) ;LMWH治疗组显效率明显高于常规治疗组 (P<0 .0 1) ,未发现明显副作用。结论　脑梗死急性期存在血浆凝血、抗凝、纤溶功能异常 ;LMWH可影响血浆KPTT、ATⅢ、tPA、PAI水平 ,调节凝血、抗凝及纤溶系统平衡 ;应用LMWH治疗脑梗死有效、安全     

血清前白蛋白、总胆汁酸、凝血指标、血小板参数检测在肝硬化中的临床意义

目的探讨血清前白蛋白(PA)、总胆汁酸(TBA)、凝血指标、血小板参数的检测对评估肝硬化患者病情的临床价值。方法 140例肝硬化患者按Child-Pugh分级分为Child-Pugh A级组(38例)、Child-Pugh B级组(60例)、Child-Pugh C级组(42例),另选择50例健康体检者为对照组,分别测定患者PA、TBA、凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)及纤维蛋白原(Fib)]、血小板参数[血小板(PLT)计数、血小板平均体积(MPV)、血小板分布宽度(PDW)及大血小板比率(P-LCR)],并进行对比分析。结果与对照组比较,肝硬化组PA降低,TBA升高,PT、APTT、TT延长,Fib降低,MPV、PDW、P-LCR升高,PLT降低(P均0.01)。随着患者Child-Pugh级别升高,PA逐渐降低,TBA逐渐升高(P均0.01);凝血功能PT、APTT、TT逐渐延长,Fib逐渐降低(P均0.01);血小板参数MPV、PDW、P-LCR逐渐增高,PLT逐渐降低(P均0.01)。结论 PA、TBA、凝血指标、血小板参数与肝硬化Child-Pugh分级密切相关,联合检测上述指标对评估肝硬化患者病情及预后有重要意义。