The Antithrombotic Effect of Heparin in Deep Venous Thrombosis: Relation to Four Heparin Assays

Abstract In a prospective study, 280 patients with phlebographically proven deep venous thrombosis intravenous heparin infusion; 224 of the patients were subjected to control phlebography after 5–8 days of treatment. Females above 70 years showed least phlebographic improvement despite similar heparin dosage and heparin activity. Heparin activity in daily drawn blood samples was determined by four different assays. Chromogenic substrate (CS) assay (Coatest heparin), activated partial thromboplastin time (Cephotest), and thrombin time with recalcified plasma (CaTT) showed weak but significant correlations with thrombus resolution judged by phlebography (p=0.004, 0.003 and 0.018, respectively). A linear prediction equation showed that the phlebographic result was about equally influenced by the mean dose and by the result of any of the three heparin assays. Thrombin time with citrated plasma showed no correlation. CS assay and CaTT showed significantly lower mean heparin activity in patients with (n=13) than without clinically diagnosed pulmonary embolism (p=0.012 and 0.001, respectively).     

低分子肝素钙预防心力衰竭患者深静脉血栓观察

目的观察低分子肝素钙对慢性心力衰竭患者深静脉血栓形成的预防效果。方法将未检出深静脉血栓的慢性心力衰竭患者随机分为试验组(95例)和对照组(91例)。在常规治疗基础上,试验组应用低分子肝素钙5 000 U,每日一次皮下注射。对照组应用安慰剂,连续应用2周。于2周及4周后复查下肢深静脉多普勒超声,计算两组深静脉血栓的发生率。结果治疗2周后试验组静脉血栓的发生率为3.1%,对照组为10.9%,两组比较有统计学意义(P<0.0 5);治疗4周后试验组静脉血栓的发生率为4.4%,对照组为13.3%,两组比较有统计学意义(P<0.05)。两组均无严重不良反应。结论应用低分子肝素钙预防慢性心力衰竭患者深静脉血栓形成效果确切,安全性及耐受性良好。     

低分子肝素对老年重症肺炎患者预后的影响

目的探讨低分子肝素抗凝治疗对老年重症肺炎预后的影响。方法选取2018年1月至2019年1月入住北京世纪坛医院呼吸与危重症医学科重症监护病房(RICU)的年龄≥65岁的重症肺炎患者100例,利用随机数字表分为两组,对照组给予常规治疗,试验组在常规治疗基础上加用低分子肝素4000 U皮下注射,每日1次,治疗14 d。分别于治疗前及治疗第3、7、14天比较两组患者急性生理和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、血气分析、凝血指标、D二聚体、血常规、C反应蛋白、降钙素原,以及28天死亡率、出血率、深静脉血栓形成率。结果治疗前,两组患者的基本资料和APACHEⅡ评分差异无统计学差异(P>0.05)。治疗第3天,两组患者的APACHEⅡ评分、D二聚体、白细胞、中性粒细胞百分比和C反应蛋白水平无显著差异。治疗第7天、14天,试验组的上述指标显著低于对照组(P<0.05)。血气分析显示,仅在治疗第14天,试验组乳酸水平显著低于对照组(P<0.05)。治疗期间,两组患者凝血指标和降钙素原差异均无统计学意义(P>0.05)。试验组的28天平均死亡率为8%,显著低于对照组(24%,P<0.05)。两组患者出血发生率无显著差异(P>0.05)。试验组深静脉血栓形成率显著低于对照组(P<0.05)。结论临床上对老年重症肺炎患者应用低分子肝素辅助治疗,可减少APACHEⅡ评分,降低28天死亡率,减少医院内深静脉血栓的发生。     

肝素诱导的血小板减少症研究进展

肝素诱导的血小板减少症是一种特异性自身免疫性疾病,是由于抗体对肝素-血小板因子4复合物的识别,损伤了血小板以及内皮细胞而导致,以血小板减少及血栓形成为主要表现,通过4T评分以及实验室检查可有助于诊断,治疗上需要立即停用肝素及其相关制剂并开始替代抗凝治疗。     

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。     

低分子肝素与普通肝素治疗不稳定型心绞痛的对比分析

目的 比较低分子肝素（LMWH）与普通肝素（UFH）治疗不稳定型心绞痛（UA）的有效性及安全性：方法 65例UA病人，随机分为LMWH组（33例）和UFH组（32例），对比观察风组病人心绞痛改善程度、心电图变化情况及不良反应：结果 LMWH组和UFH组心绞痛改善程度比较，两组总有效率比较有统计学意义（93．9％和75．0％，P〈0．05），心电图变化情况总有效率比较无统计学意义（66．7％和62．5％，P〉0．05），不良反应发生率比较有统计学意义（9．1％和15．6％，P〈0、05）。结论 LMWH治疗UA较UFH治疗可显著减少心绞痛的发作，且不良反应少。     

低分子肝素佐治充血性心力衰竭的临床研究

目的探讨低分子肝素对充血性心力衰竭患者心功能、凝血功能的影响。方法将62例慢性心力衰竭患者随机分为两组,对照组31例给予强心、利尿、扩血管、p受体阻滞剂、血管紧张素转换酶抑制剂、醛固酮受体拮抗剂等常规治疗;治疗组31例在此基础上加用低分子肝素5000U／次皮下注射,2次／d,共15d,2周后检查心脏超声。评估心功能、测定血浆D一二聚体,血浆纤维蚤白原水平。结果两组治疗后左室舒张末径（LVEDd）水平明显降低,左室射血分数（LVEF）水平明显升高,与治疗前比较差异有统计学意义（P〈0．05）;并且治疗组治疗后LVEDd、LVEF水平改善明显优于对照组,两组比较差异有统计学意义（P〈0．05）;治疗组血浆D-二聚体、血浆纤维蛋白原（FPG）水平明显降低（P〈0．05）。结论低分予肝素既能降低血浆D—dimer、FPG水平,又可改善充血性心力衰竭心脏功能,有益于充血性心力衰竭的治疗。     

Toxicity of Plasma from Hemodialysis Patients Treated with Heparin or Prostacyclin

Abstract Hemodialysis was performed in 6 uremic patients with either a bolus dose of 5 000 IU heparin or prostacyclin at a constant infusion rate of 5 ng/kg/min. Clinical data, plasma triglycerides (TG), free fatty acids (FFA), platelet aggregation, white blood cell count and plasma toxicity were measured prior to and during both procedures. No serious sideeffects were recorded. Heparin induced a fall in plasma TG, a rise in FFA and increased plasma toxicity. Prostacyclin infusion had no effect on these parameters. During both tests a marked drop in white blood cell count was found 15 min after the start of hemodialysis. During heparin dialysis no clotting was observed in the extracorporeal circuit. During prostacyclin dialysis clotting was observed at the venous line in three cases     

Combined use of orgaran and reopro during coronary angioplasty in patients unable to receive heparin

Orgaran, a heparinoid, has been used successfully in patients with heparin-induced thrombocytopenia. We report three cases in which Orgaran was combined with the glycoprotein IIb/IIa receptor antagonist Reopro during coronary angioplasty. Orgaran was given as a single intravenous bolus of 1500 anti-factor Xa units. No ischemic or hemorrhagic complications occurred during or following the procedure. Cathet. Cardiovasc. Intervent. 46:352–355, 1999. © 1999 Wiley-Liss, Inc.     

Pruritus in Patients on Maintenance Hemodialysis

ABSTRACT Twenty-nine patients undergoing maintenance hemodialysis were examined for dermatologic symptoms. Nineteen patients (66%) complained of pruritus, which was classified as mild (34%), moderate (24%), and severe (8%). Patients with pruritus did not differ from those without pruritus regarding serum concentrations of creatinine, urea, calcium, alkaline phosphatase or aluminum, nor was there any difference in duration of hemodialysis, age or sex. In pruritic patients serum concentrations of parathyroid hormone were significantly higher when determined with a mid-region radioimmunoassay technique (p<0.01) and higher, although not significantly, when the intact parathyroid hormone molecule was measured. Serum concentrations of phosphate were significantly lower in patients with pruritus (p<0.05).     

Excessive anticoagulation in patients with mild renal insufficiency receiving long-term therapeutic enoxaparin

Low-molecular-weight heparins, such as enoxaparin, are increasingly being used for treatment of venous thromboembolism. We describe two patients who received therapeutic enoxaparin for several months. Although their serum creatinine values were normal, both had mild renal insufficiency (creatinine clearance 60-70 ml/min), and both accumulated the drug abnormally and experienced clinical bleeding. These results suggest that patients receiving enoxaparin (or other low-molecular-weight heparins) in therapeutic doses for periods of more than 4 weeks should be considered for laboratory monitoring to avoid bleeding.     

陕西省消除疟疾全球基金项目实施效果评价

目的 目的 评价陕西省消除疟疾全球基金项目的实施效果, 为科学实施消除疟疾行动计划及考核评估工作提供参考依据。方法 方法 收集整理2010-2012年陕西省27个全球基金疟疾项目县疟疾防治工作资料并进行统计学分析, 评价陕西省消除疟疾全球基金项目的实施效果。结果 结果 2010-2012年陕西省全球基金项目实施地区共报告疟疾病例64例, 年均发病率为0.15/10万, 发病率呈逐年下降趋势; 病例感染地来源以境外输入性为主, 占总病例数的79.69%;“三热” 病人血检工作完成率为94.14%, 血检工作开展范围扩大到88个县 （含61个三类县）; 疟防知识和技能培训覆盖率达到100%, 中小学生和居民疟防知识知晓率分别为91.68%和89.44%; 病例诊断后24 h内网络报告、 个案调查和疫点处置、 实验室检测和确诊等病例管理能力显著提高。结论 结论 全球基金疟疾项目的实施加速了陕西省消除疟疾工作的进程, 项目实施地区的疟疾防治工作能力得到显著提升。     

低分子肝素治疗急性心肌梗塞后无症状性心肌缺血的初步观察

目的：观察低分子肝素对急性心肌梗塞（AMI）后无症状性心肌缺血的影响。方法：随机将64例患者分为肝素1组、肝素2组和对照组共3组，均按AMI常规治疗，其中肝素1组加用皮下注射低分子肝素每日1次，每次0.4ml，肝素2组皮下注射低分子肝素每日2次，每次0.4ml，疗程2周，2周后行24小时动态心电图检查，计算总缺血和缺血总负荷。结果：各组缺血持续时间和缺血总负荷分析为：肝素1组3．4±6．8min；5.2±10.4min·mm；肝素2组2．7±7．2min，4．5±11．2min·mm；对照组9．3±10．8min;15.9±18．2min·mm.肝素1组、肝素2组与对照组比较P值均＜0．05。结论：低分子肝素能有效地治疗AMI后无症状性心肌缺血。     

Comparison of Sodium and Calcium Heparin in Prevention of Venous Thromboembolism

Abstract: Comparison of sodium and calcium heparin in prevention of venous thromboembolism. J. F. Cade, J. T. Andrews and A. E. Stubbs. Aust. HZ. J. Med., 1982, 12 , pp. 501–504.
The relative efficacy of sodium and calcium heparin in preventing venous thromboembolism and their relative side-effects were studied in 234 high-risk patients in a randomised, double-blind, placebo-controlled trial. The two heparin preparations were from the same batch and in the same concentration, and were given in a dose of 5000 U 12 hourly. Positive leg scans were found in 19% after placebo, 12% after sodium heparin and 8% after calcium heparin. Bruising at the injection site was more common after calcium heparin (66%) than after sodium heparin (53%) or placebo (38%). Pain at the injection site was also more common after calcium heparin (26%) than after sodium heparin (8%) or \ placebo (6%). Changes in the activated partial thromboplastin time were small and did not correlate with leg scan results or bruising. While there was a tendency for calcium heparin to be possibly more effective, it was followed by significantly more local haema toma and pain.     

Improvement of Some Blood Coagulation Factors in Cirrhotic Patients Treated with Low Doses of Heparin

Effects of subcutaneous calcium-heparin and vitamin K administration were studied in 30 cirrhotic patients showing low values of prothrombin time, antithrombin III, fibrinogen, platelet count, plasminogen, a2-antiplasmin, raised levels of fibrin(ogen) degradation products and prolonged activated partial thromboplastin time. A group of 10 patients was first treated with K vitamin for 15 d; after vitamin K therapy interruption, a treatment with 5000 IU (8000 IU in 1 patient) every 12 h of subcutaneous calcium-heparin was started. In another group of 20 patients a treatment with 5000 IU (8000 IU in 2 patients) every 12 h of subcutaneous calcium-heparin was started immediately. The heparin administration in both groups had been performed for at least 2 weeks. No significant changes of blood coagulation picture were observed after vitamin K administration, while calcium-heparin treatment showed an increase in prothrombin time, fibrinogen, platelet count, plasminogen, a2-antiplasmin, a decrease in fibrin(ogen) degradation products and a shortened activated partial thromboplastin time. There was no significant change in antithrombin III values.     

Vitamin K Antagonists After 6 Months of Low-Molecular-Weight Heparin in Cancer Patients with Venous Thromboembolism

Background

Low-molecular-weight heparin (LMWH) is the treatment of choice in cancer patients with venous thromboembolism. However, data on continuing LMWH treatment beyond 6 months remain scanty.

疏血通与低分子肝素钙联合治疗急性脑梗死的疗效研究

目的 观察疏血通联合低分子肝素钙治疗急性脑梗死的临床效果.方法 将84例急性性脑梗死患者分为A组(44例)与B组(40例),A组给予疏血通联合低分子肝素钙治疗,B组仅给予低分子肝素钙治疗.评估患者治疗前后临床疗效、神经功能缺损评分等.结果 两组患者治疗后神经功能缺损评分均明显降低,且A组下降程度大于对照组(P＜0.05);A总有效率显著高于B组,差异有统计学意义(P＜0.05).结论 疏血通联合低分子肝素钙治疗急性脑梗死安全有效,值得在临床推广.     

Bivalirudin versus Unfractionated Heparin during Percutaneous Coronary Intervention in Patients at High Risk for Bleeding

Low/medium-bleeding-risk populations undergoing percutaneous coronary intervention (PCI) show significantly less bleeding with bivalirudin (BIV) than with unfractionated heparin (UFH), but this has not been established for high-risk patients. We performed a randomized double-blind prospective trial comparing efficacy and safety of BIV versus UFH combined with dual antiplatelet therapy during PCI among 100 high-risk patients with non-ST elevation myocardial infarction (NSTEMI) or angina pectoris. The baseline characteristics were similar in both treatment arms. A radial approach was used in 84% of patients with a higher rate in the BIV group (90 vs. 78%, p < 0.05). Study end points were: major and minor bleeding, port-of-entry complications, major adverse cardiac events (MACE) in-hospital, and at long-term follow-up. There was one case of major gastrointestinal bleeding in the BIV group and 7% minor bleeding complications in both categories. Rate of periprocedural myocardial infarction (PPMI) in the BIV group was twice that in the UFH group (20 vs. 10%, p < 0.16). In-hospital MACE rate was higher in BIV patients as well (12 vs. 2%, p = 0.1). By univariate analysis, the femoral approach was the predictor of PPMI and in-hospital MACE. In a multivariate model, the independent predictor of PPMI was previous MI (odds ratio, 7.7; p < 0.0158). PPMI was 49.7 times more likely with the femoral approach plus BIV than the nonfemoral approach plus UFH (p < 0.0021). At 41.5 ± 14 months'' follow-up, end points did not significantly differ between the groups. In patients at high risk for bleeding undergoing PCI, BIV was not superior to UFH for bleeding complications, and early and late clinical outcomes.     

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).