血栓通联合低分子肝素对老年髋部骨折患者术后燃血栓形成的预防效果研究

目的研究低分子肝素联合血栓通预防老年髋部骨折术后下肢深静脉血栓形成的临床效果。方法从2012年6月至2014年5月我院接诊的病例中选择老年患者120例,按照随机数表法,随机均分为三组。治疗组对患者在术后当天进行皮下低分子肝素注射,同时静滴中成药血栓通针剂治疗;西药组采用低分子肝素皮下注射加常规措施（肢体运动等）治疗;中药组采用加血栓通静滴加常规措施（肢体运动等）治疗。然后比较三组病例术后肺栓塞和下肢深静脉血栓的发生率,以及术口出血量。结果采用血栓通联合低分子肝素治疗的患者,其肺栓塞的发生率和深静脉血栓的发生率明显低于只采用血栓通或者低分子肝素进行治疗的患者,各项数据比较有统计学意义（P〈0．05）。术后出血量没有因为采用联合治疗而额外增加。结论采用血栓通和低分子肝素联合治疗能更有效地降低老年患者术后下肢深静脉血栓形成、肺栓塞的发生率,同时也不会增加术口出血量。     

低分子肝素钙预防髋部、下肢骨折患者术后深静脉血栓形成的效果观察

目的对比观察采用低分子肝素钙预防髋部、下肢骨折患者术后深静脉血栓形成（DVT）的临床效果。方法将2007年1月~2009年12月髋部、下肢骨折手术治疗患者随机分为未用药组和用药组,其中用药组267例,围手术期给予低分子肝素钙预防,未用药组206例。2组患者均根据术后临床症状、彩色超声检查来诊断DVT。结果用药组DVT发生率为1.5%（4/267）,非用药组DVT发生率为3.4%（7/206）,2组相比差异有显著性（P〈0.05）。结论低分子肝素钙可显著降低髋部、下肢骨折患者术后下肢深静脉血栓的发生率,而且具有良好的安全性。     

低分子肝素钙预防老年髋部骨折后下肢深静脉血栓形成

目的:探讨低分子肝素钙预防老年髋部骨折后下肢深静脉血栓形成的效果及安全性。方法:将78例老年髋部骨折患者随机分为两组,试验组予以低分子肝素钙抗凝治疗,对照组口服阿司匹林,入院第7日用彩色血管多普勒检测双侧下肢深静脉血栓形成情况,并用凝血系统指标监测出血倾向。结果:试验组下肢深静脉血栓发生率为7.69%,对照组为25.64%,χ2检验P<0.05。试验组有2例、对照组有1例出现活化部分凝血活酶时间(APTT)时间延长,发生率分别为5.13%和2.56%。结论:对老年髋部骨折患者,低分子肝素钙能降低伤后下肢深静脉血栓形成的危险,效果优于阿司匹林,且使用安全。     

低分子肝素在预防髋部骨折患者下肢静脉血栓中的应用

目的:观察低分子肝素在预防髋部骨折患者下肢静脉血栓中的临床效果。方法:将2013年以来重症监护病房(ICU)收治的56例患者随机分为观察组(30例)和对照组(26例)。对照组给予常规治疗,观察组在常规治疗基础上,应用低分子肝素5 000 U,每日1次皮下注射,连续应用7~14 d。比较两组2周后双侧下肢的周径,行彩色多普勒超声检查观察其血流速度,计算两组下肢静脉血栓的发生率,并观察有无不良反应。结果:观察组双侧下肢周径及血流速度明显优于对照组,差异有统计学意义(P<0.05)。观察组使用低分子肝素治疗后无一例发生下肢静脉血栓,对照组有3例发生下肢静脉血栓,发生率为11.54%,两组比较差异有统计学意义(P<0.05)。观察组治疗前后均未发生不良反应。结论:应用低分子肝素预防髋部骨折患者下肢静脉血栓,效果确切,安全性良好,能有效改善患者的血流,减少髋部骨折患者术后下肢静脉血栓的形成。     

髋部骨折患者并发下肢静脉血栓的预防及护理

目的探讨髋部骨折患者并发下肢静脉血栓的预防及护理。方法选取了从2014年1月至2017年3月进入我院接受髋部骨折手术治疗的60例患者;将患者随机均分为观察组与对照组;分析常规治疗措施与预防及护理措施对下肢静脉血栓形成与治疗的影响。结果观察组患者在接受下肢静脉血栓预防及护理治疗后;患者的下肢静脉血栓发生率低于对照组患者(P<0.05);患者的治疗满意度高于对照组患者(P<0.05)。结论在髋部骨折患者行手术治疗后,采取预防及护理措施能够降低患者下肢静脉血栓的发生率并能够提高患者的治疗满意度。     

低分子肝素联合间歇充气加压装置预防老年髋部骨折深静脉血栓形成56例

目的 观察低分子肝素(LMWH)联合间歇充气加压装置(IPC)预防老年髋部骨折深静脉血栓形成的效果.方法 选择老年髋关节周围骨折患者112例,随机均分为两组各56例.治疗组入院后立即给予低分子肝素药物预防联合间歇充气加压装量机械预防,低分子肝素采用腹壁皮下注射0.5 mL、每12 h给药1次,间歇充气加压装量采用双下肢交替使用、每天共6 h,连续14 d.对照组仅在术后给予低分子肝素药物预防.动态观察凝血酶原和活化部分凝血活酶时间,术后10 d进行深静脉血栓症状评估、下肢深静脉彩色多普勒超声检查.结果 治疗组出现下肢深静脉血栓1例(1.79%),对照组出现下肢深静脉血栓6例(10.71%o结论髋关节周围骨折围手术期应用低分子肝素联合间歇充气加压装置,可获得持续、有效的抗凝效果,降低深静脉血栓的发生率.     

骨折术后预防下肢静脉血栓形成的护理干预

目的:探讨护理干预措施对于骨折术后下肢静脉血栓形成的预防效果。方法:选择我院收治的100例骨折术后患者,将其随机分成治疗组和对照组,治疗组患者进行一系列的护理干预措施,而对照组患者只进行传统的护理措施,对比其预防效果。结果:治疗组患者的血栓预防情况明显优于对照组患者(P<0.05)。结论:护理干预对于骨折术后患者下肢静脉血栓形成的预防有着重要临床意义,应予以高度重视。     

低分子肝素钙防治下肢骨折后深静脉血栓形成116例

下肢骨折后治疗需要制动,此时非常容易出现下肢深静脉血栓形成(deep venous thrombosis,DVT),一旦血栓脱落形成肺栓塞,可危及患者生命,抢救成功率极低。因此,下肢骨折后预防及治疗下肢深静脉血栓形成非常重要。笔者自2005年10月—2007年10月,给116例下肢骨折患者用低分子肝素钙预防治疗下肢深静脉血栓,效果良好,现报告如下。     

利伐沙班与低分子肝素预防髋部骨折内固定术后血栓形成的效果对比

深静脉血栓（DVT）形成患者易发生肺栓塞（PE）,在临床研究中得到广泛重视,《中国骨科大手术静脉血栓栓塞预防指南》对髋膝关节置换围手术期抗凝进行了规范化指导[1]。但指南对髋部骨折如何预防血栓形成,特别是围手术期如何抗凝并没有提出明确的方案。本研究对利伐沙班和低分子肝素（LMWH）预防髋部骨折术后血栓形成的有效性和安全性进行了初步分析,报告如下。     

低分子肝素预防脑出血后静脉血栓的安全性研究

目的探讨脑出血患者抗凝预防静脉血栓栓塞时颅内血肿体积变化及相关安全性。方法回顾性分析脑出血或脑出血合并脑室出血的患者,均在入院7 d内予以注射低分子肝素,并在用药7 d后复查头颅CT。计算患者低分子肝素治疗前后CT上的颅内血肿体积的变化,血肿体积的计算使用ABC/2法,脑室出血量的计算使用手绘出血区域方法。结果共入选64例,平均年龄65岁,美国国立卫生研究院卒中量表（NIHSS）评分中位值为10.6,基线时血肿体积平均为（24.3±22.3）ml,低分子肝素治疗前后CT检查上的颅内血肿体积变化为（-4.35±10.5）ml,仅有1例的血肿体积增大。经分析,自发性脑出血患者发病7 d内给予低分子肝素预防深静脉血栓并不导致颅内血肿的增大。结论在脑出血伴/不伴脑室出血的急性期,给予皮下注射低分子肝素预防静脉血栓栓塞不导致颅内血肿的增大。     

The safety of fondaparinux for the prevention and treatment of venous thromboembolism

Fondaparinux is the first synthetic selective Factor Xa inhibitor. Along with its antithrombotic efficacy, the safety of fondaparinux has been documented in several Phase II and III clinical trials, including the prevention of venous thromboembolism in patients undergoing major orthopaedic surgery or high-risk abdominal surgery, or in acutely ill medical patients with restricted mobility, and the treatment of patients with deep-vein thrombosis and pulmonary embolism. In all these indications, the safety of fondaparinux used according to its registered regimen was similar to that of reference comparators. In conclusion, due to its superior efficacy and satisfactory safety, fondaparinux may substantially improve the prevention and treatment of venous thrombosis.     

Safety of low molecular weight heparins in the treatment of venous thromboembolism

Low molecular weight heparins (LMWHs) are commonly employed as a substitute for unfractionated heparin (UFH) in the treatment of venous thromboembolic events. Despite their higher cost, the preferential use of LMWHs seemed justified initially as, based on the results of earlier meta-analyses, these compounds were deemed to be more effective and safer than UFH. Although, in this respect, their purported superiority over UFH could not be confirmed by subsequent large, randomised trials and updated meta-analyses, other peculiar features of LMWHs were highlighted, favouring their preferential utilisation in patients with venous thromboembolism. Among these, the possibility of once-daily administration on an out-patient basis, the lower incidence of Type II heparin-induced thrombocytopenia and the lower likelihood of osteoporosis after prolonged treatment periods, appear to be especially prominent. This review attempts to evaluate the available evidence focusing on the safety of LMWHs for the treatment of venous thromboembolism and the current therapeutic options and potential advantages of LMWHs, either in general or in selected patient populations.     

低分子肝素对于人工全髋关节置换术后下肢深静脉血栓形成的预防

目的探讨人工髋关节置换术(THR)后用低分子肝素预防下肢深静脉血栓(DVT)形成的疗效和安全性。方法将2002年1月至2006年6月行人工全髋关节置换术的94例患者随机分为未用药组和用药组,其中未用药组46例,未预防性使用任何药物;用药组48例,围手术期给予低分子肝素预防性治疗。术后第7天,两组患者均行双侧下肢彩色多谱勒超声检查,了解DVT形成情况及两组术后DVT的发生率。结果未用药组中有22例DVT阳性,DVT的发生率47.8%,用药组中有9例DVT阳性,DVT的发生率18.8%,两组比较,差异有统计学意义(P<0.05)。未用药组近端DVT的发生率为19.6%,用药组近端DVT的发生率为2.1%,两组比较,差异有统计学意义(P<0.05)。用药组未发现术中术后出血增多以及药物不良反应。结论低分子肝素能显著降低人工全髋关节置换术后下肢深静脉血栓的发生率,且具有良好的安全性。     

Incidence of recurrent venous thromboembolism of patients after termination of treatment with ximelagatran

Objective Recurrent thromboembolic events may occur after termination of anticoagulant therapy for acute venous thromboembolism (VTE) using oral direct thrombin inhibitor ximelagatran. Methods Patients with VTE recruited at the German study centres were followed-up for an additional 18 months, treated initially with 2×36 mg ximelagatran daily or with enoxaparin/warfarin over 6 months (THRIVE Treatment study) and 2×24 mg ximelagatran daily or placebo over 18 months (THRIVE III study). Recurrent VTE and the combined outcome events consisting of recurrent VTE, other thrombotic complication, major bleeding and mortality were analysed. Results In the THRIVE Treatment study, no patient suffered from a recurrent VTE, but 1 patient randomised to enoxaparin/warfarin experienced major bleeding. During follow-up, 4/32 and 3/32 patients initially randomised to ximelagatran and enoxaparin/warfarin developed recurrent VTE (p=0.7024). No major bleed occurred. One patient in each group died. The incidences of the combined outcome events were not different (p=0.9326). In the THRIVE III study, 0/9 versus 5/14 patients randomised to ximelagatran and placebo developed recurrent VTE including 1 fatal pulmonary embolism (p=0.0501). During follow-up, 3/9 and no patients initially randomised to ximelagatran and placebo developed recurrent VTE. One and 3 other outcome events occurred in patients initially randomised to ximelagatran or placebo. During follow-up, recurrent VTE (p=0.6893) and combined outcome events (p=0.3642) were not different between the groups. Conclusion The results of the follow-up studies suggest that thromboembolic events may re-occur in patients with acute VTE after termination of treatment with both vitamin K-antagonists and ximelagatran.     

The HORIZON Recurrent Fracture Trial: design of a clinical trial in the prevention of subsequent fractures after low trauma hip fracture repair

SUMMARY

Objective: To present the novel design of a trial testing the safety and efficacy of a yearly bisphosponate, zoledronic acid, in preventing new clinical fractures in patients with recent low trauma hip fracture repair.

Research design and methods: Randomized, placebo-controlled, triple-blind study. One hundred and fifteen clinical centers worldwide are recruiting approximately 1714 subjects aged 50?years and over (no upper age limit, median age of enrolled subjects to date 79?years) who have undergone surgical repair of a low trauma hip fracture in the preceding 90?days. Patients will be assigned at random to an intervention group (5?mg zoledronic acid intravenously yearly) or a control group (placebo infusion yearly). Both groups receive a loading dose of Vitamin D2 or D3 IM or orally, followed by 800–1200?IU Vitamin D and 1000–1500?mg elemental calcium orally on a daily basis. Concomitant therapy with calcitonin, hormone replacement therapy, selective estrogen receptor modulators, tibolone, and external hip protectors are allowed.

Main outcome measures: The primary endpoint is subsequent skeletal fractures as adjudicated by a clinical endpoints committee blinded to intervention status. Secondary outcomes include delayed hip fracture healing, changes in bone mineral density, and health resource utilization. Subjects will be recruited over a 3–4?year period and will be followed until 211 primary endpoints are accrued and adjudicated.

Conclusions: This randomized clinical trial is novel among osteoporosis therapies as it (1) targets hip fracture patients, a previously understudied group, and (2) uses only clinically evident fractures as the primary outcome. Ethical and practical considerations in studying this frail population are discussed.     

Tinzaparin in the treatment of venous thromboembolism

Low molecular weight heparin (LMWH) has been widely used for the initial treatment of patients presenting with venous thromboembolism. The LMWH, tinzaparin, has been shown in randomised clinical trials to be as effective and safe as unfractionated heparin for the initial treatment of venous thromboembolism and in clinical trials, it has been used in place of warfarin for the long-term treatment of deep vein thrombosis. Tinzaparin can safely be given to patients with significant renal impairment (creatinine clearance of ≥ 20 ml/min) and the dose of tinzaparin does not need to be altered in patients with a body mass index of > 25.     

低分子肝素预防髋、膝关节术后下肢深静脉血栓形成的临床观察

目的探讨低分子肝素(LMWH)对预防髋、膝关节术后下肢深静脉血栓(DVT)的有效性和安全性。方法将52例行髋、膝关节手术的患者随机分为治疗组和对照组各26例。对照组不予任何抗凝药物,术后24h开始行物理方法预防DVT;治疗组在对照组治疗基础上于术前12h、术后给予LMWH腹部皮下注射,2组均治疗7d。观察并比较2组术后双下肢DVT和不良反应发生情况及血常规指标。结果治疗组治疗后DVT发生率为3.8%,低于对照组的26.9%,差异有显著统计学意义(P<0.05)。2组患者血小板计数(PLT)、血红蛋白(Hb)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及不良反应发生率比较差异均无统计学意义(P>0.05)。结论应用LMWH预防髋、膝关节术后DVT疗效确切,对凝血机制无影响,安全性好,值得临床推广应用。     

Economic evaluation of enoxaparin for the prevention of venous thromboembolism in acutely ill medical patients

OBJECTIVE: To conduct an economic evaluation of the prevention of venous thromboembolism in acutely ill medical patients. METHOD: We used a previously described economic model created in the context of the UK National Health Service and applied it to St. Thomas' Hospital, London. A clinical review to determine the number of medical admissions that would require thromboprophylaxis at St. Thomas' Hospital, based on the inclusion criteria of a medical thromboprophylaxis trial (MEDENOX), was conducted. Costs and effectiveness were determined, based on the provision of thromboprophylaxis to 2000 medical patients. RESULTS: Comparing treatment with low-molecular-weight heparin (enoxaparin, 40 mg once daily), unfractionated heparin (5000 IU twice daily), or no prophylaxis, the highest cost of thromboprophylaxis was associated with unfractionated heparin (199,000 pounds sterling = 4306,000 Euros), compared with enoxaparin (198,000 pounds sterling = 305,000 Euros) or no prophylaxis (176,000 pounds sterling = 271,000 Euros). The model suggested that enoxaparin thromboprophylaxis would result in fewer thromboembolic-related events. Using sensitivity analysis, incorporating certain St. Thomas'-specific costs showed enoxaparin compared with unfractionated heparin or no thromboprophylaxis was cost saving. The cost savings of 65,000 pounds sterling ( = 100,000 Euros) and 31,000 pounds sterling ( = 48,000 Euros) respectively are based on maximum uptake of thromboprophylaxis. CONCLUSIONS: The graded implementation of enoxaparin thromboprophylaxis over a four-year period would require funding redistribution. The funding Health Authority would save overall but St. Thomas' would require an increase in drug expenditure across the clinical directorates of 35,000 pounds sterling ( = 54,000 Euros) after 4 years.