低分子肝素钙治疗急性脑梗死并发下肢深静脉血栓形成疗效分析

将78例脑梗死并发下肢深静脉血栓（DVT）形成患者随机分为两组,两组均给予低分子右旋糖酐、阿司匹林等药物,治疗组加用低分子肝素钙0．6ml脐周皮下注射,连用10d。结果两组治疗后神经功能缺损评分及疗效于第7天有明显差异（P〈0．05）,随治疗时间延长差异增加（P〈0．01）。治疗组DVT疗效与对照组比较有统计学意义（P〈0．05）。两组治疗前后血小板计数、出凝血时间、凝血酶原时间均无显著差异（P〈0．05）。认为低分子肝素钙治疗脑梗死合并下肢DVT安全有效。     

低分子肝素钙对晚期肺癌生存时间的影响

目的研究低分子肝素钙对晚期肺癌生存时间的影响。方法收集Ⅳ期非小细胞肺癌和广泛期小细胞肺癌患者的临床资料。所有患者随机分为2组(n=33),对照组仅给予最佳支持治疗,治疗组在最佳支持治疗的基础上予低分子肝素钙皮下注射15天。比较两组生存率差异。结果治疗组的中位生存时间为53天,对照组的中位生存时间为35天,两组的生存率比较有显著差别(P<0.05),在排除ECOG评分因素的影响下,低分子肝素钙治疗对生存时间仍然有显著影响,治疗组较对照组死亡相对危险度为0.30。咯血人数在两组间无显著差异(P>0.05)。结论低分子肝素钙治疗对晚期肺癌的生存时间可能有一定延长作用。     

低分子肝素治疗对ⅢB期非小细胞肺癌化疗效果的影响

目的 评价低分子肝素治疗对ⅢB期非小细胞肺癌化疗结局的影响.方法 62例不可手术切除的ⅢB期非小细胞肺癌患者接受了多西紫杉醇联合顺铂(DP)方案化疗(多西紫杉醇75 mg/m2,静滴60 min;顺铂75 mg/m2,静滴2h,每21天为1个周期,共4～6个周期),患者随机进入低分子肝素治疗组(化疗之日起每日1次低分子肝素钠注射液(齐征)100 IU/kg,皮下注射,连用5 d)或非肝素治疗组,比较两组患者的生存时间、无进展生存时间、粒细胞减少、功能状态评分、出血事件及D-二聚体水平.结果 低分子肝素治疗组的1年整体生存率(64.52％)、2年整体生存率(22.58％)均大于非肝素治疗组(38.71％,9.68％),差异有统计学意义(P=0.048);低分子肝素治疗组的1年无进展生存率(32.26％)、2年无进展生存率(12.90％)和非肝素治疗组(29.03％,9.68％)相比差异无统计学意义(P=0.723);粒细胞减少、ZPS评分以及出血事件在两组之间无显著性差异;治疗结束时低分子肝素治疗组D-二聚体水平[(145.97±58.66) μg/L]低于非肝素治疗组[(190.39±55.81) μg/L],差异有统计学意义(P =0.003).结论 低分子肝素治疗可以延长多西紫杉醇联合顺铂化疗方案治疗ⅢB期非小细胞肺癌患者的生存时间,改善血液高凝状态.     

低分子肝素治疗急性脑梗死的临床研究

目的 :研究低分子肝素治疗急性脑梗死的疗效。方法 :以低分子肝素治疗急性脑梗死 32例 ,观察其有效性 ,并与常用脑血管病治疗剂 (对照组 )进行比较。结果 :低分子肝素治疗急性脑梗死总有效率达 87.5 % ,较对照组的总有效率 ( 6 6 .7% )高。结论 :与常用脑血管病治疗剂相比 ,低分子肝素具有作用快、使用方便、疗效好的特点     

低分子肝素的临床研究现状

低分子肝素已用于外科术后和内科系统血栓栓塞性疾病的预防和治疗，其有效性和安全性优于未降解肝素，本文就近年来低分子肝素的临床研究现状及其应用前景作一概述。     

早期应用低分子肝素预防腹腔镜脾切除食管胃底静脉断流术后门静脉血栓形成临床研究*

目的 研究早期使用低分子肝素预防腹腔镜脾切除食管胃底静脉断流术（LSED）治疗患者术后门静脉血栓（PVST）发生的作用。方法 我院2014年3月至2015年6月期间收治的112例肝硬化门静脉高压症（PHT）患者,所有患者均行LSED治疗,按患者入院顺序分为两组,每组56例,对照组56例患者采用常规抗凝治疗,另56例患者在上述基础上采用低分子肝素治疗（观察组）。随访两组患者两周,观察两组患者肝功能、门静脉血流状况、凝血功能、PVST以及并发症发生情况。结果 两组患者治疗前后血清TBIL、ALB、INR水平均无显著性差异（P＞0.05）;治疗前两组患者门静脉最大血流速度、平均血流速度和门静脉直径无明显差异（P＞0.05）;治疗后观察组患者门静脉最大血流速度、平均血流速度和门静脉直径分别为（20.83±1.15）cm/s、（15.12±1.19cm/s）和（15.86±3.12）mm,均大于对照组的上述指标【分别为（14.36±0.74）cm/s、（10.28±0.71）cm/s和（14.27±2.96）mm,P＜0.05】;治疗前两组患者凝血功能指标比较无显著差异（P＞0.05）;治疗后,观察组患者血APTT、PT、FIB和TT分别为（25.72±3.64） s、（14.96±2.26）s、（3.51±0.86）g/L和（20.11±3.65）s,均长于对照组的上述指标【分别为（23.37±3.52）s、（13.87±2.14）s、（2.62±0.73）g/L和（18.14±3.23）s,均P＜0.05】;术后观察组和对照组PVST发生率分别为7.14%和42.86%,观察组明显较低（P＜0.05）,观察组和对照组其他并发症发生率无显著相差（P>0.05）。结论 早期应用低分子肝素对预防LSED术后门静脉血栓具有良好的作用,能有效改善凝血功能,同时降低各种并发症,安全性高。     

低分子肝素联合低分子右旋糖酐治疗心绞痛的临床观察

我们用低分子肝素联合低分子右旋糖酐治疗心绞痛，旨在观察其疗效及安全性。     

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。     

肝素、低分子肝素的抗肿瘤作用研究进展

肝素、低分子肝素是临床常用的一种抗凝药物.近年来研究发现,其还具有多种生物活性和临床用途,包括抗血管生成及抗肿瘤作用等.肝素、低分子肝素可通过改变肿瘤细胞的细胞和分子学环境而干预肿瘤的发展,例如,肝素、低分子肝素具有抗肿瘤细胞增殖作用,抑制血管内皮细胞增殖和抑制血管形成,通过抑制乙酰肝素酶、基质金属蛋白酶等酶的活性及作...     

低分子肝素用于血液透析抗凝

本文使用低分子肝素作为抗凝剂一生给药进行血液透析，观察了２６例患者２９４次血液透析的疗效。结果显示，使用Ｆｒａｇｍｉｎ抗凝时，透析器重复使用平均４．５次，未见明显透析器内及透析管路凝血。     

Treatment of venous thromboembolism with low-molecular-weight heparin

Summary There is now ample evidence to indicate that certain low-molecular-weight heparins given subcutaneously can replace continuous intravenous unfractionated heparin for the initial treatment of venous thromboembolism. The low-molecular-weight heparins have a predictably high absorption rate when given subcutaneously and a prolonged duration of action, permitting them to be given by a once or twice daily injection for the prevention or treatment of venous thrombosis. Furthermore, treatment does not require laboratory monitoring, thus eliminating the need for continuous IV infusion and permitting the early discharge of patients with venous thromboembolism. This should eventually lead to the outpatient treatment of venous thromboembolism. Studies to date indicate that low-molecular-weight heparin is more cost-effective than unfractionated heparin in the treatment of venous thromboembolism and the cost effectiveness will be increased by out-of-hospital treatment. At the present time, the findings associated with any individual lowmolecular-weight heparin preparation cannot be extrapolated to different low-molecular-weight heparins, and therefore each must be evaluated in separate clinical trials. The information to date is that low-molecular-weight heparin is safer and more effective than continuous intravenous unfractionated heparin in the treatment of proximal venous thrombosis. The decreased mortality rate seen in two clinical trials, particularly in patients with metastatic cancer, was quite unexpected. This requires further confirmation in larger prospective randomized trials.     

Low molecular weight heparin in the prevention and treatment of venous thromboembolism

Several low molecular weight (LMW) heparin preparations have been evaluated by clinical trials measuring the outcomes of thromboembolism, bleeding, and mortality. This article summarizes the current status of LMW heparin in the prevention and treatment of venous thromboembolism. LMW heparin is simpler to use because it does not require laboratory monitoring of the anticoagulant effect and dose adjustment. The specific LMW heparins include enoxaparin, ardeparin, tinzaparin, dalteparin, and nadroparin. The heparinoid ORG 10172 (danaparoid) is also effective. The results of clinical trials to date suggest that LMW heparin will be a major advance in the treatment of patients with venous thromboembolism. The simplified therapy provided by LMW heparin may allow many patients with uncomplicated proximal-vein thrombosis to be cared for in an outpatient setting.     

Home treatment of deep venous thrombosis with low molecular weight heparin: Long-term incidence of recurrent venous thromboembolism

Outpatient treatment of deep venous thrombosis (DVT) with low molecular weight heparin (LMWH) seems as safe and effective as inpatient treatment with unfractionated heparin (UFH). However, most of the randomized trials comparing a LMWH with UFH described clinical outcomes within 3-6 months. The long-term incidence of recurrent VTE after treatment of DVT with LMWH remains to be established. The primary objective of this retrospective study was to document the long-term incidence of recurrent venous thromboembolism (VTE) in patients with DVT treated with a LMWH, nadroparin in an outpatient basis. The patients were evaluated 46 months after inclusion in two cohorts comparing home treatment with nadroparin (n = 130) with in-hospital treatment with intravenous UFH (n = 149). More than 60% of the patients in the nadroparin group could be treated at home, either entirely or after a short stay in hospital. The age-adjusted thrombosis-free survival was not statistically significant between nadroparin and UFH-treated patients (P = 0.084). There was a nonsignificant trend favoring nadroparin as compared with UFH. The hazard ratio (HR) for recurrent VTE in the nadroparin group with respect to the UFH group was 0.44 (95% confidence interval, 0.17-1.12). No significant differences were observed in overall mortality or major hemorrhage between the two treatment groups. Our study suggests that home treatment of DVT with LMWH is at least as effective and safe as in-hospital UFH after a long-term follow-up period.     

肺癌合并静脉血栓栓塞症的临床特点及易患因素分析

目的探讨肺癌合并静脉血栓栓塞症(VTE)的临床特点及易患因素。方法收集我院收治的33例肺癌合并VTE患者(VTE组)的临床资料,选择同期入院但未发生VTE的66例患者(非VTE组)病历资料作为对照,分析两组患者的一般情况、实验室检查、肺癌病理类型、分化程度、TNM分期、基因检测、治疗情况等临床信息。结果 VTE组中ZPS评分≥2分的患者显著多于非VTE组(24 vs 8例,P=0.000),血清总蛋白和白蛋白较非VTE组降低(分别为58.23±7.04 vs 61.43±6.03,P=0.021;30.72±5.90 vs 34.84±5.11,P=0.001),D-二聚体升高比例明显大于非VTE组(93.94%vs 60.61%,P=0.001)。两组患者肺癌病理类型均以腺癌为主,低分化多见,Ⅳ期占多数,VTE组腺癌所占比例高于非VTE组(75.76%vs 46.97%,P=0.034),接受EGFR-TKI治疗的患者多于非VTE组(39.39%vs 9.09%,P=0.000)。VTE组在肺癌确诊前、确诊时及确诊后3、6和12个月VTE累积发生率分别为6.06%、33.33%、48.48%、57.58%、69.70%,化疗前及化疗后3、6和12个月VTE累积发生率分别为31.82%、81.82%、86.36%、90.91%。结论 ZPS评分≥2分、血清总蛋白和白蛋白降低、D-二聚体升高以及病理类型为腺癌、接受EGFR-TKI治疗的肺癌患者,发生VTE的风险较高,且多发生在肺癌确诊后和化疗后的3~6个月内。     

45例老年肺癌合并静脉血栓栓塞症患者的临床观察

目的分析老年肺癌合并静脉血栓栓塞症（VTE）患者的临床危险因素。方法选取我院收治的1026例经确诊的肺癌患者为研究对象,并分析以下相关因素：患者年龄、性别、病理类型、治疗前血小板计数、白细胞介素1（IL-1）、D-二聚体、肿瘤坏死因子（TNF）。结果上述肺癌患者中,45例（4.39%）患者并发静脉血栓栓塞。相关因素方面,血小板计数、IL-1、D-二聚体、TNF水平正常的患者VTE发生率分别为3.71%、0.32%、2.43%和3.26%,而上述水平升高的患者VTE发生率分别为6.27%、19.92%、10.31%和7.81%,差异明显（P〈0.05）。Logistic分析,IL-1、D-二聚体、TNF水平升高是肺癌患者并发静脉血栓栓塞症的临床危险因素（P〈0.05）。结论肺癌患者发生VTE的危险因素为IL-1、D-二聚体和TNF。     

低分子肝素治疗癌症相关急性肺血栓栓塞症的疗效

目的评价低分子肝素单药抗凝治疗癌症相关急性肺血栓栓塞症的疗效和预后。方法选择于我院就诊的60例癌症相关急性肺血栓栓塞症患者,分为试验组30例和对照组30例,对照组给予常规华法林抗凝治疗,试验组则采用低分子肝素单药抗凝治疗。观察两组患者动脉血氧分压(Pa O2)改善情况,治疗前后D-二聚体和纤维蛋白原(FIB)改善情况,预后情况。结果两组患者治疗后临床症状均有显著缓解,Pa O2、D-二聚体和纤维蛋白原(FIB)比较(P0.05),且试验组患者的改善情况显著优于对照组患者(P0.05),两组患者的病死率及血小板减少发生率均无显著差异(P0.05),但试验组患者的再栓塞率及出血事件发生率显著低于对照组患者(P0.05)。试验组患者的疾病控制率为96.7%高于对照组患者80.0%(χ2=4.0431,P=0.0444)。结论低分子肝素单药抗凝治疗癌症相关急性肺血栓栓塞症的临床疗效显著,可以有效降低再栓塞发生率及出血风险。     

Survival in patients with malignancy and venous thromboembolism by tumour subtype and thrombus location

Background: Although the association between malignancy and venous thromboembolism (VTE) is firmly established, less is known about the survival following VTE among different malignant subtypes. Aims: We sought to estimate survival from first VTE in consecutive patients with known malignancy receiving extended low molecular weight heparin therapy. Methods: Five hundred and fifty‐nine consecutive patients presenting to the Thrombosis Unit Registry at Auckland City Hospital between January 1997 and October 2006 were observed. Events were confirmed by standard imaging procedures. The diagnosis date and site of VTE as well as the type of malignancy were recorded. Results: Mean follow up was 21.4 months. Overall median survival from VTE was 13.5 months. Six‐month, one‐, two‐ and five‐year survivals were 64%, 53%, 43% and 33% respectively. Survival was longest for haematological malignancy at 44.4 months, followed by prostate, bowel, breast (metastatic breast), lung and pancreatic malignancy at 29.4, 27.4, 15.5 (6.2), 2.4 and 1.9 months respectively. Median survival varied with thrombotic location from 31.1 months for upper limb/jugular deep vein thrombosis reducing to only 10.1 months for iliocaval/abdominal deep vein thrombosis, but this did not reach statistical significance. Survival from cancer diagnosis was also determined. Discussion: The 1‐year 53% survival in cancer patients with VTE treated using extended low molecular weight heparin is longer than that reported from large registry and population studies in which specific patient information and therapeutic regimens are unknown. Survival is critically determined by tumour type and correlates with tumour stage in women with breast cancer. There is also a trend towards differing survival by thrombus location.     

Cost comparison of at-home treatment of deep venous thrombosis with low molecular weight heparin to inpatient treatment with unfractionated heparin

Abstract
Aims : Low molecular weight heparins (LMWH) permit safe and effective treatment of uncomplicated deep venous thrombosis (DVT) at home. The aim of this study was to evaluate the cost minimization, cost shifting and patient satisfaction associated with at-home DVT treatment using the LMWH enoxaparin, compared to standard inpatient care in an Australian health-care setting.
Methods : Subjects presenting with a principal diagnosis of uncomplicated DVT to the Emergency Department at The Queen Elizabeth Hospital, Adelaide, were recruited over 1997–1999. Costs to the hospital, to Federal funding (Medicare) and to patients were tracked prospectively, and satisfaction was also measured. Subjects were matched to historical controls (1994–1997) for age, gender and level of comorbidity (same or lower) by two medical officers who were blinded to costs. Control costs were obtained using the clinical costing system Trendstar®, and adjusted for consumer price index.
Results : Twenty-eight subjects participated in the at-home programme. Of these, 26 were discharged without any inpatient admission (including one who agreed to self-injection) and two were admitted briefly. Audit demonstrated that only 29% of eligible subjects were managed at home. Mean (SEM) total treatment cost was $756 (76) per patient for at-home, and $2208 (146) for controls. Minimal cost shifts to patients and to Medicare occurred, and satisfaction was high.
Conclusions : At-home treatment of uncomplicated DVT using enoxaparin in an Australian metropolitan setting provides effective cost minimization, with little cost-shifting. Our cost minimisation estimates are conservative as most at-home subjects received enoxaparin twice daily (now used once per day) and controls had at least as high comorbidity. However, uptake of the at-home programme was limited. (Intern Med J 2002; 32: 29–34)     

恶性肿瘤并发静脉血栓栓塞症的临床分析

目的分析并发静脉血栓栓塞症(VTE)恶性肿瘤患者的原发肿瘤种类、分期、分化程度等,以识别高危患者,提高防治意识,减少VTE的发生。方法回顾性分析北京医院2003年1月至2013年1月期间并发静脉血栓栓塞症的恶性肿瘤患者的年龄、性别、基础疾病、原发肿瘤种类、病理类型、分化程度、TNM分期、化疗方案及预后等临床信息。结果在所有18 531例恶性肿瘤患者中,280例并发VTE,其中男性157例,女性123例,年龄(66.60±12.60)岁。包括单纯肺栓塞(PTE)41例,单纯下肢深静脉血栓形成(DVT)189例,PTE合并DVT 50例。肺癌82例,消化道肿瘤78例,泌尿系肿瘤32例,妇科肿瘤27例,血液科肿瘤27例,乳腺癌12例,其他部位肿瘤22例。相比未并发VTE肿瘤患者,并发VTE多见于肺癌、妇科肿瘤和其他肿瘤患者,差异有统计学意义(P0.05)。151例(53.9%)并发VTE肿瘤患者病理类型为腺癌;206例(73.6%)患者发生VTE时,肿瘤处于进展期;247例有明确TNM分期患者中Ⅲ~Ⅳ期患者187例(66.8%);144例有明确病理组织分化程度报告,中、低度分化程度者120例(85.4%)。至随访结束,共有130例患者死亡,中位生存时间为(24.0±7.8)个月,明确诊断VTE后3,6,9,12个月的累积死亡率分别为46.9%、69.2%、80.0%和82.3%。导致死亡的主要原因是肿瘤本身、肺栓塞和感染。结论肿瘤与VTE密切相关,腺癌、进展期肿瘤、分化程度低的肿瘤患者和化疗方案中含铂类药物者更易发生VTE,临床医师应注意对这部分患者进行VTE风险评估,采取必要的预防措施,减少VTE的发生。