低分子肝素钠注射液对急性脑梗死患者血液流变学影响的临床分析

目的：分析低分子肝素钠注射液对急性脑梗死患者血液流变学的影响。方法：对急性脑梗死患者64例进行低分子肝素钠注射液抗血栓形成治疗,于治疗前及治疗后第6～7d分别检测血液流变学指标。结果：对照组血液流变学指标明显高于正常值。治疗组血液流变学指标均明显低于治疗前,两者相比有显著性差异（P〈0.05）。结论：急性脑梗死患者存在血液流变学异常,低分子肝素钠注射液能显著降低血液粘度,改善血液流变性     

小剂量尿激酶联合低分子肝素钙、血栓通治疗亚急性期下肢深静脉血栓临床观察

目的：探讨小剂量尿激酶联合低分子肝素钙、血栓通治疗亚急性期下肢深静脉血栓的疗效及安全性。方法51例确认为LEDVT的患者给予尿激酶20万U溶于100mL生理盐水中,应用输液泵经患肢足背静脉注射,于半小时内滴完,每天一次,连续5～7d。同时应用注射用血栓通（冻干）0.5溶于生理盐水250mL静脉滴注,每日1次。低分子肝素钙注射液4100U皮下注射,1次/12h,连续5d。第3天加用华法林钠片2.5mg,每日一次,并根据PT调整药量。结果本组51例,痊愈8例（16%）,有效34例（67%）,无效9例（17%）,总有效率为82%。治疗前后HCT、Fg都有所降低,自身对照有显著性差异（P＜0.05）。结论小剂量尿激酶延迟溶栓联合低分子肝素钙、血栓通治疗亚急性期下肢深静脉血栓是安全有效的方法。     

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.     

凝血因子Ⅸ复合物中活化凝血因子的检测及体外潜在致血栓性研究

目的：检测凝血因子Ⅸ复合物中的活化凝血因子,体外考察样品的潜在致血栓性。方法：检测了两种不同工艺制备的凝历因子Ⅸ复合物中FⅡa,FⅨa,FⅩa的含量,同以体外血栓性分析（NAPTT,TGt50)实验结果为指标,考察了不同种类和比例的稳定剂（普通肝素和低分子量肝素）对制品潜在致血栓性的影响。结果：与改良凝胶吸附法制备的因子Ⅸ复合物相比,用国产DEAE－Sepharose Fast Flow离子交换层析及Ca3(PO4)2吸附法制备的因子Ⅸ复合物中仅含少量的活化因子,当普通肝素和低分子量肝素以一定比例（70：30）加入到制品中时,制品的血栓安全性相对提高,结论：用国产分离介质制备因子Ⅸ复合物在减少凝血因子的活化,提高制品的血栓安全性方面是成功的,在普通肝素中按一定比例加入低分子量肝素将更有利于制品血栓安全性的提高。     

Low-molecular-weight protein tyrosine phosphatase expression as a prognostic factor for men with metastatic hormone-naïve prostate cancer

Objectives

Recent studies have demonstrated that up-front docetaxel combined with androgen deprivation therapy (ADT) prolongs survival in some patients with metastatic hormone-naïve prostate cancer (mHNPC). However, new biomarkers for selecting personalized treatment strategies for mHNPC are warranted. We evaluated the value of low-molecular-weight protein tyrosine phosphatase (LMW-PTP) expression as a prognosticator in men with mHNPC.

Routine use of LMWH prophylaxis is associated with a lower incidence of venous thromboembolic events following an ankle fracture

BackgroundVenous thromboembolic events (VTE) are well-known and serious complications following a trauma to the lower extremities. There is an ongoing debate on the benefit of low-molecular-weight heparin (LMWH) as prophylaxis following ankle fracture treatment. We examined the association between the incidence of VTE and the use of LMWH-prophylaxis following an ankle fracture, as well as factors affecting the risk of VTE.MethodsIn this retrospective cohort study, data on ankle fractures and fracture treatment from the Swedish Fracture Register was linked to data from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Patients with VTE and patients who received LMWH prophylaxis were identified. The treating orthopedic departments were sent a questionnaire about their guidelines regarding the use of LMWH prophylaxis.Results222 cases of diagnosed VTE were identified among 14,954 ankle fractures. Orthopedic departments with higher-than-average use of LMWH prophylaxis among non-operatively treated ankle fractures had a lower incidence of VTE (OR 0.60, CI 0.39–0.92). Among operatively treated patients, departments with a guideline for the routine use of LMWH prophylaxis also had lower incidence of VTE (OR 0.56, CI 0.37–0.86). A later onset of VTE was seen among patients prescribed LMWH prophylaxis, with a mean of 56 days to onset (CI 44–67), compared to 39 days (CI 33–45) in patients without prescribed prophylaxis. During the first two weeks following injury, there was only one case of VTE in patients with prescribed LMWH, compared to 39 cases of VTE among patients without prescribed prophylaxis.ConclusionsRoutine use of LMWH in patients with operatively treated ankle fractures was associated with a lower incidence of VTE. A more frequent use of LMWH among patients with non-operatively treated ankle fractures were associated with a lower incidence of VTE. The onset occurred later among patients with LMWH-prophylaxis who still suffered a VTE.     

低分子肝素与灯盏细辛注射液联合治疗不稳定型心绞痛疗效观察

目的:观察低分子肝素与灯盏细辛注射液联合治疗不稳定型心绞痛(UAP)的疗效。方法:将96例UAP患者随机分为常规治疗对照组和加用低分子肝素和灯盏细辛注射液治疗组各48例进行疗效观察。结果:10d后总有效率治疗组为91.7%,对照组为68.8%(P <0.01);观察4周总心血管事件发生率治疗组明显低于对照组(P <0.05);治疗组未发现明显不良反应。结论:在常规治疗的基础上加用低分子肝素和灯盏细辛注射液,能更有效地控制心绞痛发作,显著降低近期心血管事件的发生率。     

应用血栓弹力图评价血液透析患者低分子肝素剂量的研究

目的探讨应用血栓弹力图评价血液透析患者低分子肝素剂量的临床研究。方法选取2018年1月至2019年8月在广东省佛山市三水区人民医院进行血液透析患者200例,根据低分子肝素应用总量不同分为对照组(高剂量组,总量≥80U/kg体重)和研究组(低剂量组,总量<80U/kg体重),分别在透析前、透析3h及透析完成24h时段对两组患者活化部分凝血活酶时间(activated partial thromboplastin time,APTT)及血栓弹力图指标进行对比分析,比较两组抗凝效果,对比两组静脉压、跨膜压等指标变化情况,通过监测患者血浆尿素浓度对透析效果进行评价。结果与对照组比较:患者透析前APTT检测结果差异无显著性(P>0.05),血栓弹力图检测中R值、MA值、K值、CI值结果差异无显著性(P>0.05);透析3h后,两组患者APTT明显延长且差异无显著性(P<0.05),研究组R值、MA值、K值、CI值较对照组差异有显著性(P<0.05);透析完成24h后,两组APTT明显延长且差异有显著性(P<0.05),研究组APTT小于对照组;透析患者低分子量肝素剂量与患者体重的ROC曲线下面积为0.68时即可达到充分抗凝效果;研究组较对照组出血倾向低,差异有显著性(P<0.05),两组静脉压、跨膜压、透析效果比较差异无显著性(P>0.05)。结论血栓弹力图指标更能反映透析患者凝血实时功能,低分子肝素小剂量应用即可达到充分抗凝且不影响透析效果,透析患者使用小剂量低分子量肝素出血风险更低。     

Cost and utility of a low-molecular-weight heparin and unfractionated heparin for treatment of deep venous thrombosis in a Balkan country: A model analysis

OBJECTIVE: Low-molecular-weight heparins are cost-saving for treating venous thrombosis in developed countries, but their cost-effectiveness in developing Balkan countries has not been investigated. The objective of the present study was to evaluate whether the results of cost-effectiveness studies of low-molecular-weight heparins versus unfractionated heparin for treatment of acute deep venous thrombosis conducted in a developed country are applicable to Serbian socioeconomic circumstances. METHODS: A Markov model was constructed based on the decision model used by Gould et al (Ann Intern Med 1999;130:789-99), with the help of TreeAge Software (TreeAge Software Inc, USA). Probabilities for clinical outcomes were obtained from that study, while the costs were derived from the Serbian Republic Institute for Health Insurance and other sources. Patients with acute deep venous thrombosis, 60 years of age, were introduced into the model. A Monte Carlo microsimulation trial with 1000 patients was used for drawing conclusions from the model. The time horizon was six years, and the Serbian Republic Institute for Health Insurance was used. RESULTS: Enoxaparin for treatment of deep venous thrombosis in Serbian patients was not cost-saving, but was a cost-effective therapeutic strategy (from 5,322.97 CSD [Serbia and Montenegro dinars] per quality-adjusted life-year gained when used in out-patients, to 10,929.76 CSD per quality-adjusted life-year gained when used in inpatients). The drug acquisition cost was the major factor influencing the cost-effectiveness, due to the low cost of labour and hospitalization. CONCLUSIONS: The results of pharmacoeconomic studies performed in developed countries cannot be directly extrapolated to developing Balkan countries. However, enoxaparin is still a cost-effective strategy for the treatment of deep venous thrombosis.     

低分子肝素对脑梗死患者甲襞微循环的动态影响及疗效观察

目的观察低分子肝素(Low molecular weight heparin,LMWH)对脑梗死(Cerebral infarction,CI)患者甲襞微循环的动态影响和疗效。方法按入院的先后随机将入选的CI病例分为LMWH组和对照组。LMWH组(n=25)予LMWH5000抗XaIU腹壁皮下注射,2次/d,共7d;对照组(n=30)予阿司匹林肠溶片口服,100mg/d。LMWH组患者分别于LMWH注射前和治疗后1h、2h、3h、4h、5h、6h、7h、治疗后第8天检查甲襞微循环,对照组分别于治疗前和治疗后第8天检查甲襞微循环。两组患者治疗前、治疗后第8天进行神经功能缺损程度评分和疗效评定。结果与治疗前比较,LMWH组治疗后2h～5h甲襞微循环总积分明显下降(P<0.01),尤其以治疗后3h最明显。LMWH组、对照组的总有效率88%和60%,两者差异有统计学意义(P<0.05)。两组治疗前后的神经功能缺损评分、甲襞微循环总分对比差异有统计学意义(P<0.05或P<0.01),LMWH组治疗前后神经功能缺损评分、甲襞微循环总分减分率分别为0.60±0.33和0.32±0.26,两者呈正相关(r=0.47,P<0.05)。结论LMWH可有效改善CI患者的微循环状态,改善其神经功能和预后,是CI早期治疗的有效手段之一。