Prospective randomized clinical study in general surgery comparing a new low molecular weight heparin with unfractionated heparin in the prevention of thrombosis

A prospective, randomized, controlled clinical trial was performed comparing the antithrombotic efficacy of the low molecular weight heparin LMWH 21–23, (Braun) with an unfractionated heparin in elective general surgical patients over an observation period of 7 postoperative days. A total of 230 patients were admitted: 103 (group I) received low molecular weight heparin and 100 (group II) low-dose unfractionated heparin treatment given subcutaneously. In group I 41 patients (46%) were operated on for malignant disease and in group II 54 patients (54%). Due to the large amount of great abdominal procedures the intra- and perioperative application of hydroxyethyl starch was allowed for volume substitution. None of the patients died due to fatal pulmonary embolism. In group I four patients revealed positive ¹²⁵I-labeled fibrinogen uptake (3.9%); two patients belonged to the hydroxyethyl starch subgroup. In group II five patients displayed a positive fibrinogen uptake (5%); two belonged to the hydroxyethyl starch subgroup. The results of the hemostaseological investigations (e.g., prothrombin time, activated partial thromboplastin time, thrombin clotting time, fibrinogen, antithrombin III, protein C, plasminogen, ₂-antiplasmin , tissue-type plasminogen activator, plasminogen activator inhibitor) revealed no statistically significant differences between groups I and II or their subgroups, although a tendency to prolonged clotting times was observed. The antifactor Xa activity values, however, displayed a statistically significant difference between the two groups (P < 0.05). The antifactor Xa activity measured up to 0.16 U/ml for the low molecular weight heparin (group I) and 0.05 U/ml for the unfractionated heparin (group II) in the postoperative period. Major bleeding complications were not encountered in this study. Fundamental for the low incidence of thrombosis, the additive administration of hydroxyethyl starch appeared in almost one-third of the patients in both study groups.Abbreviations APTT activated partial thromboplastin time - aXa anti-factor Xa - DVT deep venous thrombosis - FUT ¹²⁵I-labeled fibrinogen uptake test - HES hydroxyethyl starch - LMWH low molecular weight heparin - PE pulmonary embolism - UFH unfractioned heparin     

Optimizing the treatment of unstable angina

Unstable angina and non-Q-wave myocardial infarction (MI) are at the center of the spectrum of myocardial ischemia, which ranges from stable angina to acute Q-wave MI. In addition to clinical evaluation, cardiac specific markers such as troponin T or I can assist in early diagnosis, triage, and risk stratification. Antithrombotic therapy with aspirin and heparin have been shown to improve the outcome of patients with acute ischemic syndromes. Thrombolytic therapy does not appear to be beneficial in these syndromes. Antiischemic therapy remains an important component of the overall therapy. A strategy of early coronary angiography and revascularization leads to a similar long-term outcome as compared with a more conservative strategy of revascularization for recurrent ischemia, but the early invasive strategy is more expeditious as a large number of conservatively treated patients have recurrent ischemia. At present, many new antithrombotic agents are under active investigation, with the hope that they will lead to further improvement in the clinical outcome of patients with acute ischemic syndromes.     

Further studies of the turnover of dog antithrombin III. Study of 131I-labelled antithrombin protease complexes

Fresh plasma containing 131I-antithrombin III (*I-AT) was coagulated and incubated at 37 degrees C for 2 hr. A "complex peak," separated on heparin-agarose contained AT and *I-AT antigen but no heparin cofactor activity. Crossed immunoelectrophoresis showed only AT complexes. SDS PAGE showed 80% of the *I-AT in a major band (approximately 80,000 daltons), 15% in a minor band (approximately 100,000 daltons) and the rest in trace bands (approximately 60,000 and/or 115,000 daltons). Ammonia treatment of the complex peak released alpha-thrombin. After i.v. injection 80% of the complexed *I-AT, chiefly as the major band, left the plasma with t 1/2 approximately 15 min and was almost immediately catabolized to low molecular weight breakdown products. A major catabolic site was the liver. A simple kinetic model describes the findings approximately.     

降纤酶低分子肝素治疗短暂性脑缺血发作的研究

目的 观察降纤酶与低分子肝素治疗短暂性脑缺血发作的效果及副作用。方法 选择本院神经内科住院患者36例应用降纤酶10U加入加入250ml生理盐水中静脉滴注，隔日1次，共3次；低分子肝素0．5ml脐旁皮下注射，12h 1次，连用7—10d,同时常规给予复方丹参滴注，口服尼莫地平，维生素E，维生素C，停用低分了肝素后给予肠溶阿斯匹林75mg，每日1次口服。结果 治疗开始后TLA发作相继减少，停止发作时间分别为1d内9例，3d内15例，5d内12例。随访6个月—1年，1例2个月后复发，重新应用上药治愈。结论 降纤酶与低分子肝素治疗TLA安全有效、无明显副作用、不易复发。     

尿激酶肝素治疗急性脑梗死临床研究

目的研究小剂量尿激酶与肝素治疗急性脑梗死的疗效及安全性.方法将100例急性脑梗死患者随机分为治疗组和对照组(各50例),治疗组给以小剂量尿激酶10万U加生理盐水50ml颈动脉注射,另 给以肝素50～100mg加生理盐水250ml静脉滴注,每日一次,共七天.对照组给以复方丹参20ml加生理盐水250ml,静脉滴注,每日一次,连用15d,两组均合并用甘露醇、阿斯匹林等.结果治疗后一周及治疗后一个月进行神经功能缺损状态评分,治疗组分别为8.2±2.9,9.6±4.6,对照组分别为4.4±2.3,7.3±2.4,两组对比有显著差异(P＜0.05),无出血并发症.结论小剂量尿激酶与肝素治疗急性脑梗死疗效肯定,安全性较好.     

低分子肝素治疗糖尿病肾病的疗效观察

目的　观察低分子肝素治疗糖尿病肾病的临床疗效和安全性。 方法　 将 30例临床期糖尿病肾病患者随机分为治疗组和对照组各 15例 ,所有病人均给予积极降糖降压治疗 ,治疗组加用低分子肝素 5 0 0 0U ,1次 /d治疗 ,疗程 8周。观察血脂、血小板、纤维蛋白原、肝肾功能、内生肌酐清除率、2 4h尿蛋白定量变化及副作用。 结果　治疗组治疗 8周后血脂、纤维蛋白原、2 4h尿蛋白定量下降 ,血尿素氮、肌酐降低 ,内生肌酐清除率升高 ,和治疗前及对照组治疗后比较均有显著性差异 (P <0 .0 1或P <0 .0 5 )。 结论　低分子肝素可安全有效的用于糖尿病肾病的临床治疗     

低分子肝素阿魏酸钠治疗不稳定型心绞痛

目的 了解低分子肝素与阿魏酸钠联合应用治疗不稳定型心绞痛的疗效，提高不稳定型心绞痛治疗效果。方法 选用本院治疗的120例病人，治疗组60例．对照组60例，对照组以静脉滴注二硝酸异山梨酯为主。治疗在对照组治疗基础上，采用低分子肝素5000U皮下注射，每日2次，连续7d，阿魏酸钠0．3加入5％葡萄糖液中缓慢滴注，1日1次，连用14d为一疗程。两组对比了心绞痛控制，心绞痛缓解和消失时间及心电图变化及治疗前后纤维蛋白原血浆比黏度等情况。结果 治疗组在心绞痛控制，心绞痛缓解和消失时间及心电图变化及血液比黏度，纤维蛋白原等情况，明显优于对照组。结论 低分子肝素联合阿魏酸钠治疗不稳定型心绞痛疗效显著。     

低分子量肝素与香丹合用治疗急性脑梗死效果评价

目的 :评价低分子量肝素与香丹注射液联用治疗急性缺血性脑梗死的临床疗效和安全性。方法 :10 0例病人分为 3组 ,联用组 4 0例 ,用低分子量肝素 5 0 0 0抗Xa国际单位腹部脐周皮下注射 ,每12h 1次 ,香丹注射液 4 0ml加入 5 %葡萄糖注射液5 0 0ml中 ,静脉滴注 ,每天 1次 ;低分子量肝素组 30例 ,只用低分子量肝素治疗 ;香丹组 30例 ,只用香丹注射液治疗。 3组治疗时间均为 10～ 14d。结果 :联用组的临床疗效高于低分子量肝素组和香丹组(P <0 .0 5 )。不良反应发生率 3组间无显著的统计学意义 (P >0 .0 5 )。结论 :低分子量肝素和香丹注射液联用治疗急性缺血性脑梗死效果优于单用其中一种药物治疗 ,不良反应发生率低 ,安全有效。     

抗凝药物的临床应用及安全性评价

目的 :评价抗凝药物肝素和维生素K拮抗剂的临床应用及安全性。方法 :查阅国内外近期相关文献进行综述。结果与结论 :临床上多种血栓栓塞、缺血性疾病中应用肝素、维生素K拮抗剂等抗凝药物时 ,应注意根据患者个体情况 ,掌握剂量 ,防治各种可能发生的不良反应     

低分子肝素用于急性心肌梗死溶栓后辅助治疗的临床观察

目的 :探讨低分子肝素用于急性心肌梗死溶栓后辅助治疗的疗效与安全性。方法 :6 4例急性心肌梗死患者采用尿激酶溶栓再通后随机分为肝素组 (肝素钙 75 0 0U皮下注射 ,每日 2次 )和低分子肝素组 (低分子肝素 0 .1mL/kg皮下注射 ,每日 2次 ) ,连续 7d。结果 :治疗后两组心肌再梗死、梗死后心绞痛、血管性死亡及出血肝素组均显著高于低分子肝素组 (P <0 .0 5 )。结论 :急性心肌梗死溶栓后使用低分子肝素代替普通肝素作为抗凝剂是安全有效的。