胆钙化醇灭鼠剂的研究

长期高强度的施用抗凝血灭鼠剂,家栖鼠已经出现较大范围的拒食和耐药现象,需要研发一种可以有效克服抗凝血灭鼠剂耐药性或抗药性的新型灭鼠剂。胆钙化醇灭鼠剂(cholecalciferol)是一种安全性好、可以防治对抗凝血灭鼠剂产生抗药性鼠的新型灭鼠剂,在美国、新西兰等发达国家得到广泛应用。本文综述了胆钙化醇灭鼠剂的毒力、现场灭效、适口性及对抗药鼠灭效等国内外研究进展,以此展望胆钙化醇灭鼠剂在我国的应用潜力。     

左旋门冬酰胺酶对急性淋巴细胞白血病患者凝血功能的影响

目的探讨左旋门冬酰胺酶对急性淋巴细胞白血病患者凝血功能的影响。方法回顾性分析2013年1月~2017年1月我院血液科收治的100例急性淋巴细胞白血病患者的一般资料。所有患者在化疗前均未接受过任何抗凝治疗。入院后所有患者均接受常规治疗,即使用长春新碱+柔红毒素+波尼松诱导治疗,治疗后予VDLP方案化疗。同时加用左旋门冬酰胺酶8000 U/m2,静脉注射,隔日注射1次。治疗3个月后对其临床疗效进行评价,并对治疗期间的不良反应进行观察,同时比较患者治疗前及治疗后第1天、第7天的凝血功能各项指标的变化情况。结果 100例患者中,完全缓解22例、部分缓解40例、病情稳定26例、病情进展12例,总有效率达62%(62/100)。100例患者治疗期间,10例发生过敏、白细胞计数下降9例、8例出现胃肠道反应包括恶心、呕吐。治疗后第1天,100例患者的PT、APTT、TT水平较治疗前比较显著升高,差异存在显著性(P0.05或P0.01)。但患者的FIB水平与治疗前比较显著降低,差异存在显著性(P0.05)。治疗后1周,所有患者的PT、APTT、TT水平较治疗前比较,未见明显差异(P0.05),而FIB水平虽然较治疗后第1天有所升高,但差异不显著,但与治疗前水平比较显著降低,差异存在显著性(P0.05)。结论左旋门冬酰胺酶治疗急性淋巴细胞白血病疗效确切,安全性好,但易产生凝血功能异常等不良反应,因此,应用左旋门冬酰胺酶临床治疗急性淋巴细胞白血病中应动态监测患者的的凝血功能,才能积极纠正凝血功能障碍,必要时应停药。     

Arterial thrombotic manifestations in young women associated with the lupus anticoagulant

Summary To demonstrate the wide variety of clinical syndromes associated with the lupus anticoagulant (LAC), we report the case histories of three young females with arterial thrombosis in whom LAC was demonstrated. Two patients had a diagnosis of systemic lupus erythematosus and mixed connective tissue disease respectively; the other patient had no signs of underlying auto-immune disease. Arterial thrombotic events in young females should arouse suspicion of the presence of LAC although its pathophysiological significance is not established.     

Floating right heart thrombi: A pooled analysis of cases reported over the past 10 years

Introduction

Floating right heart thrombi (FRHTS) are a rare phenomenon associated with high mortality. Immediate treatment is mandatory, but optimal therapy is controversial.

Association of cerebral vasculitis with a lupus anticoagulant. A case with brain pathology

Summary The authors report the case of a sixty-five year old woman initially suffering from a thrombocytopenia. The patient was diagnosed as having an autoimmune disease with a lupus anticoagulant, positive antinuclear antibodies and negative anti-DNA antibodies. She then developed an encephalopathy which was fatal despite corticosteroids. Brain pathology revealed a vasculitis with some giant cells, evoking a granulomatous angiitis of the central nervous system. These clinical and biological features suggest a systemic lupus erythematosus with vasculitis or a primary granulomatous angiitis of the central nervous system. Taking into account the clinical manifestations and the presence of a lupus anticoagulant, we finally preferred to identify it as a primary antiphospholipid antibodies syndrome, despite absence of anticardiolipin antibodies. Contrary to thrombosis, vasculitis is rarely associated with an anticardiolipin antibody or a lupus anticoagulant. However, vasculitis in the course of primary antiphospholipid antibodies syndrome has been reported previously as in this case report.     

Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy： Endoscopic findings, clinical management and outcome

AIM: Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy. The purpose of this study was to describe the causes and clinical outcome of these patients. METHODS: From January 1999 to October 2003, 111 patients with acute upper gastrointestinal bleeding (AUGIB) were hospitalized while on oral anticoagulants. The causes and clinical outcome of these patients were compared with those of 604 patients hospitalized during 2000-2001 with AUGIB who were not taking warfarin. RESULTS: The most common cause of bleeding was peptic ulcer in 51 patients (45%) receiving anticoagulants compared to 359/604 (59.4%) patients not receiving warfarin (P<0.05). No identifiable source of bleeding could be found in 33 patients (29.7%) compared to 31/604 (5.1%) patients not receiving anticoagulants (P=0.0001). The majority of patients with concurrent use of non-steroidal anti-inflammatory drugs (NSAIDs) (26/35, 74.3%) had a peptic ulcer as a cause of bleeding while 32/76 (40.8%) patients not taking a great dose of NSAIDs had a negative upper and lower gastrointestinal endoscopy. Endoscopic hemostasis was applied and no complication was reported. Six patients (5.4%) were operated due to continuing or recurrent hemorrhage, compared to 23/604 (3.8%) patients not receiving anticoagulants. Four patients died, the overall mortality was 3.6% in patients with AUGIB due to anticoagulants, which was not different from that in patients not receiving anticoagulant therapy. CONCLUSION: Patients with AUGIB while on long-term anticoagulant therapy had a clinical outcome, which is not different from that of patients not taking anticoagulants. Early endoscopy is important for the management of these patients and endoscopic hemostasis can be safely applied.     

Circulating lupus type anticoagulant and pulmonary hypertension associated with mixed connective tissue disease

Summary We report the case of a young woman, with mixed connective tissue disease (MCTD), associated with disabling pulmonary hypertension and presence of the lupus anticoagulant. The lupus anticoagulant, an antibody directed against phospholipid components, was linked in our patient to extensive thrombophlebitis and premature labor. Raynaud's phenomenon progressed towards finger necrosis in spite of optimal vasodilating treatment. The part played by the lupus anticoagulant in pulmonary hypertension remains to be established. Both these complications responded to prednisolone therapy, but the improvement was limited and short-lived.     

SV预防血栓药理学作用及其机制研究探讨

血栓栓塞性疾病是人类首要致死病因,临床预防血栓药物均存在出血危险。选择性的内源性凝血途径抑制剂已成为低出血倾向预防血栓药物研发的重点方向。SV是以天然岩藻糖化糖胺聚糖(FG)为先导化合物经结构优化获得的选择性内源性凝血因子Xase抑制剂(IC50=30 nm),其抑制内源性凝血活性与依诺肝素相当,在等效抗凝血剂量的倍数剂量下出血倾向显著降低。本文探讨低出血倾向的SV预防血栓药理学作用及其机制,为选择性Xase抑制剂及其新药发现研究提供参考依据。     

Impact of time to resumption of antithrombotic therapy on outcomes after surgical evacuation of chronic subdural hematoma: A multicenter cohort study

BackgroundThe decision to resume antithrombotic therapy after surgical evacuation of chronic subdural hematoma (CSDH) requires judicious weighing of the risk of bleeding against that of thromboembolism. This study aimed to investigate the impact of time to resumption of antithrombotic therapy on outcomes of patients after CSDH drainage.MethodsData were obtained retrospectively from three tertiary hospitals in Singapore from 2010 to 2017. Outcome measures analyzed were CSDH recurrence and any thromboembolic events. Logistic and Cox regression tests were used to identify associations between time to resumption and outcomes.ResultsA total of 621 patients underwent 761 CSDH surgeries. Preoperative antithrombotic therapy was used in 139 patients. 110 (79.1%) were on antiplatelets and 35 (25.2%) were on anticoagulants, with six patients (4.3%) being on both antiplatelet and anticoagulant therapy. Antithrombotic therapy was resumed in 84 patients (60.4%) after the surgery. Median time to resumption was 71 days (IQR 29 – 201). Recurrence requiring reoperation occurred in 15 patients (10.8%), of which 12 had recurrence before and three after resumption. Median time to recurrence was 35 days (IQR 27 – 47, range 4 – 82 days). Recurrence rates were similar between patients that were restarted on antithrombotic therapy before and after 14, 21, 28, 42, 56, 70 and 84 days, respectively. Thromboembolic events occurred in 12 patients (8.6%), of which five had the event prior to restarting antithrombosis.ConclusionsTime to antithrombotic resumption did not significantly affect CSDH recurrence. Early resumption of antithrombotic therapy can be safe for patients with a high thromboembolic risk.     

对比抗血小板与抗凝治疗对心脏瓣膜置换同期行冠状动脉旁路移植术后桥血管通畅情况的影响

目的对比抗血小板与抗凝治疗对心脏瓣膜置换同期行冠状动脉(冠脉)旁路移植术(CABG)后桥血管通畅情况的影响。方法选择2011年1月至2017年12月于中国医学科学院阜外医院行心脏瓣膜置换同期CABG手术并规律随诊的患者96例,其中男性78例,年龄(43~73)岁,平均年龄(60.8±9.05)岁。所有患者分为两组,抗血小板组为移植生物瓣或行瓣膜成形术的患者,该组患者双联治疗(拜阿司匹林联合华法林)至术后3~6个月,之后单用拜阿司匹林抗血小板治疗;抗凝组为移植机械瓣的患者,该组患者双联治疗至术后3~6个月后单用华法林抗凝治疗,并按照指南要求维持INR水平。通过收集患者冠脉桥血管CT血管成像检查结果评价桥血管通畅情况。结果抗血小板组和抗凝治疗组乳内动脉桥的通畅率分别为80.0%vs.82.5%(P=0.8),大隐静脉桥通畅率分别为77.2%vs.72.1%(P=0.512);随访期间两组出血事件均为牙龈出血,抗血小板组和抗凝治疗组出血事件比率为14%vs.7.5%(P=0.307),两组间比较差异无统计学意义。结论长期抗凝治疗与抗血小板治疗在维持桥血管通畅率方面无显著差异,且在医师指导下接受抗凝治疗的出血风险并未显著高于抗血小板治疗。