凝血和抗凝及纤溶功能改变在进展型脑梗死患者中的临床意义

目的研究进展型脑梗死患者凝血、抗凝和纤溶系统功能指标的变化,探讨进展型脑梗死的发病机制,为其临床早期诊断和治疗提供依据。方法对比检测了209例进展型脑梗死患者与209例完全型脑梗死患者血浆凝血酶原时间、凝血酶时间、部分凝血活酶时间、纤维蛋白原、血小板聚集率、血管性血友病因子含量、抗凝血酶、组织型纤溶酶原激活物及纤溶酶原激活物抑制剂-1活性水平。结果与完全型脑梗死患者比较,进展型脑梗死患者的血浆凝血酶原时间、凝血酶时间、部分凝血活酶时间显著缩短,抗凝血酶、组织型纤溶酶原激活物水平显著降低,而纤维蛋白原、血小板聚集率、血管性血友病因子、纤溶酶原激活物抑制剂-1水平显著升高(P<0.01)。结论进展型脑梗死患者存在着明显的高凝血和较低的抗凝和纤溶活性。     

Acquired heparin-like anticoagulants: a second case in metastatic breast carcinoma and literature review

Summary We report the second case of an acquired heparin-like anticoagulant in a patient with disseminated breast carcinoma. AH but one of the small numbers of other cases have also been associated with an underlying malignancy. We comment on the distinction between an immunoglobulin and proteoglycan causing the antithrombin effect and suggest points of interest for consideration in any future cases together with a review of treatment options.     

肝硬化患者抗凝血酶Ⅲ的改变

本文对28例肝硬化患者和35例非肝病患者进行血清抗凝血酶Ⅲ蛋白含量和功能活性测定,两者有显著差异(P<0.01)。结果提示肝硬化患者血清抗凝血酶Ⅲ降低可能是肝硬化患者门静脉血栓形成的血液病理学基础。     

中国眼镜蛇毒蛋白酶(natrahagin)的抗凝作用

目的观察具有纤维蛋白原水解活性的中国眼镜蛇毒蛋白酶（ｎａｔｒａｈａｇｉｎ）在动物体内的抗凝作用。方法将不同浓 度的ｎａｔｒａｈａｇｉｎ分别静脉注射入大鼠体内,观察其在动物体内的抗凝作用并与生理盐水对照。凝血仪上直接测定血浆 凝血酶原时间（ＰＴ）、凝血酶时间（ＴＴ）和活化部分凝血活酶时间（ＡＰＴＴ）,双缩脲法测定血浆纤维蛋白原水平。结果与对照 组比较,不同剂量ｎａｔｒａｈａｇｉｎ静脉注射给药后,大鼠ＰＴ、ＴＴ和ＡＰＴＴ显著延长,效应呈浓度依赖性。剂量为０．１ｍｇ．ｋｇ·ｂｗ． 时,ＰＴ、ＴＴ和ＡＰＴＴ分别为对照组的１．５、１．５和１．９倍;兔血浆纤维蛋白原水平也显著降低,血浆纤维蛋白原水平降至 对照组的３３．３％。结论Ｎａｔｒａｈａｇｉｎ在体内具有抗凝活性。     

Updates in venous thromboembolism management: evidence published in 2016

The management of venous thromboembolic disease (VTE) is rapidly evolving and staying updated on practice-changing evidence can be challenging. In an attempt to alleviate this daunting task, we sought to determine the most important practice-informing articles published in 2016 relevant to the non-specialist provider managing VTE. We performed a systematic search of the literature, limiting the search to a publication date of 2016 (see Supplementary Appendix). Two reviewers screened the 3819 resulting abstracts to identify high-quality, clinically relevant publications related to VTE management.

Two hundred sixteen full-text articles were considered for inclusion. The five authors used a modified Delphi method to reach consensus on inclusion of 7 articles for in-depth appraisal, following predetermined criteria of clinical relevance to non-specialist providers, potential for practice change, and strength of the evidence.     

阿加曲班治疗急性脑梗死的有效性和安全性研究

目的：评价国产阿加曲班注射液治疗急性脑梗死的有效性及安全性.方法：观察急性脑梗死患者48例,采用随机、双盲、双模拟、阳性对照研究.将急性脑梗死患者随机分为阿加曲班注射液组和奥扎格雷钠组,分别用两种药物治疗,用药14 d,总观察时间为28 d.主要疗效指标采用MESSS评估;次要指标采用ADL评估.结果：（1）阿加曲班组患者治疗后第14天和第28天的主要疗效指标MESSS评分明显低于治疗前（P＜0.05或P＜0.01）;阿加曲班组的次要疗效指标ADL评分也低于治疗前（P＜0.01）,而奥扎格雷钠组的次要疗效指标与治疗前差异无统计学意义（P＞0.05）.（2）阿加曲班组治疗有效率为91.67%,奥扎格雷钠组有效率为87.50%,两组间比较差异无统计学意义（P＞0.05）.结果显示两种药物治疗急性脑梗死患者均有较好疗效;阿加曲班组疗效优于奥扎格雷钠组.患者在用药后未出现严重出血反应,无一例因不良事件停药.结论：国产阿加曲班注射液对急性脑梗死有肯定的疗效,对人体无明显的不良反应,是治疗急性脑梗死的安全、有效的药物.     

结肠癌患者凝血、抗凝、纤溶指标检测及其临床意义

目的：探讨结肠癌患者凝血、抗凝、纤溶指标的变化与其病理分型、分化程度、转移及患者预后的关系.方法：结肠癌患者109例,对照组41例.检测凝血酶原时间（PT）、活化部分凝血活酶时间（APT）、纤维蛋白原（FIB）、抗凝血酶（AT）、D-二聚体（D-Dimer）.结果：PT、APTT随病情加重稍有延长但各组间差异无统计学意义（P＞0.05）;FIB、D-Dimer随病情加重而增高,AT随病情加重活性逐渐降低,此3项指标各组间差异均有统计学意义（P＜0.05）.结论：结肠癌患者存在明显的凝血、抗凝及纤溶机制的异常且其变化与病情发展及预后有关.     

Argatroban during percutaneous transluminal coronary angioplasty: Results of a dose-verification study

Background. Thrombin is a key enzyme in thrombogenesis. In animals, specific antithrombotic therapy at the time of coronary angioplasty reduced the incidence of subacute occlusion and inhibited the restenosis response. Argatroban is a highly selective synthetic thrombin antagonist that binds in a competitive manner. This is a report of a dose-verification study, assessing the safety and feasibility of intravenous Argatroban administration in patients undergoing percutaneous transluminal coronary angioplasty. Methods. Before angioplasty an intravenous bolus of 30 g/kg argatroban was administered, followed by a continuous infusion of 3.5 g/kg/min for 72 hours. Bolus injection was repeated, and the infusion rate was increased in order to achieve an activated coagulation time (ACT) of over 300 seconds. Following interim analysis, the bolus and initial infusion rate for the subsequent treatment groups was determined. Study endpoints were the occurrence of adverse events, coagulation tests, and qualitative angiogram reading. Patients were monitored by continuous 12-lead electrocardiographic recording over 24 hours, and underwent control angiography 18–24 hours following angioplasty. Results. Four treatment groups, comprised of 2, 8, 9, and 11 patients, respectively, were studied. The first two patients were excluded from analysis, since the initial dose was ineffective to attain an ACT-authorizing coronary angioplasty. The group with the highest dosage received a 250 g/kg intravenous bolus of argatroban, followed by a 4 hour infusion of 15 g/kg/min. At 4 hours the infusion rate was lowered to 3.8 g/kg/min and was continued for 68 hours without adjustment for catheter removal. The adverse event profile included myocardial infarction, aortocoronary bypass graft, bailout procedures, and repeat coronary angioplasty. Thrombin-time (TT), activated partial thromboplastin time (APTT), and prothrombin time (PT) were significantly related to argatroban plasma concentration, as demonstrated by regression analyses (R-square 0.64, 0.71, and 0.84, respectively). Prothrombin fragments 1 and 2 and thrombin-antithrombin III complex did not fit into a mathematical model, but showed slightly increased levels after reduction or cessation of the infusion rate. Conclusions. This dose-verification study, including 30 patients at four dose levels, indicated that argatroban infusion in coronary angioplasty patients can be administered safely, and results in an adequate and predictable level of anticoagulation.