ObjectiveTo evaluate efficacy and safety of early anticoagulation therapy with low molecular weight heparin (LMWH) in prevention of venous thromboembolism (VTE) after pancreatoduodenectomy (PD).MethodsThe patients who received PD in our hospital from January 2017 to December 2018 were collected retrospectively, then were divided into the anticoagulant group and the non-anticoagulant group. The operation time, intraoperative blood loss, tumor property, coagulation function indexes such as prothrombin time (PT), PT activity (PTA), fibrinogen (FIB), activated partial thromboplastin time (APTT), thrombin time (TT), and D-dimer (DD), platelet (PLT), VTE, bleeding related complications etc. were compared between the two groups.ResultsA total of 103 patients underwent PD were included in this study, including 52 patients in the anticoagulant group and 51 patients in the non-anticoagulant group. There were no significant differences in the baseline data such as the gender, age, and preoperative coagulation function indexes, etc. between the two groups (P>0.05). The incidence of VTE in the anticoagulant group was lower than that in the non-anticoagulant group (13.5% versus 47.1%, P<0.001). There was no significant difference in the incidence of bleeding between the anticoagulant group and the non-anticoagulant group (9.6% versus 7.8%, P>0.05). There were no statistically significant differences in the coagulation indexes between the two groups before operation and day 1 after operation (P>0.05). On day 8 after operation, the FIB and DD values of the anticoagulant group were significantly lower than those of the non-anticoagulant group (P values were 0.040 and 0.002, respectively). A comparison of different phases in the same group on coagulation indexes between day 8 and day 1 after surgery showed that there were statistically significant differences (P<0.05), the changes of all indexes were within the normal range.ConclusionThe results of this study indicate that LMWH administered at 24 h after PD could decrease incidence of VTE and don’t increase risk of bleeding.
目的探讨低分子肝素预防下肢静脉曲张术后深静脉血栓形成的临床效果。 方法将2011年1月至2013年12月期间于笔者所在医院行大隐静脉高位结扎＋分段剥脱术＋腔内激光闭合术的513例下肢静脉曲张患者随机分为2组：低分子肝素组238例，下肢静脉曲张术后采用低分子肝素预防性治疗；对照组275例，术后不采用任何抗凝药物。比较2组患者深静脉血栓形成和并发症发生情况。 结果低分子肝素组发生浸透敷料的出血14例（5.9%），切口出血或皮下血肿25例（10.5%），血小板减少1例（0.4%），肝功能异常2例（0.8%），无深静脉血栓形成发生；对照组发生浸透敷料的出血19例（6.9%），切口出血或皮下血肿27例（9.8%），肝功能异常2例（0.7%），深静脉血栓形成7例（2.5%），无血小板减少发生。2组患者浸透敷料的出血、切口出血或皮下血肿、血小板减少及肝功能异常发生率比较差异均无统计学意义（P＞0.05），但低分子肝素组深静脉血栓形成的发生率低于对照组（P＜0.05）。术后获访487例，随访时间为4～12个月，平均10个月。其中低分子肝素组获访225例，对照组获访262例。获访患者随访期间发生下肢静脉曲张复发9例（低分子肝素组4例，对照组5例），隐神经损伤11例（低分子肝素组5例，对照组6例），无远期下肢深静脉血栓形成病例。2组患者的下肢静脉曲张复发率和隐神经损伤发生率比较差异均无统计学意义（P＞0.05）。 结论采用低分子肝素预防下肢静脉曲张术后下肢深静脉血栓形成具有良好的临床效果和安全性，值得临床推广应用。
Objective To investigate the diagnosis and treatment of pulmonary thromboembolism (PTE) after thoracotomy. Methods We analyzed the clinical data of 10 patients with PTE after thoracotomy treated from January 2011 to March 2015. Among them were 8 males and 2 females, with their age ranging from 51 to 73 years old, averaging 61. Six patients had lung cancer lobectomy, and 4 had esophagus carcinoma resection. All the 10 patients suffered sudden shortness of breath, chest pain and palpitation within the first 40 hours to 128 hours after surgery, and the physical examinations revealed tachypnea, drop of blood pressure and tachycardia. The PTE diagnosis was confirmed after using echocardiography, three-dimensional imaging of CT pulmonary angiography. All the patients accepted the treatment combination of low molecular weight heparin and warfarin. Results All the patients were cured without complications like chest or wound bleeding. Follow-up checks 3 months after the surgery showed no relapses. Conclusions Thoracotomy patients are of high risks of PTE. The diagnosis should be based on imaging examinations. Treatment combination of low molecular weight heparin and warfarin has a remarkable effect in treating PTE patients after thoracotomy, which also has a low rate of bleeding complications.
ObjectiveTo explore the effect of different doses of low molecular weight heparin (LMWH) on the patency rate of cuffed central venous catheter used by patients for hemodialysis therapy.MethodsFrom June 2012 to January 2018, patients who received long-term hemodialysis in 363 Hospital with cuffed central venous catheter were enrolled in this retrospective study. According to the dose of LMWH used in hemodialysis, they were divided into below 60 U/kg group and greater than or equal to 60 U/kg group. The general parameters, frequency of urokinase use, bleeding events, severe coagulation in dialysis line and occurrence of catheter dysfunction were collected and compared between two groups.ResultsA total of 48 cases were enrolled. Of these, the doses of LMWH of 31 cases were below 60 U/kg and 17 cases were greater than or equal to 60 U/kg. There was no significant difference between the two groups in terms of age, sex, diabetes, hemoglobin, platelets, albumin, low-density lipoprotein cholesterol, or hypersensitive C-reactive protein parameters (P>0.05). Between the below 60 U/kg group and the greater than or equal to 60 U/kg group, there was no statistically significant difference in the incidence of catheter dysfunction (16.1% vs. 29.4%; χ2=0.507, P=0.476) or the incidence of bleeding events (1.77 vs. 2.81 times per 1 000 catheter-days; χ2=1.500, P=0.221). The frequency of urokinase used in the two group were 27.89 and 36.18 times per 1 000 catheter-days, respectively (χ2=5.927, P=0.015) and the frequency of severe coagulation were 6.88 and 2.30 times per 1 000 catheter-days, respectively (χ2=5.140, P=0.023). The differences were statistically significant.ConclusionThe lower dose of LMWH used in hemodialysis for preventing extra-corporeal circuit thrombosis does not result in the decrease of the patency rate of cuffed central venous catheter.
ObjectiveTo systematically review the efficacy and safety of different low-molecular-weight heparins (LMWHs) for prevention of thromboembolic events in patients with atrial fibrillation (AF).MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized clinical trials (RCTs) on efficacy and safety of different low-molecular-weight heparins (LMWHs) in preventing thrombotic diseases in patients with atrial fibrillation from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 16.0 software.ResultsA total of 11 RCTs involving 7 400 patients who were treated with enoxaparin, dalteparin, or tinzaparin to prevent thromboembolic events were included. The results of network meta-analysis showed that: in patients with AF and perioperative AF patients, there were no statistical differences in the incidence of stroke, TIA, major bleeding, minor bleeding, and all-cause mortality caused by dalteparin, enoxaparin, and tinzaparin. Furthermore, the surface under the cumulative ranking area (SUCRA) showed that enoxaparin was superior for prevention of stroke and TIA than dalteparin and tinzaparin. As for major bleeding, minor bleeding, and all-cause death, dalteparin treatment was superior than enoxaparin.ConclusionsCurrent evidence showed enoxaparin to be a viable option for high ischemic risk AF patients requiring LWMH treatment, while dalteparin to be a viable option for those with bleeding high risk. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Objective To investigate the pathogenesis of deep vein thrombosis (DVT) after total hip arthroplasty (THA) and the preventive effectiveness of low molecular weight heparin (LMWH). Methods The occurrence condition of DVT in 90 cases undergoing THA treated with LMWH between February 2003 and March 2004 was restrospectively analyzed. Among 90 cases, 39 were treated with LMWH at a dose of 5 000 U/day (high dose group) and 51 at a dose of 2 500 U/day (low dose group). Another 90 cases undergoing THA without LMWH treating between February 2002 and February 2003 were used as control group. There was no significant difference in gender, age, illness cause, course of disease, or the type of prosthesis among 3 groups (P gt; 0.05). Results DVT occurred in 19 cases (21.1%) of control group, in 2 cases (5.1%) of high dose group, and in 5cases (9.8%) of low dose group, showing significant differences between two treated groups and control group (P lt; 0.05), but no significant difference between two treated groups (P gt; 0.05). There was no significant difference in gender, age (gt; 65 years and ≤ 65 years), pathogen (trauma and bone disease) of each group, as well as of the same type patients within 3 groups (P gt; 0.05). The DVT incidence rate in the patients with bone cement artificial joint was significantly higher than that in the patients with non-bone cement artificial joint (P lt; 0.05), but there was no significant difference in the same type patients within 3 groups (P gt; 0.05). The postoperative blood loss in high dose group, low dose group, and control group was (463.5 ± 234.2), (342.4 ± 231.6), and (288.2 ± 141.6) mL; showing no significant difference between the high and low dose groups, between low dose and control groups (P gt; 0.05), while showing significant difference between high dose and control groups (P lt; 0.05). Conclusion The DVT incidence rate in THA patients with bone cement artificial joint is high; LMWH can reduce the DVT incidence rate and has good safety.
ObjectiveTo investigate the clinical efficacy of low molecular weight heparin on community-acquired pneumonia (CAP). MethodsA total of 78 patients with CAP admitted to hospital between January 2013 and March 2015 were randomly assigned into a conventional treatment group and a heparin treatment group. Both groups received anti-infection and symptomatic treatment, and the patients in heparin treatment group additionally received low molecular weight heparin by abdominal subcutaneous injection once daily for a course with seven days. The age, sex and severity of the disease were recorded. White blood cell (WBC) count and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured on and during admission. ResultsThe baseline information including age and sex, severity of illness, CRP, ESR and WBC counts on admission and the first treatment day had no difference between two groups (P > 0.05). CRP and ESR on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significantly more decreased than those in the conventional treatment group (P < 0.05). For the moderate and severe CAP patients, the level of CRP on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significant lower than those in the conventional treatment group (P < 0.05). ConclusionCombination therapy of low molecular weight heparin may improve the clinical efficacy of CAP.
Objective During primary total knee arthroplasty (TKA), anticoagulant drugs are used for prevention of major venous thrombosis of lower limbs, and this often leads to the increase of perioperative blood loss. To retrospectively analyse the impact of low molecular weight heparin on hidden blood loss and transfusion rate after primary TKA by comparing with the use of aspirin. Methods Between October 2007 and August 2009, the clinical data from 286 patients undergoing primary TKA surgery were retrospectively analyzed. In accordance with different anticoagulation methods, the cases were divided into 2 groups, the trial group (n=166) and the control group (n=120). In the trial group, the patients received low molecular weight heparin (4 000-6 000 U/day) from 8-12 hours after TKA for 14 days; there were 27 males and 139 females with an average age of 66.1 years (range, 22-82 years); the body mass index (BMI) was 26.79 ± 3.87; and the locations were the left knee in 99 cases and the right knee in 67 cases with an average disease duration of 4.1 years (range, 1.8-8.6 years). In the control group, the patients received aspirin (150 mg/day) for 14 days; there were 21 males and 99 females with an average age of 64.9 years (range, 40-84 years); the BMI was 27.87 ± 3.62; and the locations were the left knee in 78 cases and the right knee in 42 cases with an average disease duration of 4.9 years (range, 1.5-8.2 years). There was no significant difference in the general data between 2 groups (P gt; 0.05). Results The incisions healed by first intention in all patients. Postoperative deep venous thrombosis occurred in 37 patients of the trial group and in 28 cases of the control group. All the patients were followed up 12-34 months (mean, 21.6 months). There were significant differences in the United States Hospital for Special Surgery (HSS) score of 2 groups between before surgery and after surgery (P lt; 0.05). The hidden blood loss was (40.55 ± 37.75) g/L in the trial group and (32.52 ± 40.13) g/L in the control group, showing significant difference (t=3.387, P=0.001); the dominant blood loss was (24.08 ± 14.63) g/L and (27.91 ± 18.47) g/L respectively, showing no significant difference (t= —1.899, P=0.059). The blood transfusion rates were 40.4% (67/166) in the trial group and 30.0% (36/120) in the control group, showing no significant difference (χ2=2.771, P=0.081); the transfusion volumes were (1.44 ± 4.03) U and (0.97 ± 3.50) U respectively, showing significant difference (t=2.071, P=0.039). Conclusion The low molecular weight heparin has effect on the hidden blood loss after primary TKA, which may increase postoperative blood loss and blood transfusion rate. The changes in hemoglobin should be monitored during the anticoagulant therapy, and the blood volume should be added promptly.
摘要:目的: 观察低分子肝素联合ACEI/ARB治疗糖尿病肾病(DN)的疗效。 方法 :将55例2型DN患者随机分为对照组(ACEI/ARB)和治疗组(ACEI/ARB+低分子肝素),疗程8周。比较两组治疗前和治疗后24h尿蛋白,Scr、BUN、血浆白蛋白等指标的变化。 结果 :(1)治疗后治疗组和对照组24h尿蛋白、Scr均显著下降(〖WTBX〗P lt;001,〖WTBX〗P lt;005),治疗组比对照组下降更为明显(〖WTBX〗P lt;005)。(2)治疗后两组血浆白蛋白均增加(〖WTBX〗P lt;001),治疗组与对照组治疗后比较无明显差异(〖WTBX〗P gt;005)。(3)治疗后两组BUN均降低(〖WTBX〗P lt;005),治疗组与对照组治疗后比较无明显差异(〖WTBX〗P gt;005)。(4)治疗后两组TC和TG均无明显变化。 结论 :联合应用低分子肝素能有效减少DN患者的蛋白尿,改善肾功能。Abstract: Objective: To study the clinical effects of lowmolecularweight heparin (LMWH) and ACEI/ARB on diabetic nephropathy(DN).Methods :55 patients of type 2 Diabetic nephropathy were randomly divided into treatment group(ACEI/ARB+ LMWH)and control group (ACEI/ARB).SCr,quantity of protein in 24hour urine,BUN and plasma albumin figures were compared between two groups before treatment and eight weeks after treatment.Results :(1)SCr,quantity of protein in 24hour urine had been decreased significantly in both groups(P lt;001,P lt;005),and more significantly in treated group than in control group (P lt;005).(2)Plasma albumin increased significantly in both groups(P lt;001).But no significantly increase of plasma albumin had been found in treatment group during the followup(P gt;005).(3)BUN decreased significantly in both groups(P lt;005), but no significantly decrease of BUN had been found in treatment group during the followup(P gt;005).(4)There were no significantly difference in TC and TG between two groups.Conclusion : LMWH and ACEI/ARB can ameliorate proteinuria and improve renal function of the patients with DN.