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。
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.
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.
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.
Objective To investigate the impact of preoperative use of low-molecular-weight heparin （LMWH） on early outcomes of off-pump coronary artery bypass grafting （OPCAB） . Methods Clinical data of 809 patients undergoingisolated OPCAB from April 1st，2011 to September 30th，2012 in the First Affiliated Hospital of China Medical University were retrospectively analyzed. All the patients were divided into LMWH group and control group according to preoperative use of LMWH or not. In LMWH group，there were 386 patients including 290 male and 96 female patients with their age of 49-81 years，who routinely received anticoagulation therapy with LMWH （LMWH sodium or LMWH calcium，4 000 U twice a day，subcutaneous injection） after discontinuation of anti-platelet therapy until the day before surgery. In the control group，there were 423 patients including 321 male and 102 female patients with their age of 46-78 years，who didn’t receive LMWH or any other anticoagulant after discontinuation of anti-platelet therapy. Postoperative mortality，incidence of perioperative myocardial infarction （MI），operation time，amount of blood loss and transfusion，and incidence of postoperative acute renal injury were compared between the 2 groups. Results Intraoperative blood loss （296±94 ml vs. 249±81 ml，P=0.03），postoperative thoracic drainage （526±159 ml vs. 410±125 ml，P=0.02），blood transfusion （2.6±1.1 U vs. 1.4±0.9 U，P=0.04） and operation time （172±34 min vs. 154±41 min，P=0.04） of LMWH group were significantly larger or longer than those of the control group. There was no statistical difference in postoperative mortality（1.0% vs. 1.2%，P=1.00）or incidence of perioperative MI（4.4% vs. 3.8%，P=0.55）between the 2 groups. Conclusion For OPCAB patientswith stable ischemic heart disease，preoperative management without use of LMWH can decrease operation time and amountof blood loss and transfusion without increasing postoperative mortality or incidence of perioperative MI.
ObjectiveTo systematically review the clinical efficacy of low molecular weight heparin (LMWH) in treating patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). MethodsDatabases including PubMed, The Cochrane Library (Issue 10, 2013), EMbase, CBM, CNKI, VIP and WanFang Data were searched for the randomized controlled trials (RCTs) about LMWH in treating acute exacerbation of COPD from the establishment to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of the included studies. Meta-analysis was then performed using RevMan 5.2 software. ResultsA total of 6 RCTs involving 501 patients were finally included. The results of meta-analysis showed that:compared with the control group, LMWH significantly improved levels of D-dimmer (MD=-0.28, 95%CI-0.50 to-0.05, P=0.02), reduced carbon dioxide partial pressure (PaCO2) (MD=-3.42, 95%CI-6.66 to-0.18, P=0.04), improved coagulation (PT) (MD=1.85, 95%CI 1.29 to 2.42, P < 0.000 01), and improved clinical symptoms and signs (RR=1.33, 95%CI 1.12 to 1.58, P=0.001), but it did not improve oxygen partial pressure (PaO2) (MD=0.28, 95%CI-3.04 to 3.61, P=0.87). During treatment, no severe adverse reaction occurred in both groups. ConclusionLMWH could significantly improve symptoms caused by acute exacerbation of COPD. Due to limited quantity and quality of the included studies, the above conclusion needs to be confirmed by conducting more high quality RCTs with larger sample size.
ObjectiveTo systematically evaluate the efficacy and safety of different low-molecular-weight heparins (LMWHs) in improving pregnancy outcomes in patients with recurrent abortion. MethodsThe PubMed, EMbase, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to July 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 16.0 software. ResultsA total of 25 RCTs involving 4 631 patients were included. Enoxaparin, dalteparin, nadroparin, and tinzaparin were included. The results of network meta-analysis showed that the live birth rate of the tinzaparin was higher than that of enoxaparin and dalteparin. The live birth rate in nadroparin was higher than that in enoxaparin and dalteparin. The cumulative sorting probability showed that tinzaparin ranked best for improving the live birth rate, nadroparin ranked best for reducing the miscarriage rate, and enoxaparin ranked best for reducing the preterm birth rate. ConclusionCurrent evidence suggests that tinzaparin and nadroparin may be the best choice for improving pregnancy outcomes in patients with recurrent abortion. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo explore the concentration of the plasma homocysteine (Hcy) and the relationship with TOAST subtypes in patients with acute cerebral infarction. MethodsA total of 120 patients with acute cerebral infarction (ACI) treated from April 2012 to April 2013 were enrolled into the ACI group.They were classified with Korean TOAST classification as five subtypes:atherothrombosis (AT) type,small artery disease (SAD) type,cardioembolism (CE) type,stroke of other disease (SOD) type,and stroke of undetermined etiology (SUE) type.The plasma Hcy concentrations in each group and in 60 heathy people who were selected into the control group were measured.Furthermore,the relationship between plasma Hcy concentration and their subtypes were analyzed. ResultsThe plasma Hcy level in ACI group was significant higher than that in the control group (P<0.01).The levels of plasma Hcy were much higher in patients with AT,SAD,SOD,and CE than those in the control groups (P<0.01).In different subtypes,AT and SAD subtypes had higher homocysteine concentration than SUD and CE subtypes did.The concentration of Hcy in AT and SAD group had no significant difference. ConclusionACI is related to hyperhomocysteinemia.The plasma Hcy level varies with different TOAST subtypes of ACI,specially elevating in the subtypes of AT and SAD,which may indicate that hyperhomocysteinemia may increase stroke risk through proatherogenic effect and endothelial dysfunction.