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 evaluate the efficacy and safety of low molecular weight heparin(LMWH) in prophylaxis of postoperative deep vein thrombosis (DVT) following hip and knee surgery. METHODS From April 1997 to October 1998, 46 patients undergoing hip and knee orthopedic procedures were randomized into 2 groups for studying. The following eligibility criteria were applied: age over 40 years old, no recently history of venous thromboembolism (over 3 months), normal result of preoperative hemostasis test and normal result of Doppler examination of the lower extremities. One group was control group and the other group received subcutaneously a low molecular weight heparin(Fraxiparine) with anti-factor X, activity of 41 IU/kg.day for three days, then 62 IU/kg.day from the 4th day to 10th day. All patients had venegraphy performed in the operated leg at 4 to 7 days after surgery. RESULTS eight patients(34.8%) developed DVT in the control group of 23 patients and 1 patient (4.3%) in the experimental group, also of 23 patients(P lt; 0.05). Two groups had no any bleeding complications. CONCLUSION The low molecular weight heparin is safe and effective in preventing postoperative deep vein thrombosis in patients following hip and knee surgery.
Objective To analyze the effect of arteriovenous impulse system (AVIS) combined with lowmolecular-weight heparins calcium (LMWHC) for prophylaxis of deep vein thrombosis (DVT) following total knee arthroplasty (TKA). Methods From March 2006 to March 2008, 76 cases of osteoarthritis patients (76 knees) accepted TKA, including 25 males and 51 females with an average age of 66.6 years (range, 58-79 years). The affected knees were left side in 41 cases and right side in 35 cases. They were randomly divided into experimental group and control group before surgery. Then LMWHC and rehabil itation training were routinely given in two groups before and after surgery. However, only experimental group was treated with AVIS continually during the first four days and then two times a day for 30 minutes one time during 5-7 days. At 7 daysd after operation, color Doppler ultrasound was used to detect the occurrence condition of DVT. Results Five cases (13.16%) had thrombosis of calf and recovered after treated with urokinase and salvia in the experimental group. Eleven cases had thrombosis of calf and 3 cases had thrombosis of whole low extremities (36.84%), and improved after treated with urokinase and salvia in the control group. There was significant difference in DVT incidencerate between two groups (P lt; 0.05). No pulmonary embol ism or death was found in both groups. Conclusion AVIScan effectively accelerate the venous blood return velocity, a combination of AVIS and LMWHC has a better effect in theprevention of DVT following TKA.
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 systematically review the safety of low molecular weight heparin (LMWH) in pregnancy. MethodsPubMed, EMbase, The Cochrane Library, WanFang Data, VIP, and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the safety of LMWH in pregnancy from inception to March 30th, 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. ResultsA total of 77 RCTs and 13 cohort studies were included. The results of meta-analysis showed that LMWH increased the incidence of postpartum hemorrhage (RR=1.50, 95%CI 1.00 to 2.25, P=0.05). However, there was no significant difference. The incidence of hematological adverse events was different from the results of RCTs and cohort studies. The results of RCT subgroup analysis showed that LMWH increased ecchymosis at the injection site (RR=1.60, 95%CI 1.24 to 2.08, P=0.000 4). However, the incidence of overall skin system adverse events did not increase significantly. LMWH reduced the incidence of cardiovascular adverse events (RR=0.18, 95%CI 0.07 to 0.46, P=0.000 3). LMWH failed to increase the occurrence of fetal congenital malformations, digestive system, central nervous system, skeletal system, and systemic adverse events. ConclusionsCurrent evidence suggests that LMWH is relatively safe to use during pregnancy. However, whether it increases postpartum hemorrhage and hematological adverse events is unclear. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
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 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.
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.
Objective To investigate the safety and efficacy of two different anticoagulation regimens of fondaparinux and low molecular weight heparin (LMWH) in continuous renal replacement therapy (CRRT). Methods The clinical data of patients undergoing CRRT in West China Hospital of Sichuan University between October 2021 and April 2022 were retrospectively analyzed. The patients were divided into fondaparinux sodium group and LMWH group according to anticoagulation with fondaparinux or LMWH during CRRT. The general condition, life expectancy of cardiopulmonary bypass, coagulation events, bleeding events, hemoglobin, and coagulation function-related indicators were compared between the two groups. Results A total of 78 patients were finally included, including 38 in the LMWH group and 40 in the fondaparinux group. The age of the patients in the LMWH group was older than that in the fondaparinux group [76.0 (57.0, 85.0) vs. 63.0 (52.3, 76.0) years, P=0.016]. There was no significant difference in other clinical baseline conditions (including gender, vascular access site, and treatment indications) between the two groups (P≥0.05). The cardiopulmonary bypass life of patients in the fondaparinux group was better than that in the LMWH group [67.1 (35.0, 72.0) vs. 42.0 (20.0, 55.3) h, P=0.003]. The survival rate of cardiopulmonary bypass in the fondaparinux group at 24, 48, and 72 h were higher than that in the LMWH group (87.5% vs. 65.8%, P=0.023; 67.5% vs. 36.8%, P=0.007; 42.5% vs. 13.2%, P=0.004). The incidence of blood filter coagulation events in the fondaparinux group was lower than that in the LMWH group (50.0% vs. 84.2%, P=0.001). There was no significant difference in the incidence of coagulation events and mild bleeding events between the two groups (P>0.05). There was no significant difference in hemoglobin and coagulation function-related indicators between the two groups before and after CRRT (P>0.05). Conclusion The continuity of maintenance therapy with fondaparinux is better than that of LMWH, and the safety of both in the course of CRRT treatment is comparable.
Abstract： Objective To compare the influence of different doses of low molecular weight heparin on blood coagulation system of patients who have received thoracic surgery. Methods Eightytwo patients (with lung cancer, esophageal cancer, thymoma, pleural endotheliomas or other diseases) who were treated in Tongji Hospital of Huazhong University of Science and Technology from January 2009 to March 2010 were divided into three groups, based on the time of hospitalization. In the control group, there were 24 patients including 10 females and 14 males with an average age of 43.5±21.3 years. No low molecular weight heparin was given after operation. There were 32 patients in group I, including 14 females and 18 males, with an average age of 45.2±18.6 years. An amount of 0.2 ml (2 125 U) low molecular weight heparin was subcutaneously injected daily during the first 7 days after operation. In group Ⅱ, there were 26 patients including 11 females and 15 males with an average age of 43.8±20.1 years. An amount of 0.4 ml (4 250 U)low molecular weight heparin was subcutaneously injected daily during the first 7 days after operation. The differences of preoperative and postoperative coagulation factors including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D dimer (D-D), platelet count (PLT) and anti-Ⅹa activity were observed. Results The preoperative average values of PT, APTT, Fib, D-D, PLT of all the three groups were in the normal range and showed no significant difference (Pgt;0.05). For all three groups, after operation, PT prolonged, APTT shortened, the amount of Fib, D-D increased, PLT reduced on the 3rd day and then increased on the 7th day and anti-Ⅹa activity increased, all of which showed a significant difference from preoperative values (Plt;0.05). The amount of Fib in group Ⅱ was significantly lower than that in group Ⅰ after operation (the 5th day after operation: 4.7±2.5 g/L vs. 7.0±3.3 g/L, Plt;0.05); the amount of D-D in group Ⅱ was significantly lower than that in the control group (the 5th day after operation: 891.3±891.3 μg/L vs. 1 583.2±984.7 μg/L, Plt;0.05) and group Ⅰ (the 5th day after operation: 891.3±891.3 μg/L vs. 1 452.6±1 052.9 μg/L,Plt;0.05); and the anti-Ⅹa activity of group Ⅱ was significantly higher than that in group Ⅰ (the 5th day after operation: 0.54±0.05 U/ml vs. 0.29±0.04 U/ml, Plt;0.05). Conclusion In a certain weight range, fixeddose (4 250 U) of low molecular weight heparin is able to improve postoperative hypercoagulable state and avoid the occurrence of venous thromboembolism without increasing risk of complications like bleeding.