低分子肝素联合华法林早期抗凝治疗颅内静脉窦血栓临床效果观察

Anticoagulation effect of LMWH combined with warfarin on intracranial venous sinus thrombosis at early stage

目的：探讨颅内静脉窦血栓采用华法林与低分子肝素（LMWH）联合实施早期抗凝治疗的临床疗效。方法将2011年1月至2015年1月收治并符合研究标准的颅内静脉窦血栓48例患者随机分为两组，每组24例。华法林组口服华法林治疗，2.5 mg/次，2次/ d；联用组采用口服华法林2.5 mg/次＋低分子肝素注射治疗。对比两组临床疗效、静脉窦恢复情况，并检测对比两组凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（ FBG）等凝血四项指标变化情况。结果联用组临床疗效（87.50%）高于华法林组（62.50%），差异有统计学意义（P 〈0.05）；治疗后，联用组静脉窦恢复率（83.33%）高于华法林组（54.17%），差异有统计学意义（P 〈0.05）；两组治疗后 PT、FBG、TT、APTT 等凝血四项指标均较治疗前显著改善，PT、TT、APTT 显著升高，FBG 显著下降，且联用组 PT、APTT、FBG 改善效果均优于华法林组，差异有统计学意义（P 〈0.05）。结论颅内静脉窦血栓采用华法林与低分子肝素联合实施早期抗凝治疗效果显著，能有效恢复再通颅内静脉窦血栓，改善 PT、FBG、TT、APTT 等凝血指标，值得推广。

Objective To investigate the anticoagulation effect of warfarin combined with low molecular weight heparin（ LMWH） on cerebral venous sinus thrombosis（ CVST） at early stage. Methods From January 2011 to January 2015,48 patients with intracranial venous sinus thrombosis were randomly divided into the warfarin group and the combination group,with 24 cases in each group. The patients in the warfarin group were treated with oral warfarin 2. 5 mg / times,2 times/ d,and the pa-tients in the combination group were treated with oral warfarin 2. 5mg / times and low molecular weight heparin treatment. The clinical efficacy,the recovery of venous sinus,and prothrombin time（ Pt）, thrombin time and thrombin time（TT）and activated partial extra transportation charges time（APTT）,fi-brinogen（ FBG）of the two groups were compared. Results The clinical efficacy in the combination group（87. 50% ）was higher than that of the warfarin group（62. 50% ）,the difference was significant （P 〈 0. 05）. After treatment,the venous sinus recovery rate in the combination group（83. 33% ）was higher than that in the warfarin group（54. 17% ）,the difference was significant（P 〈 0. 05）. After treat-ment,the levels of PT,FBG,TT,APTT significantly improved compared with before treatment,the lev-els of PT,TT,APTT increased significantly,the level of FBG decreased significantly,and the levels of PT,APTT and FBG in the combination group were superior to those in the warfarin group,the differences were significant（P 〈 0. 05）. Conclusions The anticoagulation effect of warfarin combined with LMWH on CVST at early stage is remarkable,it can effectively restore recanalization of intracranial venous sinus thrombosis,improve the levels of PT,FBG,TT and APTT,so it is worthy to be popularized.