Low-molecular-weight heparin and preeclampsia—does the sword cut both ways?Three case reports and review of literature

BACKGROUND Low-molecular-weight heparins(LMWH)are the most commonly used anticoagulants during pregnancy.It is considered to be the drug of choice due to its safety in not crossing placenta.Considering the beneficial effect in the improvement of microcirculation,prophylactic application of LMWH in patients with preeclampsia became a trend.However,the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated.This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia.CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy.All the cases experienced catastrophic hemorrhagic events.After reviewing the twenty-one meta-analyses,the bleeding risk related with LMWH seems ignorable.Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH.Other studies reported minor bleeding risks,none of these were serious enough to stop LMWH treatment.Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored.Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial.CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.

Clinical effectiveness of a pneumatic compression device combined with low-molecular-weight heparin for the prevention of deep vein thrombosis in trauma patients:A single-center retrospective cohort study

BACKGROUND:To investigate the clinical effectiveness of a pneumatic compression device(PCD)combined with low-molecular-weight heparin(LMWH)for the prevention and treatment of deep vein thrombosis(DVT)in trauma patients.METHODS:This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020.Patients treated with only LMWH served as the control group,and patients treated with a PCD combined with LMWH as the observation group.The incidence of DVT,postoperative changes in the visual analogue scale(VAS)score,and coagulation function were observed and compared between the two groups.Excluding the influence of other single factors,binary logistic regression analysis was used to evaluate the use of a PCD in the patient’s postoperative coagulation function.RESULTS:After excluding 34 patients who did not meet the inclusion criteria,252 patients were were included.The incidence of DVT in the observation group was significantly lower than that in the control group(5.6%vs.15.1%,χ^(2)=4.605,P<0.05).The postoperative VAS scores of the two groups were lower than those before surgery(P<0.05).The coagulation function of the observation group was significantly higher than that of the control group,with a better combined anticoagulant effect(P<0.05).There were no significant differences between the two groups in preoperative or postoperative Glasgow Coma Scale scores,intraoperative blood loss,postoperative infection rate,or length of hospital stay(P>0.05).According to logistic regression analysis,the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD(P<0.05).The area under the receiver operating characteristic(AUROC)curve of partial thromboplastin time(APTT)and platelet(PLT)were greater than 0.5,indicating that they were the influence indicators of adding PCD to prevent DVT.Excluding the influence of other variables,LMWH+PCD effectively improved the coagulation function of patients.CONCLUSIONS:Compared with LMWH alone,LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture,reduce the incidence of DVT,shorten the length of hospital stay,and improve the clinical effectiveness of treatment.

Impact of Pharmaceutical Care on Self-Administration of Outpatient Low-Molecular-Weight Heparin Therapy

Outpatient subcutaneous (s.c.) therapies are becoming more and more common in the treatment of different diseases. The effectiveness of community-pharmacy-based interventions in preventing problems that arise during s.c. self-injections of low-molecular-weight heparins (LMWH) is unknown. Our objective was to provide a standard operating procedure (SOP) for community pharmacists and to compare pharmaceutical vs. standard care in both clinical and daily life settings. We hypothesized that: pharmaceutical care results in improved adherence, safety, and satisfaction, and in fewer complications;the interventions used are feasible in daily life;and the results achieved in clinical and daily life settings are comparable. In the clinical setting (randomized controlled trial), patients were recruited sequentially in hospital wards;in the daily life setting (quasi-experimental design with a comparison group), recruitment took place in community pharmacies by pharmacists and trained master students during their internship. Interventions were offered according to patient needs. Data were collected by means of a monitored self-injection at home and structured questionnaire-based telephone interviews at the beginning and the end of the LMWH treatment. The main outcome measures were: scores to assess patient’s skills;syringe count to assess adherence;and frequency, effectiveness, and patient’s assessment of received interventions. The results show a median age of the 139 patients of 54 years. Interventions resulted in improved application quality (p p = 0.03). Oral instructions were pivotal for improving patients’ application quality. We found no significant score differences between the intervention groups in the clinical and daily life settings. Patients’ baseline skills were high, with the lowest score being 0.86 (score range ?2.00 to +2.00). Adherence rate was high (95.8%). In conclusion, our SOP for pharmacist interventions was of good quality, adequate, appreciated, and feasible in daily life. Patients are capable of managing s.c. injection therapies if adequate assistance is provided.

Evaluation of a Dose-Monitoring Method for Prophylactic Anticoagulant Therapy with Low-Molecular-Weight Heparin

Objective: In the present study, we report on the results of our investigation of optimum dose monitoring using coagulation and fibrinolytic system indicators during obstetric prophylactic anticoagulant therapy with enoxaparin. Study Design: Of 103 cases of cesarean section performed at our hospital, 37 cases were selected for this study after obtain ing their consent for blood collection. Variables of the coagulation and fibrinolytic systems [anti-factor Xa activity, endogenous thrombin potential (ETP), prothrombin time (PT) or international normalized ratio (INR), activated partial thromboplastin time (APTT) and D-dimer levels] were determined. Results: In the 5-day administration group, the anti-factor Xa activitywas 0.0 U/ml on the postoperative day 1, increased to 0.05 U/ml ± 0.04 U/ml on the postoperative day 3, and mildly increased to 0.06 U/ml ± 0.05 U/ml on the postoperative day 5. On the other hand, the anti-factor Xa activity in the 3-day administration group was 0.0 U/ml on the postoperative day 1 (before enoxaparin administration), increased to 0.06 U/ml ± 0.05 U/ml on the postoperative day 3, and significantly decreased to 0.02 U/ml ± 0.03 U/ml on the postoperative day 5 (p = 0.003);thus, the pattern of change was significantly different from that in the 5-day administration group (p = 0.004). Enoxaparin administration did not result in any significant fluctuation of the ETP, and no significant difference was observed between the 5-day and 3-day administration groups. Conclusion: Enoxaparin administration was associated with increase of the anti-factor Xa activity, and prolonged administration led to more sustained increase of the activity.

Effect of adjuvant low-molecular-weight heparin therapy on placental hypoxia and cell apoptosis in puerperae with severe preeclampsia

Objective:To study the effect of adjuvant low-molecular-weight heparin therapy on placental hypoxia and cell apoptosis in puerperae with severe preeclampsia.Methods:A total of 94 puerperae with severe preeclampsia who received treatment and safely gave birth in our hospital between May 2014 and May 2016 were selected as the research subjects and randomly divided into the LMWH group who received low-molecular-weight heparin combined with conventional symptomatic treatment and the control group who received conventional symptomatic treatment. Before and after treatment, serum was collected respectively to determine the levels of placental hypoxia-related cytokines, and after delivery, the placentas were collected to detect oxidative stress indexes and cell apoptosis indexes.Results: After treatment, serum PLGF and PAPP-A levels of both groups were significantly higher than those before treatment while sFlt-1 and sEng levels were significantly lower than those before treatment, and after treatment, serum PLGF and PAPP-A levels of LMWH group were significantly higher than those of control group while sFlt-1 and sEng levels were significantly lower than those of control group;ROS and RNS levels as well as Fas, FasL, caspase-3 and caspase-8 protein expression in placenta tissue of LMWH group were significantly lower than those of control group while GPx-1, SOD-1 and Trx levels as well as Survivin, XIAP and Bcl-2 protein expression were significantly higher than those of control group.Conclusion:Adjuvant low-molecular-weight heparin therapy can relieve the placental hypoxia, improve oxidative stress reaction and inhibit cell apoptosis in puerperae with severe preeclampsia.

Rivaroxaban for the treatment of heparin-induced thrombocytopenia with thrombosis in a patient undergoing artificial hip arthroplasty:A case report

BACKGROUND Anticoagulation treatment after lower limb surgery is one of the key methods to avoid thrombosis,and low-molecular-weight heparin is the treatment that is most frequently used in clinical practice.But one uncommon side effect of lowmolecular-weight heparin is heparin-induced thrombocytopenia(HIT),which can develop into thrombosis if not caught early or managed incorrectly.CASE SUMMARY We present a case of a patient who underwent hip arthroplasty and experienced thrombocytopenia due to HIT on the 9th d following the application of lowmolecular-weight heparin anticoagulation.We did not diagnose HIT in time and applied 1 unit of platelets to the patient,which led to thrombosis.Luckily,the patient recovered following effective and timely surgery and treatment with rivaroxaban.CONCLUSION Patients using low-molecular-weight heparin after lower limb surgery need to have their platelet counts regularly checked.If HIT develops,platelet treatment should be given with caution.

Recurrent Implantation Failure and Low Molecular Weight Heparin

Implantation of the embryo into the endometrium is the first step in the establishment of pregnancy. This process is complex, and depends on many factors. Recurrent implantation failure is a source of distress to patients and specialists. It is defined as failure to achieve a viable pregnancy, following “>3 embryo transfers with high quality embryos or the transfer of ≥ 10 embryos in multiple transfers”. Thrombophilic conditions that contribute to recurrent implantation failure are the main concern in this review. The mechanism of implantation failure is believed to be due to decreased blood flow to the endometrium and placenta which can hinder normal endometrial receptivity leading to miscarriage. Defects in early placentation resulting in pregnancy failure, have focused attention on the therapeutic potential of low molecular weight heparin in the implantation process. Heparin has a role at all stages of implantation to improve pregnancy outcomes. There are controversies in literature regarding the association between thrombophilia and recurrent implantation failure and available literature regarding this issue is very heterogeneous. Various investigators, have shown that women with RIF are more likely to have a thrombophilia disorder, yet a clear cause cannot be acknowledged from these studies. Heparin treatment has been evaluated in several studies, showing conflicting evidence. However, several studies have pointed out that it may play a role in a subset of patients who presents a thrombophilia mutation, thus the group of patients that might benefit is needed to be identified. This review is dedicated to evaluate the published literature about the role of low molecular weight heparin in case of recurrent implantation failure with or without the presence of thrombophilia.

Heparin-induced thrombocytopenia in patients undergoing cardiac surgery

Objective Heparin-induced thrombocytopenia(HIT)is a complication characterized by thrombocytopenia,hemorrhage and/or thrombosis,which is caused by initial or repeated application of unfractionated heparin(UFH)and low-molecular-weight heparin(LMWH).This study aims to summarize the clinical features of HIT in patients undergoing cardiac surgery.

The Safety and Feasibility of Low-Molecular-Weight He-parin Prophylaxis in Major Abdominal Surgery Combined with Neuraxial Anesthesia

Background: Global guidelines for venous thromboembolism (VTE) prophylaxis of patients undergoing major surgery are well established. However, their applicability and safety in patients receiving neuraxial anesthesia is unproven. We sought to evaluate the safety and feasibility of chemical VTE prophylaxis in a prospective group of patients undergoing major foregut procedures under a combination of epidural and general anesthesia. Methods: A prospective database of all patients undergoing major foregut surgery from 2004-2009 was maintained and analyzed. Epidural catheters were placed pre-operatively and used for post-operative analgesia for three days in all patients. Factors evaluated included age, ethnicity, sex, length of stay, duration of epidural placement, complications of epidural placement and post-operative management, and VTE events. A uniform protocol was followed regarding the timing of low-molecular-weight heparin (LMWH) administration with epidural catheter insertion/removal. Results: A total of 237 patients formed the study group. The mean age was 57 years (range, 19 - 88) among 121 (51.1%) women and 65 years (range, 20 - 95) among 116 (48.9%) men. One hundred and sixty-six patients were Caucasian (70%), 37 Black (15.6%), 15 Hispanic (6.3%), 12 Asian/Pacific (5.1%), and 7 other (3%). All epidural catheters were removed on the third post-operative day. There were a total of five VTE (2.1%) events postoperatively. No peri-operative or post-operative epidural catheter associated complications occurred. Conclusions: Concomitant epidural catheterization and LMWH anticoagulation is safe and feasible in major abdominal surgery patients, including those undergoing major hepatic resection. Guidelines for VTE prophylaxis and LMWH administration in the setting of neuraxial anesthesia are well established and applicable to this unique patient population.

Viabahn覆膜支架与旁路途径治疗下肢动脉硬化闭塞症有效性的系统评价及Meta分析

目的系统评价Viabahn覆膜支架与以人工血管为移植物的旁路途径治疗下肢动脉硬化闭塞症的有效性,并且探讨不同直径的Viabahn覆膜支架对股浅动脉通畅率的影响。方法检索数据库包括万方数据知识平台、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、EmBase、Cochrane Library和PubMed上有关肝素涂层覆膜支架治疗下肢动脉硬化闭塞症的临床研究。文献检索时间及语言无限制,文献筛选、质量评估、数据提取至少由2位研究者独立完成并交叉核对,采用Cochrane软件和RevMan 5.3软件完成结果分析。结果纳入文献共10篇(对照研究7篇、非对照研究3篇),肝素涂层覆膜支架与旁路途径疗效对比研究7篇,不同肝素涂层覆膜支架直径疗效对比研究5篇。肝素涂层支架组(Viabahn组)患者792例,旁路途经组(Bypass组)患者299例,Viabahn组行不同支架直径亚组分析(a组:5 mm、b组:6 mm、c组:7 mm),a、b、c组分别有61例、474例、84例患者。Bypass组不仅一期通畅率优于Viabahn组[OR 0.47(0.23,0.94),P=0.03],而且技术成功率更高[RR 0.97(0.94,1.00),P=0.02],但是Bypass组的住院时间明显长于Viabahn组[MD-4.89(-5.29,-4.48),P<0.00001],两组在截肢率及二期通畅率上没有统计学差异(P>0.05)。a组与b组通畅率没有统计学差异[OR 0.63(0.31,1.28),P=0.20],c组的通畅率要优于b组[(OR 0.57(0.33,0.98),P=0.04]。结论与Viabahn相比,以人工血管作为移植物的旁路途经具有更好的一期通畅率及技术成功率,但是需要更长的住院时间;推荐置入7 mm直径的Viabahn会得到更高的通畅率,但是需要根据患者实际血管直径来选择。

肝素涂层覆膜支架与裸支架植入治疗中心静脉狭窄的临床对照研究

目的 探讨肝素涂层覆膜支架与裸支架相比治疗慢性肾脏病患者中心静脉狭窄(CVS)的疗效。方法 选取2017年1月至2021年1月在暨南大学附属第一医院接受血管成形术+支架植入术治疗的58例慢性肾脏病合并CVS患者。根据植入支架种类不同,分为裸支架组(34例)和肝素涂层覆膜支架组(24例)。术中行中心静脉造影评估病变闭塞位置及程度。术后随访患者症状缓解情况、支架通畅率等评估疗效。结果 手术技术成功率为100%。共植入裸支架34枚,肝素涂层覆膜支架24枚。两组术后症状缓解时间差异无统计学意义(t=1.153,P=0.254),围手术期均未发生手术相关并发症。裸支架术后3、6、9、12、15个月一期通畅率分别为100%、88.2%、79.4%、73.5%、58.8%,二期通畅率分别为100%、100%、94.1%、85.3%、82.4%;覆膜支架组术后3、6、9、12、15个月一期通畅率分别为100%、100%、91.7%、87.5%、83.3%,二期通畅率分别为100%、100%、100%、100%、95.8%。两组间仅术后15个月一期通畅率差异有统计学意义(P<0.05)。不同长度支架间再狭窄率差异有统计学意义(P<0.05)。结论 肝素涂层覆膜支架治疗慢性肾脏病患者CVS早期疗效与裸支架相似,中期疗效优于裸支架。支架长度增加可能降低支架通畅率,治疗时应综合考虑支架类型和长度。

纤维蛋白原与吸附白蛋白、肝素的新型血管支架材料氧化钛的血液相容性

探索纤维蛋白原(Fibrinogen,FIG)与吸附白蛋白、肝素的新型血管支架材料氧化钛(Titanium Oxide,Ti-O)的血液相容性。(1)研制Ti-O,切割成薄膜;(2)Ti-O薄膜涂层白蛋白和肝素;(3)血小板(platelet,PL)吸附试验;(4)酶联免疫试验测FIG吸附量;(5)动物犬股动脉内植入涂层的Ti-O薄膜与对照试片Ti-O和不锈钢(Stainless steel,SS)薄膜。结果发现:Ti-O完全具有固定白蛋白和肝素的结构与性能,比未涂层的Ti-O能更一步减少PL和FIG的吸附,实验动物体内薄膜6个月后取出扫描电镜观察黏附的PL少,形态无改变,血管内无血栓,优于未涂层的Ti-O,更明显优于SS。Ti-O为N型半导体,不易接受FIG的电荷,并且与血细胞有相似的界面张力,决定生物材料Ti-O有较好的血液相容性。Ti-O对白蛋白、肝素有极好的亲和力是因以化学键相结合,在血中进一步减少FIG和PL被涂层的Ti-O吸附。实验证明涂层的Ti-O有持久和稳定的抗凝血性能。

颈动脉支架成形术后肝素与低分子肝素抗凝效果和安全性比较

目的比较评价肝素与低分子肝素在颈动脉支架成形术(carotid artery stenting angioplasty,CASA)后的抗凝效果和安全性。方法 2012年1月—2012年12月对30例患者行CASA治疗,并将患者分为肝素组15例和低分子肝素(low molecular weight heparin,LMWH)组15例。肝素组给予肝素生理盐水,持续静脉滴注,剂量420 u/h,维持72 h。LMWH组术后给予LMWH 0.4 ml(5 000 u),皮下注射,每12 h 1次,连续6次。抗凝期间,两组患者于2、8、24、48、72 h各监测1次凝血酶原时间(PT)和活化部分凝血活酶时间(APTT),并观察患者是否出现血栓栓塞和出血性事件。结果在颅内出血性事件和血栓栓塞事件发生率方面两组间差异无统计学意义(P>0.05);术后2、8、24、48、72 h的PT和APTT值两组间差异亦无统计学意义(P>0.05)。结论肝素和LMWH在CASA术后抗凝效果和安全性类似,但鉴于肝素具有剂量可监测、半衰期短、抗凝作用可快速逆转的特性,仍应作为CASA术后的首选抗凝策略。

新型生物可降解心血管涂层支架的制备及其生物相容性的研究

采用共价键连接技术,以二环己基碳化二亚胺(DCC)为偶联剂,将肝素与具有官能侧基的脱保护聚乳酸和吗啉二酮衍生物共聚物材料连接,肝素本体重量含量达到15%。与共混肝素材料的肝素体外释放实验对比结果证明该连接技术对肝素有良好的控制释放效果。并且利用独特的计算机控制喷涂工艺将共聚物的四氢呋喃(THF)溶液喷涂到支架上,制备出了心血管涂层支架,扩张后表面涂层无脱落和撕裂。涂层支架与金属裸支架对比动物实验发现,1、2和3个月的动物实验血管切片显示涂层支架无急性血栓和再狭窄情况的发生。说明该材料具有良好的生物相容性,具有广阔的应用前景。

层层自组装壳聚糖／肝素复合涂层膜对支架血栓形成的影响

目的:观察层层自组装壳聚糖/肝素复合涂层膜对支架血栓形成的影响。方法:通过逐层自组装的方式将壳聚糖和肝素逐层结合在316L不锈钢槽内,制成不同层数的涂层膜,以凝固法测定健康人血液在聚合物膜和不锈钢上作用2h后的部分凝血活酶时间(APTT)、凝血酶原时间(PT)和凝血酶时间(TT),并检测其抗凝血功能的稳定性。制备壳聚糖/肝素复合涂层膜支架,研究复合涂层膜支架在猪动静脉分流血栓模型中对支架血栓形成的影响。结果:各组复合涂层膜APTT和TT均较316L不锈钢组极显著延长(P<0.01),并且APTT和TT延长和复合涂层膜层数增加相关。复合涂层膜在2周内上述凝血功能无显著差异(P>0.05)。在猪动静脉分流血栓模型中,复合膜涂布的金属支架形成的血栓重量极显著低于316L裸支架(P<0.001)。结论:层层自组装壳聚糖/肝素复合涂层膜具有极显著的抗支架血栓作用,而且具有良好的稳定性。

国产雷帕霉素-肝素洗脱支架的制备及其体外实验研究

目的:探讨国产外周动脉雷帕霉素-肝素洗脱支架的物理性能、生物相容性及体外药代动力学特性。方法:利用喷涂装置将聚丙交酯乙交酯(PLGA)与肝素的混合溶液雾化喷出,在涂载雷帕霉素聚合物涂层的12枚镍钛合金支架表面形成载肝素聚合物涂层。对载药涂层支架进行物理性能检测、降解特性检测、血液相容性试验及药物释放特性研究。结果:雷帕霉素-肝素支架表面质量良好,与支架有良好的结合力。降解实验表明:PLGA和PLGA载雷帕霉素薄膜的降解时间为3个月左右。血液相容性实验结果表明:PLGA涂层与血小板接触,血小板粘附量明显较少,变形较小,未引起大量聚集;载药的PLGA涂层表面粘附的血小板数量更少,没有变形,未引起进一步的聚集;载药涂层的凝血时间长,凝血因子被激活的程度低。体外药物释放结果表明:雷帕霉素涂层释放曲线为线性释放,可持续释放时间约3个月。肝素涂层在释放初期存在突释,为60%左右,后期释放较平缓,在1个月左右释放为总量的70%,全部释放约50天。结论:国产外周动脉雷帕霉素-肝素洗脱支架具有良好的生物相容性,雷帕霉素及肝素能够持续缓慢释放,提高了洗脱支架的预防再狭窄及抗凝性能。

肝素化支架在头颈部动脉狭窄治疗中的应用

目的 :探讨肝素化血管内支架在头颈部动脉狭窄治疗中的安全性和有效性。 方法 :39例反复短暂性脑缺血发作(TIA)、动脉狭窄程度在 5 0 %以上且药物治疗无效的头颈部动脉狭窄患者 ,均采用直接肝素化 BX冠状动脉支架植入治疗 ,术后未予肝素化治疗。结果 :本组 39例患者均成功地植入支架 ,无手术相关并发症。 2 5例患者狭窄血管恢复正常直径 ,10例狭窄程度减少 90 %以上 ,4例残余狭窄 10 %～ 2 5 %。临床随访 3～ 18个月 ,33例症状完全缓解 ,5例明显好转 ,1例症状无改善。19例 DSA随访 6～ 12个月 ,无 1例发生支架内血栓或再狭窄。结论 :肝素化支架在头颈部动脉狭窄的治疗中是安全的 ,可有效降低血栓和再狭窄的发生。

大黄素洗脱可降解涂层支架的制作及其体内外实验研究

以肝素化吗啉二酮苄酯与L-丙交酯的共聚物材料作为药物支架可降解涂层的药物载体材料,大黄素作为药物,在自制的计算机控制的喷涂设备上成功制备了大黄素药物洗脱支架(药物含量(150±5)μg)。并研究了大黄素支架在体外磷酸盐缓冲液(PBS,pH=7.4)中,(37±0.5)℃下的释放。最后在体内与裸支架和不含药的聚合物涂层支架进行了1个月和3个月的对照实验。研究发现,所制备的药物支架扩张后表面无撕裂、挂膜。此外,高含量比的药物支架(大黄素含量50%)中的药物10 d内的释放达到90%。3个月后体内涂层材料大部分发生降解,从血管切片和内膜厚度可以看出,大黄素对内膜增生有着明显的作用,可以抑制血管内的再狭窄。

肝素涂层支架对粥样硬化冠状动脉的短期保护效应

目的 研究肝素涂层支架 (Wiktor- I)植入后 ,对冠状循环及体循环中血管活性物质内皮素 (ET)和降钙素基因相关肽 (CGRP)水平的短期影响 ,为肝素涂层支架的冠状动脉保护机制提供理论依据 .方法 选择植入普通无涂层支架 (n1 =16 )和肝素涂层支架 (n2 =14)的两组冠心病患者共 30例 ,于手术前后不同时间点 ,同时采集冠状静脉窦和外周肘静脉血 ,采用放射免疫分析法检测血浆 ET- 1和 CGRP浓度 ,并求出ET/CGRP比值以反映两者的动态平衡 .结果 普通支架(NCS)组 ET- 1水平在支架后即刻和支架后 12 h呈现大小两个高峰 ,CGRP的变化与其呈一致性 ,ET/CGRP比值于 PT-CA后 5 min达高峰 ,并维持较高水平至术后 12 h;肝素支架(HCS)组 ET- 1水平在支架后即刻略低于 NCS组 ,在支架后5 m in,10 min和 12 h显著降低 (P<0 .0 5 ,P<0 .0 1和 P<0 .0 5 ) ,CGRP水平与 NCS组无显著差异 ,ET/CGRP比值于支架后 5 min,10 m in和 12 h显著低于普通组 (P<0 .0 1,P<0 .0 5和 P<0 .0 5 ) .结论 肝素支架的近期保护作用的机制之一是通过降低术后 ET- 1水平 ,恢复 ET/CGRP比值的动态平衡来实现 ,对防止支架植入术后急性血管痉挛和 (亚 )

肝素涂层覆膜支架治疗股浅动脉硬化闭塞病变1例报告

本文报道1例股浅短段闭塞(TASC C级病变)经肝素涂层覆膜支架治疗,0.035英寸超硬导丝配合单弯导管通过闭塞段至远端腘动脉,使用4-150 mm Mustang球囊12个大气压扩张2 min后,造影见左股浅动脉中段狭窄病变消失,但近段仍有残余重度狭窄,路途下于狭窄处放置肝素涂层覆膜支架5-50 mm,释放后使用5-40 mm球囊6个大气压下给予支架内扩张。术后造影见血流明显恢复,残余狭窄消失,无造影剂外溢。术后观察8个月跛行症状无复发。我们认为肝素涂层覆膜支架治疗股浅动脉硬化闭塞病变可行。