凝血-抗凝、纤溶功能联合检测对血栓或出血性疾病的诊断意义

分析凝血-抗凝,纤溶功能联合检测对血栓或出血性疾病的诊断意义。方法 本研究选取2022年10月至2023年8月本院血液科诊断的30例弥漫性血管内凝血疾病作为观察组,对照组中有30例健康检查合格人群,比较相应的诊断结果。结果 观察组患者检测后血浆抗凝血酶活性(AT)指标小于对照组,P<0.05,检测后两组患者凝血因子Ⅷ活性(FⅧ)指标组间数据对比差异显著,P<0.05,差异有统计学意义。结论 凝血-抗凝及纤溶功能联合测定能更全面地反映患者凝血、抗凝和纤溶功能的变化,对血栓形成和出血的早期诊断有很大的帮助。

妊娠妇女凝血-抗凝与纤溶测定的临床意义

目的:检测妊娠妇女和妊高征患者凝血与纤溶的变化,探讨孕妇在不同状态下各项指标的临床意义。方法:将63例妊娠妇女分为正常孕妇组43例和妊高征20例,采用磁珠凝固法检测凝血酶原时间(PT)、部分活化凝血酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(Fbg)和游离蛋白S(FPS);免疫比浊法检测D-二聚体(D-D)、血管性血友病因子(vWF),并与非孕妇的健康对照组作比较。结果:43例孕妇和20例妊高征患者血浆PT、APTT、均显示不同程度的缩短;TT延长率在妊娠组仅为1％,而妊高征为18％;两组Fbg水平增高明显;妊娠组FPS与对照组比较差异无显著性,但妊高征患者表现明显降低;两组D-D水平均增高,且妊高征患者明显增高;妊娠组vWF水平与对照组比较尽管差异无显著性,但仍有3例高于对照组;妊高征患者增高率达100％。结论:妊娠妇女与妊高征患者均存在不同水平的凝血活化、纤溶亢进和内皮细胞一定程度的损伤,妊娠期作凝血-抗凝、纤溶指标的检测,对预防出血,降低DIC等的发生率具有指导意义。

凝血-抗凝、纤溶功能联合检测对血栓或出血性疾病的诊断意义

分析凝血-抗凝、纤溶功能联合检测对血栓或出血性疾病的诊断意义。方法 将2020年4月至2023年1月作为本次实验时间参考范围,纳入对象均在上述时间段内抽取,抽取人数合计66例,其中包括33例弥漫性血管内凝血疾病,33例健康检查合格人群,在本次实验中组别类目按照患者就诊时间进行划分,并使用观察组及对照组表示,将弥漫性血管内凝血疾病患者设为观察组,将健康检查合格人群设为对照组,观察两组患者采用凝血-抗凝、纤溶功能联合检测后凝血因子Ⅷ活性(FⅧ)、血浆抗凝血酶活性(AT)、D-二聚体(D-D)检出指标组间数据对比情况。结果 检测后观察组患者凝血因子Ⅷ活性与对照组对应指标组间数据对比存在显著差异,P<0.05;检查后两组患者血浆抗凝血酶活性统计分析结果存在对比差异,P<0.05;检查后对照组患者D-二聚体检出指标显著优于观察组,P<0.05。结论 采用凝血-抗凝、纤溶功能联合检测对血栓或出血性疾病进行临床诊断后,发现凝血因子Ⅷ活性、血浆抗凝血酶活性、D-二聚体检出指标均与正常患者存在较大差异,同时可对血栓等疾病的客观评价提供重要数据支持。

Anticoagulation therapy prevents portal-splenic vein thrombosis after splenectomy with gastroesophageal devascularization

AIM:To compare the incidence of early portal or splenic vein thrombosis(PSVT) in patients treated with irregular and regular anticoagulantion after splenectomy with gastroesophageal devascularization.METHODS:We retrospectively analyzed 301 patients who underwent splenectomy with gastroesophageal devascularization for portal hypertension due to cirrhosis between April 2004 and July 2010.Patients were categorized into group A with irregular anticoagulation and group B with regular anticoagulation,respectively.Group A(153 patients) received anticoagulant monotherapy for an undesignated time period or with aspirin or warfarin without low-molecular-weight heparin(LMWH) irregularly.Group B(148 patients) received subcutaneous injection of LMWH routinely within the first 5 d after surgery,followed by oral warfarin and aspirin for one month regularly.The target prothrombin time/international normalized ratio(PT/INR) was 1.25-1.50.Platelet and PT/INR were monitored.Color Doppler imaging was performed to monitor PSVT as well as the effectiveness of thrombolytic therapy.RESULTS:The patients' data were collected and analyzed retrospectively.Among the patients,94 developed early postoperative mural PSVT,including 63 patients in group A(63/153,41.17%) and 31 patients in group B(31/148,20.94%).There were 50(32.67%) patients in group A and 27(18.24%) in group B with mural PSVT in the main trunk of portal vein.After the administration of thrombolytic,anticoagulant and antiaggregation therapy,complete or partial thrombus dissolution achieved in 50(79.37%) in group A and 26(83.87%) in group B.CONCLUSION:Regular anticoagulation therapy can reduce the incidence of PSVT in patients who undergo splenectomy with gastroesophageal devascularization,and regular anticoagulant therapy is safer and more effective than irregular anticoagulant therapy.Early and timely thrombolytic therapy is imperative and feasible for the prevention of PSVT.

Anticoagulation therapy in intra-aortic balloon counterpulsation： Does IABP really need anti-coagulation ？

Objective: To investigate if intra-aortic balloon pump(IABP) is contraindicated without anticoag-ulation therapy. Methods: Some 153 IABP patients in the King Abdulaziz Cardiac Center(KSA) were random-ly assigned into two groups. Anticoagulation group( Group A) consisted of 71 patients who were given heparin intravenously with target aPTT 50 - 70 seconds. Non-anticoagulation group( Group B) consisted of 82 patients without intravenous heparin during balloon pumping. Hematological parameters including platelet count, D-dimer, Plasminogen activator inhibitor-1 (PAI-1) and fibrinogen degradation products(FDP) were checked respectively at the point of baseline, 24 hours, 48 hours and 24 hours post IABP counterpulsation. Clot deposits on balloon surface, vascular complications from IABP including bleeding and limb ischemia were recorded.Results: Platelet count and PAI-1 level decreased at 24 hours and 48 hours in both groups ( P < 0.05) . D-dimer and FDP level increased at 24 hours and 48 hours in both groups( P < 0.05), but returned to the baseline level 24 hours post IABP removal( P > 0.05) . Three patients in Group A and 2 patients in Group B developed minor limb ischemia( P > 0.05). No major limb ischemia in either group. Two patients in Group A suffered major bleeding and required blood transfusion or surgical intervention, whereas no patient had major bleeding in Group B. Eight patients had minor bleeding in Group A, but only 2 patients in Group B ( P <0.05). No clot deposit developed on IABP surface in either group. Conclusion: IABP is safe without routine anticoagulation therapy. Selecting appropriate artery approach and early detection intervention are key methods for preventing complications.

Ellagic Acid-induced Hypercoagulable State in Animals:a Potentially Useful Animal Hypercoagulable Model for Evaluation of Anticoagulants

Objective To establish and evaluate a hypercoagulable animal model for the assessment of anticoagulants. Methods Forty mice, thirty-two rats, and twenty-four rabbits were randomly and equally divided into control group (saline) and three ellagic acid (EA)-treated groups (low, middle, and high doses). In the mice, bleeding time (BT) was estimated with tail transaction, and clotting time (CT) with template method. Prothrombin time (PT) and the activated partial thromboplastin time (APTT) in rats and rabbits were measured by means of Quick's one-stage assay and modified APTT assay respectively. In addition, thrombin activity was estimated in rats with PT assay using a hemagglutination analyzer. The circulating platelet aggregates were de- tected in rabbits through platelet counting and presented as the circulating platelet aggregate ratio (CPAR). Results EA shortened BT and CT in mice, PT and APTT in rats, and increased thrombin activity and CPAR, all in a dose-dependent manner. EA also brought reduction of PT and APTT in rabbits in dose- and time-dependent manners. Conclusion EA could induce hypercoagulable state through activating coagulation system and platelets in mice, rats, and rabbits.

Anticoagulation early after mechanical heart valve replacement

Objective： To explore the changes of coagulation activity and the characters of anticoagulation early after mechanical heart valve replacement. Methods： All patients only took warfarin orally for anticoagulation. The predicted international normalized ratio （INR） was 1.5 to 2.0. Several coagulation markers were monitored early after valve replacement. Complications associated with anticoagulation were recorded and analyzed. The patients were divided into three groups based on the number and position of mechanical valve prothesis, including group M （mitral valve replacement）, group A （aortic valve replacement） and group D （mitral and aortic valve replacement）.Comparison was made between the three groups. Results： Three events of mild cerebral embolism and five events of mild bleeding occurred during the early postoperative period. One patient suffered from mild cerebral embolism on the 4th day after operation, accompanied by large volume of pericardial drainage. Two patients with bleeding had lower INRs than predicted range. However, INR in one patient with mild cerebral embolism was in the predicted range. There was no significant difference in thrombo time （TT）, activated partial thromboplastin time （APTT） and 1NR on the 3rd day after operation compared to those before operation; meanwhile, plasma fibrinogen （FIB） concentration was higher than that before operation （P〈0.05）. 1NR had no significant changes on the 2nd day after the beginning of anticoagulation compared to that before operation; however, 1NR was significantly elevated on the 4th day （P〈0.05）. Warfarin doses and INRs were similar among the three groups, but FIB concentrations in plasma were higher in groups M and D than in group A （P〈0.01）. Conclusion： Hypercoagulabale state exists early after mechanical heart valve replacement. When anticoagulation begins is determined by the change of coagulation markers, not by the volume of chest or pericardial drainage. INR can not accurately reflect the coagulation state sometimes, especially during the first 3 days after anticoagulation. The number and position of mechanical valve prothesis could affect coagulation state. Therefore, anticoagulation therapy should be regulated accordingly.

A Review of an Unorthodox Argatroban Infusion Rate for Anticoagulation in a Patient Case

Argatroban is an intravenous DTI （direct synthetic thrombin inhibitor） that is not routinely used for anticoagulation; thus, expertise surrounding its use is very limited. Therefore, this case reviews an unusually high argatroban infusion rate, which was needed to prevent further emboli formation in a patient. In this case, a 61-year-old Caucasian male patient exhibited heparin resistance during an intraoperative vascular procedure as measured by activated clotting time and PTT （partial thromboplastin time）. The patient had multiple occlusions in his right lower extremities and underwent embolectomies of the right popliteal and posterior tibial arteries. The clinical pharmacist was consulted to manage the argatroban infusion once heparin was discontinued. The therapeutic window required a PTr of 1.5-3 times the patient baseline （35-75 s）. The patient was reported to be 89 kg with a baseline PTT of 24.7 s and INR （international normalized ratio） of 0.98. The starting dose ofargatroban was initiated by the pharmacist at 2 mcg/kg/min （10.7 mL/h） as the patient did not have hepatic failure or sepsis. The patient was maintained on argatroban in the therapeutic PTT window for more than 72 h; however, frequent and aggressive dose increases, to a final rate of 7.5 mcg/kg/min （40 mL/h）, were needed to maintain the therapeutic PTT level. From the case, the cause of heparin resistance still has not been determined despite a hematologic work-up; however, this patient required an unusually high infusion rate of argatroban to maintain a therapeutic PTT during the hospital course before being changed to an anticoagulation regimen for discharge.

云南白药保险子在重度创伤性失血急救中的应用

创伤性失血是急救领域的重要挑战,可导致凝血-抗凝系统紊乱,云南白药保险子是中医经典急救药物,兼有止血和抗凝的功效。以2018年1月至2021年12月期间在呼和浩特市第一医院急诊中心收治的骨科创伤患者为研究对象,通过前瞻性平行对照临床研究,对保险子的止血疗效进行评价,指标包括术中出血量、术后引流量、血红蛋白下降值、凝血酶原时间(PT)、激活部分凝血酶原时间、纤维蛋白原(FBG)、输血率,预后出血/凝血不良反应等。结果显示,保险子组(n=27)的术中出血量、术后引流量、血红蛋白下降值、输血率、PT以及预后出血/凝血不良反应均显著小于对照组(n=24),保险子组FBG显著高于对照组;说明保险子能够维持机体凝血-抗凝系统的平衡,在显著降低出血量的同时,兼具抗凝的功效,可预防创伤性凝血病,减少预后不良反应。

Influence of CYP2C9*3 and CYP4F2 rs2108622 gene polymorphisms on over-anticoagulation and bleeding complications of warfarin therapy in Chinese patients:a cohort study

In this retrospective cohort study,we aimed to identify the influence of the CYP2C9*3 and CYP4F2 rs2108622 gene alleles on over-anticoagulation and bleeding complications associated with warfarin therapy.A total of 196 patients were included,including 80 males,the mean age was 50.8±10.7 years,and the average follow-up was 26.9±11.8 months.These patients underwent heart valve replacement surgery in the Cardiovascular Surgery of Fujian Provincial Hospital between January 2018 and August 2019,who took warfarin for at least 3 months and had target international normalized ratio(INR)between 1.8 and 2.5.Genotypes of CYP2C9*3 and CYP4F2 rs2108622 genes were tested by polymerase chain reaction(PCR)-gene sequencing technique.SPSS19.0 software was utilized to analyze the association between genotypes and warfarin-related over-anticoagulation and bleeding complications.Of the 434 patient-years,18 severe bleedings and 59 mild ones occurred in 31 patients.Patients with CYP2C9*1/*3 were associated with a higher over-anticoagulation risk compared with the*1/*1 carriers(hazard rate(HR)7.10;95%confidence interval(CI):2.54–19.79,P<0.001).The CYP4F2 rs2108622 mutant genotype did not cause significant increase in bleeding risk(HR 0.89;95%CI:0.43–1.82,P=0.74)or over-anticoagulation(HR 0.43;95%CI:0.16–1.13,P=0.09).Meanwhile,Kaplan-Meier survival curves showed that the time to over-anticoagulation in CYP2C9*1/*3 carriers was significantly shorter compared with the*1/*1 carriers(log-rank test,P<0.001),while that in CYP4F2 rs2108622 mutant genotype patients was longer compared with the wild-type patients(P=0.05).CYP2C9*3 and CYP4F2 rs2108622 might be major predictive factors of over-anticoagulation for warfarin therapy in Chinese patients.