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.

Heparin is an effective treatment for preventing liver failure after hepatectomy

BACKGROUND Posthepatectomy liver failure(PHLF)is one of the most important causes of death following liver resection.Heparin,an established anticoagulant,can protect liver function through a number of mechanisms,and thus,prevent liver failure.AIM To look at the safety and efficacy of heparin in preventing hepatic dysfunction after hepatectomy.METHODS The data was extracted from Multiparameter Intelligent Monitoring in Intensive Care III(MIMIC-III)v1.4 pinpointed patients who had undergone hepatectomy for liver cancer,subdividing them into two cohorts:Those who were injected with heparin and those who were not.The statistical evaluations used were unpaired ttests,Mann-Whitney U tests,chi-square tests,and Fisher’s exact tests to assess the effect of heparin administration on PHLF,duration of intensive care unit(ICU)stay,need for mechanical ventilation,use of continuous renal replacement therapy(CRRT),incidence of hypoxemia,development of acute kidney injury,and ICU mortality.Logistic regression was utilized to analyze the factors related to PHLF,with propensity score matching(PSM)aiming to balance the preoperative disparities between the two groups.RESULTS In this study,1388 patients who underwent liver cancer hepatectomy were analyzed.PSM yielded 213 matched pairs from the heparin-treated and control groups.Initial univariate analyses indicated that heparin potentially reduces the risk of PHLF in both matched and unmatched samples.Further analysis in the matched cohorts confirmed a significant association,with heparin reducing the risk of PHLF(odds ratio:0.518;95%confidence interval:0.295-0.910;P=0.022).Additionally,heparin treatment correlated with improved short-term postoperative outcomes such as reduced ICU stay durations,diminished requirements for respiratory support and CRRT,and lower incidences of hypoxemia and ICU mortality.CONCLUSION Liver failure is an important hazard following hepatic surgery.During ICU care heparin administration has been proved to decrease the occurrence of hepatectomy induced liver failure.This indicates that heparin may provide a hopeful option for controlling PHLF.

Application of aspirin and low molecular weight heparin in major orthopedic surgery:Meta analysis of a randomized controlled trial

Objective:The perioperative period of major orthopedic surgery is associated with a high risk of thrombosis,but the best chemopreventive agent for thrombosis prophylaxis is still inconclusive.For this reason,this paper evaluated the efficacy and safety of aspirin versus low-molecular heparin using a Meta-analysis.Methods:Ten randomized controlled studies on the application of aspirin and low-molecular heparin for the prevention of deep vein thrombosis in orthopedic major surgery were retrieved by computer searches of PubMed,CochraneLibrary,WebofScience,China Knowledge Network,Wanfang,and Vipul databases according to inclusion and exclusion criteria,and the literature was managed using Endnote software,and the data were analyzed using Revman 5.3 software was used to perform Meta-analysis of the extracted data,focusing on the effects of these two drugs on pulmonary embolism,deep vein thrombosis,major bleeding events,minor bleeding events,wound complications,mortality and blood loss within 90 days after major orthopedic surgery.Results:(1)Ten randomized controlled trials of high quality were included,with a total of 12,974 patients,7,026 in the aspirin group and 5,948 in the low-molecular heparin group;(2)Meta-analysis showed that aspirin had a higher incidence of pulmonary embolism(OR=1.59,95%CI:1.02 to 2.49,P=0.04)and deep vein thrombosis(OR=1.60,95%CI:1.26 to 2.02,P=0.0001)than low molecular heparin;(3)The incidence of major bleeding events(OR=0.85,95%CI:0.47 to 1.55,P=0.60),minor bleeding events(OR=0.79,95%CI:0.55 to 1.12,P=0.18),adverse wound reactions(OR=0.79,95%CI:0.48 to 1.31,P=0.36),mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)in both drug groups,mortality within 90 days(OR=0.69,95%CI:0.20 to 2.31,P=0.55)and perioperative blood loss(MD=0.69,95%CI:0.20 to 2.31,P=0.55)were not statistically significant.Conclusion:Low-molecular heparin was superior to aspirin in the prevention of pulmonary embolism and lower extremity deep vein thrombosis after major orthopedic surgery,but the safety and adverse drug reactions of both groups were basically similar.Based on this,the authors recommend that low-molecular heparin should be preferred for the prevention of deep vein thrombosis in major orthopaedic surgery;however,the inclusion of randomized controlled trials remains limited,necessitating high-quality,large-sample,long-term follow-up clinical studies.

Comparison of low-molecular-weight-heparin and unfractionated heparin for acute PTE

Objective: Acute pulmonary thromboembolism (PTE) is a serious high mortality pulmonary vascular disease whose effective treatment decreases morbidity and mortality. To determine if low-molecular-weight-heparin (LMWH) is clinically as efficient and safe as unfractionated heparin (UH) in patients with diagnosis of acute non-massive PTE, our study compares the efficacy, adverse effects and costs of LMWH and UH. Methods: One hundred and fourteen patients with non-massive acute PTE were randomly divided into LMWH (nadroparin calcium) and UH groups. Oxygenation index, D-dimer, fibrinogen (FG), lung ventilation/perfusion (V/Q) scan and computed tomography pulmonary angiography (CTPA) were observed before anticoagula-tion and on day 14 after anticoagulation. Results: In both groups, the ABG (arterial blood gas) analysis showed PaO2 and PaCO2 were elevated, P(A-a)O2 was decreased and oxygenation index (PaO2/FIO2) was elevated, D-dimer and fibrinogen were decreased, lung V/Q and CTPA showed embolized segments reduced (P<0.05). Hemorrhage and thrombocytopenia occurred in 3.5% of the LMWH group. Hemorrhage occurred in 5.3% and thrombocytopenia occurred in 7.0% of the UH group. The average cost in the LMWH group was RMB 1218.60 Yuan and RMB 1541.40 Yuan in the UH group. Conclusion: LMWH and UH are equally effective for treatment of non-massive acute PTE, but LMWH may have a lower prevalence of complications and is less expen-sive.

Incidence of pocket hematoma after electrophysiological device placement：dual antiplatelet therapy versus low-molecular-weight heparin regimen

BackgroundGiven 要求双 antiplatelet 的病人的增加的数字(弹跳) 治疗和 electrophysiological 设备(EPD ) 放置， perioperative antiplatelet 管理是当前的挑战。在这研究，我们在经历的病人在 EPD 放置以后调查了袖珍 hematoma 形成的发生弹跳治疗或其他的 low-molecular-weight 肝磷脂(LMWH ) regimen.MethodsThis 临床的观察学习从 2010 年 7 月被执行到 2012 年 7 月。总共， 171 个病人在满足包括标准以后在分析被注册。这些病人被划分成二个组：86 个病人被对待与弹跳治疗在设备培植，和 DAP 治疗的时候被中止 5 ～ 7 天并且在另外的 85 个病人在设备培植前用 enoxaparin 代替了。腺苷磷酸盐(自动数据处理) 调停了血小板聚集和 arachidonic 导致酸的血小板聚集外科手术前地被测试。我们把在二个组和袖珍 hematoma 开发的协会之间的袖珍 hematoma 的发生与调停自动数据处理的血小板聚集和 arachidonic 作比较在继续的病人的袖珍 hematoma 的导致酸的血小板 aggregation.ResultsThe 发生弹跳在用 LMWH 代替了双 antiplatelet 政体的病人是比那低的(3.49%对16.47%分别地；X 2= 6.66， P <；0.01 ) 。在继续的病人之中弹跳治疗，没有袖珍 hematomas，在有袖珍 hematomas 的病人的调停自动数据处理的血小板聚集抑制的率在病人比那高。没有经历的病人弹跳或 enoxaparin 治疗得了袖珍感染， thromboembolic 事件，或另外的严肃的复杂并发症。多重逻辑回归分析表明那 LMWH 治疗是为袖珍 hematoma 的发展的一个独立风险因素(RR = 0.054， 95%CI = 0.012-0.251 ) 。而且，经历 LMWH 治疗的病人比是弹跳对待 individuals.ConclusionContinuance 的多半更是 5.1 褶层开发袖珍 hematomas 弹跳治疗不在 EPD 以后增加袖珍 hematoma 形成的风险放置。

The effect of subcutaneous injection duration on patients receiving low-molecular-weight heparin:Evidence from a systematic review

To assess the effect of the injection duration of subcutaneous low-molecular-weight heparin(LMWH)on pain and bruising in patients.Randomized controlled trials and quasiexperimental studies were searched for in four electronic databases.The pooled effect size was expressed as relative risk(RR)andmeandifference(MD)with95%confidence intervals(CI)for dichotomous and continuous data.Cochrane Q and p value were used to assess heterogeneity and the I2 statistic was adopted to quantify the level.Finally,eight studies involving a total of 532 participants met our inclusion criteria.The slow(30 second)injection was associated with a reduction in pain intensity and duration,and lower bruising occurrence at 48-72 hours and 48 hours post injection.The bruising area was also smaller at 48 hours and 60 hours post injection.Nodifferenceswere identified betweenthe slowand fast(10 second)injectionin bruising area and bruising occurrence at 24 hours and 60 hours post injection.With present evidences,slow injection of LMWH is beneficial to the patient's well being,but further studies to identify the feasibility and standardization of the technique is recommended.

Attenuation of corneal neovascularization by topical low-molecular-weight heparin-taurocholate 7 without bleeding complication

AIM：To investigate the antiangiogenic effects and safety of topically administered low-molecular-weight heparintaurocholate 7（LHT7） on corneal neovascularization（CoNV）.METHODS：Twenty-four Sprague-Dawley rats were randomly distributed into four groups of six rats each.The central corneas were cauterized using a silver/potassium nitrate solution.From 2d after cauterization,12.5 mg/mL（low LHT7 group） or 25 mg/mL（high LHT7group） LHT7 was topically administered three times daily;12.5 mg/mL bevacizumab was topically administered as positive control（bevacizumab） group,with normal saline（NS） administered as negative control（NS group）.The corneas were digitally photographed to calculate the CoNV percentage from the neovascularized corneal area at 1 and 2wk.RESULTS：The 4 study groups did not have different CoNV percentages at 1wk after injury（P〉0.05）.However,the low LHT,high LHT,and bevacizumab groups had significantly lower CoNV percentages than the NS group at 2wk（all P〈0.05）.No significant differences in CoNV percentage were found among the low LHT,high LHT,and bevacizumab groups（all P〉0.05）.All groups except the NS group had lower CoNV percentages at 2wk postinjury than the levels observed at 1wk（all P〈0.05）.CONCLUSION：Topically-administered LHT7 inhibited CoNV without complication after chemical cauterization in the rat.

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.

Anti-infection effects of heparin on SARS-CoV-2 in a diabetic mouse model

Severe acute respiratory syndrome coronavirus 2(SARSCo V-2)infection can result in more severe syndromes and poorer outcomes in patients with diabetes and obesity.However,the precise mechanisms responsible for the combined impact of coronavirus disease 2019(COVID-19)and diabetes have not yet been elucidated,and effective treatment options for SARS-Co V-2-infected diabetic patients remain limited.To investigate the disease pathogenesis,K18-h ACE2 transgenic(h ACE2^(Tg))mice with a leptin receptor deficiency(h ACE2-Lepr^(-/-))and high-fat diet(h ACE2-HFD)background were generated.The two mouse models were intranasally infected with a 5×10^(5) median tissue culture infectious dose(TCID_(50))of SARSCo V-2,with serum and lung tissue samples collected at 3days post-infection.The h ACE2-Lepr^(-/-)mice were then administered a combination of low-molecular-weight heparin(LMWH)(1 mg/kg or 5 mg/kg)and insulin via subcutaneous injection prior to intranasal infection with1×10^(4) TCID_(50)of SARS-Co V-2.Daily drug administration continued until the euthanasia of the mice.Analyses of viral RNA loads,histopathological changes in lung tissue,and inflammation factors were conducted.Results demonstrated similar SARS-Co V-2 susceptibility in h ACE2^(Tg)mice under both lean(chow diet)and obese(HFD)conditions.However,compared to the h ACE2-Lepr^(+/+)mice,h ACE2-Lepr^(-/-)mice exhibited more severe lung injury,enhanced expression of inflammatory cytokines and hypoxia-inducible factor-1α(HIF-1α),and increased apoptosis.Moreover,combined LMWH and insulin treatment effectively reduced disease progression and severity,attenuated lung pathological changes,and mitigated inflammatory responses.In conclusion,preexisting diabetes can lead to more severe lung damage upon SARS-Co V-2 infection,and LMWH may be a valuable therapeutic approach for managing COVID-19patients with diabetes.

Role of Early Low-Molecular-Weight Heparin Prophylaxis in the Surgical Treatment of Degenerative Spinal Diseases in the Elderly Patients

Study Design: Retrospective review. Summary of Background Data: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are potential complications following major orthopaedic surgical procedures. Venous thromboembolism (VTE) is the disease process underlying DVT and PE. Pharmacological options can be use low-molecular-weight heparin (LMWH). Objective: The purpose of this study is to evaluate the hemorrhage risk when LMWH is started after 24 hours from surgery and to assess venous thromboembolism and pulmonary embolism risk in patients undergoing early prophylaxis after spine surgery. Methods: A consecutive cohort of 100 patients undergoing spinal surgery. Diagnosis was multilevel lumbar spinal stenosis in 46 cases and, degenerative thoracolumbar kypho-scoliosis in 54 cases. Starting on the first postoperative day, patients were routinely administered daily prophylactic enoxaparin at 8 pm (40 mg). Analysis was performed to identify risk factors of VTE among five independent variables (age, sex, obesity defined as body mass index > 30 kg/m2, smoking, duration of surgery), with statistical significance defined as P < 0.05. Results: No deaths in this 100 patient cohort;2 patients developed symptomatic pulmonary embolism during the first three postoperative days and 1 patient had thromboembolic complications, with acute deep venous thrombosis. Only one statistically significant predictor of acute VTE (duration of surgery, P < 0.05). Conclusion: LMWH prophylaxis seems to carry a very low hemorrhage risk and low rate of PE and DVT when started 24 hours after spine surgery. Prophylaxis with LMWH should be considered in all patients underwent major spinal surgery particularly when VTE risk factors are present.

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.

Delayed Onset Low Molecular Weight Heparin Induced Skin Necrosis on a Hemodialysis Patient

Delayed onset low molecular weight heparin induced skin necrosis is a rare adverse event. It usually occurs at the site of injection, and typically develops within 2 weeks of starting therapy. However, in our case, we presented a 62-year-old woman who is on Hemodialysis twice a week. Her hemodialysis prescription included Enoxaparine 0.2 cc IV as anticoagulant. On her third month of regular hemodialysis, she developed skin necrosis on her right leg and left hand. The diagnosis was made clinically and by exclusion of other possible causes of skin necrosis in a chronic kidney disease patient, such as calciphylaxis. The most important aspect of management, in this case, is early recognition and withdrawal of its use, which were done in our patient.

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.

低分子肝素及胚胎植入前非整倍体检测对不明原因复发性流产患者妊娠结局的影响

目的:比较行胚胎植入前非整倍体检测(PGT-A)助孕和未行PGT-A助孕的不明原因复发性流产(URSA)患者应用低分子肝素(LMWH)后临床结局的差异。方法:回顾分析2016年1月1日至2022年5月17日URSA患者于郑州大学第三附属医院生殖医学科首次移植冷冻囊胚共1158个周期的临床资料,按移植前是否行PGT-A分为PGT-A组(行PGT-A+ICSI,315例)和非PGT-A组(行IVF/ICSI,843例),再根据移植日是否使用LMWH分为肝素组和非肝素组,为调整混杂因素进行1∶5倾向性评分匹配(PSM),对PSM后患者数据进行分析,比较两组患者种植率、临床妊娠率、流产率、早期流产率、活产率及单胎活产围产结局的差异。对非PGT-A组和PGT-A组PSM前数据、肝素PGT-A组和肝素非PGT-A组临床妊娠结局进行多因素logistic回归分析。结果:非PGT-A组中,肝素组和非肝素组的不孕年限差异有统计学意义(P<0.05),种植率(33.8%vs 32.1%,P=0.610)、临床妊娠率(45.4%vs 43.8%,P=0.733)、流产率(28.0%vs 28.4%,P=0.958)、早期流产率(23.8%vs 25.4%,P=0.797)、活产率(31.9%vs 30.1%,P=0.671)比较差异无统计学意义(P>0.05)。PGT-A组中,肝素组和非肝素组的女方体质量指数(BMI)比较差异有统计学意义(P<0.05),种植率(59.8%vs 57.6%,P=0.763)、临床妊娠率(59.4%vs 57.6%,P=0.806)、流产率(20.4%vs 14.7%,P=0.448)、早期流产率(16.4%vs 14.7%,P=0.803)、活产率(46.9%vs 49.2%,P=0.752)比较差异无统计学意义(P>0.05)。非PGT-A组中,肝素组和非肝素组内获得单胎活产患者的围产期结局比较差异均无统计学意义(P>0.05);PGT-A组中,肝素组较非肝素组小于胎龄儿(10.3%vs 0.8%,P=0.023),差异有统计学意义(P<0.05),余获得单胎活产患者的围产期结局差异均无统计学意义(P>0.05)。结论:行PGT-A助孕和未行PGT-A助孕的URSA患者应用LMWH并不能改善其妊娠结局,且行PGT-A助孕应用LMWH患者的围产期小于胎龄儿发生风险显著升高。

老年冠心病患者低分子肝素皮下注射后按压与出血发生率的效应研究

目的探讨老年冠心病患者皮下注射低分子肝素后是否按压与皮下出血发生率的相关性。方法纳入2019年1月至2021年12月在南京医科大学附属南京医院行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后使用低分子肝素皮下注射的老年冠心病患者131例作为研究对象,按照注射后是否按压分为观察组67例和对照组64例。皮下注射低分子肝素的流程均按照本院已纳入规范的“低分子肝素皮下注射法护理质量督查标准”执行,其中观察组要求注射完毕后按压穿刺点3~5 min,力度以皮肤下陷1cm为准,比较两组患者皮下出血的发生率。结果观察组皮下瘀斑发生率(9.0%)与对照组(7.8%)比较差异无统计学意义(P>0.05),观察组皮下硬结发生率(4.5%)与对照组(1.6%)比较差异亦无统计学意义(P>0.05)。患者的年龄、性别、腹围以及体质量指数(body mass index,BMI)与注射低分子肝素后发生皮下出血没有显著相关性(P>0.05),而腹部皮脂厚度与皮下出血存在显著相关性(P<0.05),是预测注射低分子肝素后发生皮下出血的独立预测因子。结论老年冠心病患者低分子肝素皮下注射后按压与出血发生率无相关性,无需按压。患者的腹部皮脂厚度是预测注射低分子肝素后发生皮下出血的独立预测因子,应通过规范操作来避免皮下出血的发生。

Effect of heparin on recurrent IVF-ET failure patients

Objective:To elucidate the possible role of unfractionated heparin in patients with failed repeated in in vitro fertilization and embryo transfer(IVF-ET)and thrombophilia.Methods:This case control study evaluated the efficacy of the unfractionated heparin in increasing the pregnancy and implantation ratio in women with recurrent IVF-ET failures.Eighty-six women received in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)with a record of three or more previous IVF-ET failures.Participants were randomly distributed into two groups.Group A(n=43)received unfractionated heparin 5000 IU twice daily,and group B(n=43)did not take any antithrombotic drugs.Coagulation abnormalities such as factor桋Leiden(FVL)mutation,methylene tetra hydro folate reductase(MTHFR)mutation and prothrombin mutation(F栻)were evaluated.Age,body mass index,basal follicular stimulating hormone,basal estradiol,duration of infertility,and number of IVF-ET failures were compared between two groups.Results:45.0%and 17.4%of women were pregnant with and without MTHFR and prothrombin mutation,respectively,when they received unfractionated heparin treatment.The implantation rate was more in group A(12.5%)than group B(4.3%)and differences in the fertilization rate of the two groups were observed(27.7%vs.35.9%).The clinical pregnancy rate per cycle was remarkably more in group A(30.2%)than group B(14.0%).Conclusions:Heparin is a safe and valuable treatment for patients with repeated IVF-ET failures.The clinical pregnancy and implantation rates are higher in the heparin-treated group in contrast with the control group.

利伐沙班和低分子肝素在老年粗隆间骨折患者围手术期的应用效果分析

目的分析利伐沙班和低分子肝素在老年粗隆间骨折患者围手术期的应用效果。方法选取2020年6月至2021年10月于厦门大学附属中山医院就诊的老年粗隆间骨折围手术期患者130例为研究对象。按随机数字表法分为观察组和对照组,每组65例。对照组采用低分子肝素皮下注射预防血栓,观察组采用利伐沙班口服预防血栓。比较2组患者术前及术后2周的凝血指标,术后2周内下肢深静脉血栓形成(DVT)和肺栓塞的发生率,术中出血量、术后引流量及住院时间,术后1 d炎症相关指标。结果2组患者术前、术后2周组间和组内凝血相关指标差异均无统计学意义(均P>0.05)。术后观察组下肢DVT发生率显著低于对照组[4.6%(3/65)比15.4%(10/65)],差异有统计学意义(χ^(2)=4.188,P=0.041)。观察组与对照组术中出血量、术后引流量及住院时间差异均无统计学意义(均P>0.05)。术后1 d观察组降钙素原和C反应蛋白水平显著低于对照组[(0.17±0.02)μg/L比(0.22±0.01)μg/L、(20.2±2.3)mg/L比(23.9±3.6)mg/L],差异均有统计学意义(均P<0.001)。结论利伐沙班与低分子肝素在老年粗隆间骨折患者围手术期均有良好的抗凝效果及安全性,但利伐沙班预防术后下肢DVT发生的效果更显著且口服用药更方便。

乳腺癌患者外周中心静脉导管相关上肢深静脉血栓形成的抗凝治疗

目的总结分析乳腺癌患者发生外周中心静脉导管(PICC)相关上肢深静脉血栓(DVT)形成的诊治经验。方法收集2021年6月至2023年3月北京市海淀医院收治的发生PICC相关上肢DVT的134例乳腺癌患者的临床资料,根据抗凝治疗方案的不同将患者分为低分子肝素组(n=65)和利伐沙班组(n=69)。比较两组患者的乳腺癌专科信息和启动抗凝治疗后3个月的随访结果。结果两组患者的临床分期、肿瘤部位、手术情况、放疗情况比较,差异均无统计学意义(P﹥0.05)。治疗后3个月随访结果显示,两组患者的导管功能失用率、上肢DVT复发率、出血发生率比较,差异均无统计学意义(P﹥0.05)。两组患者均发生了轻微出血。治疗前,两组患者的D-二聚体水平比较,差异无统计学意义(P﹥0.05);治疗后4、12周,两组患者的D-二聚体水平均较本组治疗前下降,差异均有统计学意义(P﹤0.05),但两组患者的D-二聚体水平比较,差异均无统计学意义(P﹥0.05)。结论低分子肝素与利伐沙班治疗乳腺癌患者PICC相关上肢DVT的疗效与安全性相当,但利伐沙班可能更方便患者出院后使用。