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.

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

Background Given the increasing number of patients who require dual antiplatelet （DAP） therapy and electrophysiological device （EPD） placement, perioperative antiplatelet management is a current challenge. In this study, we investigated the incidence of pocket hema-toma formation after EPD placement in patients undergoing DAP therapy or an alternative low-molecular-weight heparin （LMWH） regimen. Methods This clinical observational study was performed from July 2010 to July 2012. In total, 171 patients were enrolled in the analysis after meeting the inclusion criteria. These patients were divided into two groups： 86 patients were treated with DAP therapy at the time of device implantation, and the DAP therapy was discontinued for 5 to 7 days and replaced with enoxaparin before device implantation in the other 85 patients. Adenosine phosphate （ADP）-mediated platelet aggregation and arachidonic acid-induced platelet aggregation were tested preoperatively. We compared the incidence of pocket hematoma between the two groups and the association of pocket hematoma develop-ment with ADP-mediated platelet aggregation and arachidonic acid-induced platelet aggregation.Results The incidence of pocket hema-toma in the patients who continued DAP was lower than that in the patients who replaced the dual antiplatelet regimen with LMWH （3.49%vs. 16.47%, respectively;X2 = 6.66,P 〈 0.01）. Among the patients who continued DAP therapies, the rate of ADP-mediated platelet aggre-gation inhibition in patients with pocket hematomas was higher than that in patients without pocket hematomas. None of the patients under-going DAP or enoxaparin therapy developed pocket infection, thromboembolic events, or other serious complications. Multiple logistic re-gression analysis revealed that LMWH therapy was an independent risk factor for the development of pocket hematoma （RR = 0.054, 95%CI = 0.012-0.251）. Furthermore, patients undergoing LMWH therapy were 5.1-fold more likely to develop pocket hematomas than were DAP-treated individuals.Conclusion Continuance of DAP therapy does not increase the risk of pocket hematoma formation after EPD placement.

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.

Observational study:efficacy of aspirin and low-molecular-weight heparin in the management of recurrent miscarriage

In the present study,we aimed to assess the comparative efficacy of low-molecular-weight heparin(LMWH)in combination with low-dose aspirin for the management of recurrent miscarriage and scrutinize alterations in coagulation function following such treatment.A retrospective analysis was conducted on clinical data obtained from 97 patients with recurrent miscarriage treated at our institution from January 2019 to June 2020.Patients were categorized into either the study or control groups based on the administration of LMWH.The control group comprised 48 patients treated solely with aspirin,while the study group included 49 patients treated with both LMWH and aspirin.Comparative evaluations between the two groups encompassed pregnancy outcomes,coagulation function,adverse reactions,and blood loss during delivery.Results revealed a higher term birth rate in the study group(83.67%)compared to the control group(50%).Post-treatment,the study group exhibited lower prothrombin time,plasminogen activator inhibitor,and D-dimer levels than the control group.Moreover,the study group experienced fewer adverse reactions and reduced blood loss during delivery in comparison to the control group,demonstrating statistical significance(P<0.05).The combination of LMWH and low-dose aspirin exhibited noteworthy application in the management of recurrent miscarriage.This therapeutic approach not only fostered the enhancement of coagulation function conducive to pregnancy but also diminished the incidence of adverse reactions observed with aspirin alone.

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.

逐瘀生骨汤联合低分子肝素钙对髋关节置换患者功能恢复、血液流变学、深静脉血栓形成的影响

【目的】探讨逐瘀生骨汤联合低分子肝素钙对髋关节置换患者功能恢复、血液流变学、深静脉血栓(DVT)形成的影响。【方法】将102例具备髋关节置换指征并拟行髋关节置换的患者随机分为对照组和观察组,每组各51例。2组患者均给予行髋关节置换治疗,对照组术后给予低分子肝素钙抗凝治疗,观察组给予逐瘀生骨汤联合低分子肝素钙治疗,疗程为2周。观察2组患者术后第1天和术后2周血液流变学指标[血浆黏度、纤维蛋白原(FIB)、红细胞比容(Hct)]及炎症指标[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、转化生长因子β(TGF-β)]水平的变化情况,统计2组术后DVT发生率,并采用Harris髋关节功能评分(HHS)对2组患者术前及术后2周、1个月及3个月的髋关节功能进行评定。【结果】(1)血液流变学方面,术后2周,2组患者的血浆黏度、FIB、Hct水平均较术后第1天明显降低(P<0.05),且观察组的降低作用均明显优于对照组(P<0.01)。(2)炎症指标方面,术后2周,2组患者的血清TNF-α、IL-6、TGF-β水平均较术后第1天明显降低(P<0.05),且观察组的降低作用均明显优于对照组(P<0.01)。(3)DVT发生率方面,观察组的DVT发生率为5.88%(3/51),明显低于对照组的19.61%(10/51),组间比较,差异有统计学意义(P<0.05)。(4)髋关节功能方面,术后2周、1个月及3个月,2组患者的HHS评分均较术前逐步升高(P<0.05),且观察组的升高作用均明显优于对照组(P<0.01)。【结论】髋关节置换术后应用逐瘀生骨汤联合低分子肝素钙治疗,可有效调节血液流变学指标和炎症因子水平,显著减少DVT的发生,有效促进髋关节功能恢复,其疗效优于单纯低分子肝素钙治疗。

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.

色谱技术在肝素结构分析中的研究进展

肝素(heparin,Hp)是目前临床应用最为广泛的抗凝剂,是由重复二糖单元组成的多硫酸化酸性直链多糖。低分子量肝素(LMWHs)是以肝素为原料,经过化学或酶降解获得的相对分子质量相对较小的肝素衍生物,相对肝素,它们的出血副作用和免疫原性更小,皮下注射时生物利用度更高。肝素及低分子量肝素具有一系列结构特点,如相对分子质量偏大且有一定分布,多种糖残基同时存在,硫酸酯位置和数量呈现多样化,以及不同工艺产生的特殊残基的种类和含量不一等。该类药物结构的复杂性对分析方法提出了巨大的挑战,也限制了其质量控制提升、工艺优化、临床用药安全和新适应证拓展等。该文以色谱分析方法为中心,从结构分析的不同角度,包括单糖、二糖、寡糖、多糖的识别、组成分析和不同层次,系统地梳理和阐述近年来肝素类药物在色谱分析方法上的进展,并对这些方法的应用范畴、创新性、局限性等进行总结。该文将为肝素类药物的结构分析、质量控制提供较系统的方法学参考,为更多新方法开发提供思路,为更深入地研究肝素类药物结构、拓展其应用提供有力支撑。

瑞替普酶并低分子肝素用于急性心肌梗死再灌注治疗的有效性与安全性研究

目的探讨急性心肌梗死(AMI)瑞替普酶静脉溶栓并应用低分子肝素(LMWH)替代普通肝素(UFH)抗凝治疗的安全性与有效性。方法106例AMI患者经瑞替普酶静脉溶栓后,随机分为LMWH组(低分子肝素5000U皮下注射,2次/d)和静脉UFH组(普通肝素静脉泵入24h后改为低分子肝素5000U皮下注射,2次/d),1周后行冠状动脉造影及冠脉介入治疗(PCI)。观察临床再通率、血管开通率、急性期并发症、出血及不良反应的发生率。结果①LMWH组与静脉UFH组相比,临床再通率(82.1%vs78.0%)、血管开通率(78.9%vs75.0%)高,临床再通病例梗死后心绞痛发生率(8.70%vs12.8%)低,但两组之间差异无统计学意义;②LMWH组出血并发症明显低于静脉UFH组(7.14%vs18.0%),差异有统计学意义(P<0.05)。③两组PCI后均予LMWH抗凝治疗,30d内无急性或亚急性支架内血栓形成发生。结论本研究结果提示,瑞替普酶并LMWH用于AMI再灌注治疗是安全、有效、方便的,LMWH用于PCI后抗凝治疗疗效确切。

低分子肝素、N-乙酰半胱氨酸干预对COPD大鼠气道重塑的影响

目的探讨低分子肝素(LMWH)、N-乙酰半胱氨酸(NAC)对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)大鼠气道重塑的影响。方法将40只6~8周鼠龄按雌雄各半的SD大鼠分为5组,即健康对照组(C组),熏香烟及脂多糖(LPS)方法制备的COPD模型组(M组),以及低分子肝素(LMWH)注射组(L组)和N-乙酰半胱氨酸(NAC)灌胃组(N组)及前二者同时干预组(LN组);光镜下观察大鼠病理学改变;以图像分析系统测量其支气管壁厚度;偏振光显微镜下观察各组大鼠支气管黏膜下胶原天狼猩红染色的气道胶原沉积。结果①模型制备:本研究制备的COPD模型大鼠支气管、肺病理改变与人类COPD变化基本一致。②支气管壁厚度:与对照组比较,M组、L组、N组和LN组管壁厚度明显增加(P<0.01);而与M组比较,L组、LN组管壁厚度均减少,且以LN组减少最为明显(P<0.01),N组亦有减少但差异无统计学意义(P>0.05)。③胶原沉积:与对照组比较,各组主要呈现Ⅰ型胶原沉积,L组和N组胶原减少,LN组胶原减少更趋明显。结论①较短时间的熏香烟+灌注LPS是建立COPD大鼠模型的简单易行的方法;②LMWH、NAC干预尤其是联合应用可通过不同作用机制减轻COPD发病过程中气道壁厚度及气道胶原沉积,进而减轻COPD气道重塑。

肺癌患者静脉血栓栓塞症的发生及其抗凝治疗

目前,肺癌的发病率和死亡率在全世界范围内居首位。静脉血栓栓塞症(venous thromboembolism,VTE)是一种公认的肺癌并发症,也是肺癌患者的主要死因之一。癌症自身因素、患者自身因素以及治疗相关因素都是导致肺癌患者发生VTE的主要原因。肿瘤细胞可产生组织因子(tissue factor, TF)、癌性促凝物质(cancer procoagulant, CP)、炎症因子和细胞因子,从而直接激活凝血;其中TF过度表达是肿瘤患者血栓形成的主要机制之一。2016年美国胸外科医师协会(American College of Chest Physicians, ACCP)发布的第10版肿瘤患者VTE防治指南(AT-10)指出,抗凝治疗是肺癌患者合并VTE的基本治疗措施;其中低分子肝素(low molecular-weight-heparin,LWMH)被认为是首选的抗凝药物,但要注意出血风险。

低分子肝素皮下注射治疗轻-中度活动性溃疡性结肠炎的疗效评价

目的评价低分子肝素(low-molecular-weight-heparin,LMWH)皮下注射辅助治疗轻-中度活动性溃疡性结肠炎(UC)的疗效。方法 48例轻-中度活动性UC患者随机分成2组(每组24例),分别接受5-氨基水杨酸和5-氨基水杨酸+低分子肝素钙皮下注射治疗,所有患者治疗前后均进行临床活动指数(CAI)、炎症指标(CRP、ESR、FIB)、凝血指标(PT、APTT、TT、D-二聚体和血小板计数)和内镜指数(EI)评价,并比较治疗后的改善情况。结果治疗后5-氨基水杨酸+低分子肝素钙组的CRP、D-二聚体较5-氨基水杨酸组显著下降(P<0.05),但CAI、EI和其他指标与5-氨基水杨酸组相比差异无统计学意义(P>0.05)。结论低分子肝素皮下注射能改善轻-中度活动性UC的部分炎症和凝血指标,但对临床症状和内镜下表现无显著改善作用。

低分子肝素在急性心肌梗死患者溶栓治疗中的早期应用价值

目的探讨急性心肌梗死(AMI)患者溶栓治疗中早期应用低分子肝素的临床疗效。方法选择2015年1月至2017年3月期间榆林市第二医院心内科收治的64例AMI患者为研究对象,根据随机数表法分为观察组和对照组,每组32例,观察组在尿激酶溶栓前开始应用低分子肝素,对照组则在溶栓后12 h开始应用,疗程7 d。比较两组患者冠状动脉再通率、再通时间、再梗死发生率及出血等不良反应发生率、心功能指标[脑钠肽(BNP)、左心室射血分数(LVEF)]的变化和病死率。结果观察组患者的冠状动脉再通率为87.50%,明显高于对照组的68.75%,再通时间为(1.4±0.6)h,明显短于对照组的(2.1±0.8)h,差异均有统计学意义(P<0.05);观察组患者的再梗死率为3.57%,明显低于对照组的18.18%,差异有统计学意义(P<0.05);治疗后,观察组患者的血清BNP水平为(148.3±28.4)pg/m L,明显低于对照组的(172.3±39.2)pg/m L,LVEF为(54.6±7.1)%,明显高于对照组的(49.4±5.8)%,差异均有统计学意义(P<0.05);观察组与对照组患者的不良反应发生率(9.38%vs 6.25%)及病死率(3.13%vs 6.25%)比较,差异均无统计学意义(P>0.05)。结论 AMI患者溶栓治疗过程中早期应用低分子肝素可提高再通率、缩短再通时间并降低再梗死率,可有效改善患者的心功能,并且具有较好的安全性。

低分子肝素钠在首次种植失败患者再次解冻移植周期中的应用

目的探讨低分子肝素钠是否能够改善首次种植失败患者再次解冻移植周期妊娠结局。方法回顾性分析2017年9月-2019年9月在新疆医科大学第一附属医院生殖医学中心首次种植失败再次解冻移植且年龄≤35岁患者(共计321个解冻周期)的临床资料,按照转化日开始是否添加低分子肝素钠分为两组:添加低分子肝素钠组(A组,162个解冻周期)、未添加低分子肝素钠组(B组,159个解冻周期),比较两组患者一般资料、移植周期特征、临床结局及不良反应等是否存在差异。结果两组患者年龄、不孕时间、体质指数(BMI)、基础卵泡刺激素(bFSH)、抗缪勒管激素(AMH)水平差异均无统计学意义;A组不良妊娠史构成比略高于B组,但差异无统计学意义;移植周期特征方面,两组患者移植胚胎构成比、平均移植胚胎数、优胚率及转化日子宫内膜厚度差异均无统计学意义;妊娠结局方面,A组生化妊娠率(56.79%vs 53.46%)、临床妊娠率(54.94%vs 50.94%)、胚胎种植率(43.06%vs 37.81%)及持续妊娠率(87.64%vs 87.72%)均略高于B组,B组早期流产率(8.99%vs 13.58%)高于A组,但差异无统计学意义(P>0.05);两组未见明显不良反应发生。结论低分子肝素钠在首次胚胎移植患者再次解冻移植周期中应用未出现明显不良副作用,但并不能明显改善患者助孕临床结局,因此在今后的临床诊疗工作中仍需谨慎使用。