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.

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.

Heparin Sodium Was Prepared from Pig Intestinal Mucosa by Dialysis and Spray Drying

A method to extract crude heparin sodium from pig intestinal mucosa by dialysis and spray drying was established. The pig intestinal mucosa was treated in the following steps: enzymolysis, resin exchange adsorption-washing, elution, pressure filtration, dialysis, spray drying. Activity of the product was measured using a heparin anti-IIa factor assay kit. The yield of crude heparin obtained by this method was 2.79% higher than that of oven drying method;the production of 1 kg crude heparin sodium saved 43.4 pigs small intestine. The activity was 98.48 ± 2.49 IU/mg (n = 5), 15.18 IU/mg higher than that obtained by oven drying method. The product is pale white powder, attractive color and easy to dissolve.

Segregation Treatment and Resource Recycling of Enteric Coating and Heparin Sodium Manufacturing Wastewater

Firstly, the water-quality characteristics of intestinal lavage wastewater and enzymolysis wastewater from the typical heparin sodium pro- ductive process were analyzed, and then the segregation treatment was applied in the treatment of enteric coating and heparin sodium manufacturing wastewater. Finally, the treatment of the two kinds of wastewater by different methods were discussed. The results showed that, COD of enzymolysis wastewater treated by centrifugation-coagulation-Fenton reagent oxidation-adsorption process was lower than 100 mg/L, while intestinal lavage wastewater treated by coagulation-ASBR-SBR process could meet the first standard of Comprehensive Discharge Standard of Sewage （GB8978-1996） after one month of continuous operation.

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.

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.

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.

小剂量肝素钠与低分子肝素钙对脓毒症治疗作用的对比研究

目的:对比小剂量肝素钠与低分子肝素钙治疗脓毒症的效果。方法:选取2021年10月—2022年10月脓毒症患者100例,随机分为观察组和对照组,每组50例。对比两组患者的治疗效果。结果:对照组弥散性血管内凝血8例(16.0%),观察组弥散性血管内凝血1例(2.0%),观察组临床疗效高于对照组(P<0.05)。随访1个月,观察组病死率低于对照组(P<0.05)。观察组各项凝血指标显著优于对照组(P<0.05)。观察组各项炎性因子水平低于对照组(P<0.05)。两组治疗后急性生理与健康评分(APACHEⅡ)优于治疗前,且观察组优于对照组,差异有统计学意义(P<0.05)。结论:低分子肝素钙相比小剂量肝素钠治疗脓毒症更加可行,可降低并发症发生率,改善短期预后。

PDCA在降低患者自行注射预灌式低分子肝素钠皮下瘀斑发生率中的应用效果

目的探讨开展计划-实施-检查-处理(plan-do-check-act,PDCA)循环在降低患者自行注射预灌式低分子肝素钠皮下瘀斑发生率中的应用效果。方法将2023年3—5月在厦门大学附属第一医院就诊并自行注射预灌式低分子肝素钠的56例患者作为对照组,将2023年8—10月自行注射预灌式低分子肝素钠的49例患者作为观察组。对照组采用常规注射流程进行注射指导,观察组运用PDCA循环工具进行注射干预管理。比较2组自行注射预灌式低分子肝素钠皮下瘀斑的发生率。结果观察组注射部位未轮换发生率为20.4%,未带空气泡注射发生率为18.4%,按压手法不准确发生率为16.3%,进针深度不准确发生率为6.1%,按压时间不够发生率为4.1%,低于对照组的44.6%、39.3%、35.7%、19.6%、17.9%,差异有统计学意义(P<0.05)。观察组注射时疼痛程度优于对照组,差异有统计学意义(P<0.05)。观察组皮下瘀斑的发生率为12.2%,低于对照组的33.9%,差异有统计学意义(P<0.05)。结论PDCA循环工具的应用有助于降低患者自行注射预灌式低分子肝素钠皮下瘀斑的发生率。

肝素钠注射液皮下注射知信行现状调查研究

目的 调查肝素钠注射液皮下注射护理操作规范的知信行现状及其影响因素,为临床护士的培训及管理提供参考依据。方法 使用方便抽样法选取2022年4-5月西安交通大学第一附属医院、西北妇女儿童医院和深圳市人民医院临床护士720人为研究对象,采用临床护士肝素钠注射液皮下注射护理操作规范的知信行调查问卷,进行问卷调查并寻找其影响因素。结果 临床护士肝素钠注射液皮下注射知信行得分(145.33±19.94)分,知识、态度、行为三维度分别是(19.23±4.48)分、(44.33±6.82)分、(81.73±15.05)分;多元线性回归结果显示临床护士对肝素钠注射液皮下注射操作知识的显著影响因素是工作时长、有无接受肝素钠注射液皮下注射操作培训;态度的显著影响因素是工作时长;行为的显著影响因素是知识、态度及有无接受肝素钠注射液皮下注射培训等。结论 临床护士关于肝素钠注射液皮下注射操作护理态度积极程度较好,但知识水平和行为执行情况有待进一步促进和提高。管理者只有采取多样化形式培训,做好肝素钠注射液皮下注射的质控管理,才能确保病人的用药安全。

肝素钠与头孢呋辛钠联合封管治疗对血液透析患者中心静脉导管感染的临床疗效及生命质量影响分析

目的分析肝素与头孢呋辛钠联合封管治疗对血液透析中心静脉导管感染患者的临床疗效及生命质量影响。方法选取2018年1月至2022年5月南昌大学第四附属医院联合鹰潭市人民医院(含门诊走透)的76例血液透析中心静脉导管感染患者作为研究对象,随机分为观察组与对照组,各38例。观察组采用肝素钠注射液联合注射用头孢呋辛钠进行封管,对照组采用肝素钠注射液联合硫酸庆大霉素注射液进行封管。比较两组临床疗效、封管治疗前后炎症因子指标、生命质量及并发症发生情况。结果观察组治疗总有效率高于对照组,但组间比较差异无统计学意义。封管治疗后,观察组白细胞介素-6、高敏C反应蛋白、肿瘤坏死因子-α水平均低于对照组,差异有统计学意义(P<0.05)。封管治疗后,观察组躯体健康、心理健康评分及总分均高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论肝素钠注射液联合注射用头孢呋辛钠联合封管治疗血液透析中心静脉导管感染疗效显著,能显著降低炎症因子水平,改善生命质量评分,降低并发症发生率,值得临床推广应用。

低分子肝素钠联合小剂量黄体酮治疗先兆流产临床效果及对妊娠结局的影响

目的探究低分子肝素钠联合小剂量黄体酮治疗先兆流产的临床效果及对妊娠结局的影响。方法选取90例先兆流产产妇,根据治疗方法不同分为研究组(50例)与对照组(40例)。对照组采用小剂量黄体酮治疗,研究组在对照组基础上联合低分子肝素钠治疗。比较两组临床疗效、血栓前状态标志物水平及妊娠结局。结果研究组治疗总有效率(94.00%)高于对照组(80.00%)(P<0.05)。研究组足月妊娠率高于对照组,流产率低于对照组(P<0.05),两组早产率比较差异无统计学意义(P>0.05)。研究组治疗后纤维蛋白溶酶原(PLG)水平高于对照组,蛋白C(PC)水平低于对照组(P<0.05)。结论低分子肝素钠联合小剂量黄体酮治疗先兆流产产妇,可以调节血栓前状态标志物水平,提高临床疗效,改善妊娠结局,值得临床推广。

低分子肝素钠辅助连续性静脉-静脉血液滤过治疗重症脓毒症患者的临床效果

目的:探讨低分子肝素钠辅助连续性静脉-静脉血液滤过(CVVH)治疗重症脓毒症的临床效果。方法:选取2022年1月-2023年6月浙江大学医学院附属第二医院收治的84例行CVVH治疗的重症脓毒症患者为研究对象,采用随机数字表法分为对照组和试验组,各42例。对照组采用肝素钠注射液抗凝辅助治疗,试验组采用低分子肝素钠抗凝辅助治疗。比较两组凝血指标、序贯性器官功能衰竭(SOFA)评分、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)评分、炎性因子水平、不良事件发生率。结果:治疗后,两组活化部分凝血活酶时间、凝血酶时间、凝血酶原时间低于治疗前,血小板计数高于治疗前,试验组优于对照组,差异有统计学意义(P<0.05);治疗后,两组SOFA、APACHEⅡ评分低于治疗前,试验组SOFA、APACHEⅡ评分低于对照组,差异有统计学意义(P<0.05);治疗后,两组肿瘤坏死因子-α、超敏C反应蛋白水平低于治疗前,试验组低于对照组,差异有统计学意义(P<0.05);两组不良事件发生率比较,差异无统计学意义(P>0.05)。结论:低分子肝素钠辅助CVVH治疗重症脓毒症患者可有效改善凝血功能,缓解炎性反应及临床症状,安全性高。

参芪寿胎丸联合黄体酮、低分子肝素钠治疗肾虚血瘀型复发性流产患者的临床效果及对血栓弹力图的影响

目的观察参芪寿胎丸联合黄体酮、低分子肝素钠治疗肾虚血瘀型复发性流产患者的临床效果及对血栓弹力图(TEG)的影响。方法选取2021年1月至2023年6月在莱州市人民医院保胎的复发性流产患者90例,按照随机数字表法分为研究组和对照组,每组45例。对照组治疗以黄体酮+低分子肝素钠为主,研究组在此基础上予以参芪寿胎丸治疗,分析两组患者治疗前后中医证候评分、TEG指标、激素水平以及保胎成功率。结果治疗后研究组中医证候积分低于对照组,TEG指标最大振幅、反应时间、凝血综合指数优于对照组,雌二醇、孕酮、β绒毛膜促性腺激素水平高于对照组,保胎成功率为86.67%,高于对照组的66.67%,差异均有统计学意义(P<0.05)。结论参芪寿胎丸联合黄体酮、低分子肝素钠不仅能够提升肾虚血瘀型复发性流产患者保胎成功率、改善临床症状,还能够明显改善患者凝血水平,具有很好的临床应用价值。

低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝在肾病综合征中的应用效果及安全性

目的探讨低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝在原发性肾病综合征(PNS)中的应用效果及安全性。方法回顾性选取2020年3月至2022年12月期间四川省凉山彝族自治州第一人民医院收治的188例PNS患者,根据肾穿刺活检病理结果及磷脂酶A2受体抗体分为膜性肾病组(n=73)与非膜性肾病组(n=115)。两组患者均根据血清白蛋白水平,采用低分子肝素钙或磺达肝癸钠序贯联合双嘧达莫抗凝。比较两组患者治疗前及治疗后4周、治疗后6个月的肾功能指标[白蛋白、尿素氮、血肌酐、肾小球滤过率(eGFR)和24 h尿蛋白定量(24 h PRO)],治疗前及治疗后4周的血栓弹力图指标[反应指数(R时间)、凝血时间(K时间)、血栓最大弹力度(MA)、凝血指数(CI)和α角],以及随访6个月记录血栓事件、出血事件。结果治疗后4周、6个月,两组的白蛋白、eGFR均较治疗前明显升高,尿素氮、血肌酐、24 h PRO均较治疗前明显降低,差异均有统计学意义(P<0.05),但两组治疗后各肾功能指标比较,差异均无统计学意义(P>0.05)。治疗后4周,两组患者的R时间、K时间均较治疗前明显延长,MA、CI值和α角均较治疗前明显降低,差异均有统计学意义(P<0.05),但两组患者治疗后4周的R时间、K时间、MA、CI值和α角比较,差异均无统计学意义(P>0.05)。膜性肾病组患者的血栓、出血事件发生率分别为6.85%、10.96%,均高于非膜性肾病组(0.87%、3.48%),但两组间血栓事件总发生率、出血事件发生率比较,差异均无统计学意义(P>0.05)。结论低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝有利于改善PNS患者的肾功能,缓解高凝状态,降低血栓栓塞事件发生率,且非膜性肾病患者获益较膜性肾病患者更明显,安全性更高。