目的探讨低分子肝素预防下肢静脉曲张术后深静脉血栓形成的临床效果。 方法将2011年1月至2013年12月期间于笔者所在医院行大隐静脉高位结扎＋分段剥脱术＋腔内激光闭合术的513例下肢静脉曲张患者随机分为2组：低分子肝素组238例，下肢静脉曲张术后采用低分子肝素预防性治疗；对照组275例，术后不采用任何抗凝药物。比较2组患者深静脉血栓形成和并发症发生情况。 结果低分子肝素组发生浸透敷料的出血14例（5.9%），切口出血或皮下血肿25例（10.5%），血小板减少1例（0.4%），肝功能异常2例（0.8%），无深静脉血栓形成发生；对照组发生浸透敷料的出血19例（6.9%），切口出血或皮下血肿27例（9.8%），肝功能异常2例（0.7%），深静脉血栓形成7例（2.5%），无血小板减少发生。2组患者浸透敷料的出血、切口出血或皮下血肿、血小板减少及肝功能异常发生率比较差异均无统计学意义（P＞0.05），但低分子肝素组深静脉血栓形成的发生率低于对照组（P＜0.05）。术后获访487例，随访时间为4～12个月，平均10个月。其中低分子肝素组获访225例，对照组获访262例。获访患者随访期间发生下肢静脉曲张复发9例（低分子肝素组4例，对照组5例），隐神经损伤11例（低分子肝素组5例，对照组6例），无远期下肢深静脉血栓形成病例。2组患者的下肢静脉曲张复发率和隐神经损伤发生率比较差异均无统计学意义（P＞0.05）。 结论采用低分子肝素预防下肢静脉曲张术后下肢深静脉血栓形成具有良好的临床效果和安全性，值得临床推广应用。
ObjectiveTo systematically review the efficacy and safety of different low-molecular-weight heparins (LMWHs) for prevention of thromboembolic events in patients with atrial fibrillation (AF).MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized clinical trials (RCTs) on efficacy and safety of different low-molecular-weight heparins (LMWHs) in preventing thrombotic diseases in patients with atrial fibrillation from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 16.0 software.ResultsA total of 11 RCTs involving 7 400 patients who were treated with enoxaparin, dalteparin, or tinzaparin to prevent thromboembolic events were included. The results of network meta-analysis showed that: in patients with AF and perioperative AF patients, there were no statistical differences in the incidence of stroke, TIA, major bleeding, minor bleeding, and all-cause mortality caused by dalteparin, enoxaparin, and tinzaparin. Furthermore, the surface under the cumulative ranking area (SUCRA) showed that enoxaparin was superior for prevention of stroke and TIA than dalteparin and tinzaparin. As for major bleeding, minor bleeding, and all-cause death, dalteparin treatment was superior than enoxaparin.ConclusionsCurrent evidence showed enoxaparin to be a viable option for high ischemic risk AF patients requiring LWMH treatment, while dalteparin to be a viable option for those with bleeding high risk. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
Objective To investigate the impact of preoperative use of low-molecular-weight heparin （LMWH） on early outcomes of off-pump coronary artery bypass grafting （OPCAB） . Methods Clinical data of 809 patients undergoingisolated OPCAB from April 1st，2011 to September 30th，2012 in the First Affiliated Hospital of China Medical University were retrospectively analyzed. All the patients were divided into LMWH group and control group according to preoperative use of LMWH or not. In LMWH group，there were 386 patients including 290 male and 96 female patients with their age of 49-81 years，who routinely received anticoagulation therapy with LMWH （LMWH sodium or LMWH calcium，4 000 U twice a day，subcutaneous injection） after discontinuation of anti-platelet therapy until the day before surgery. In the control group，there were 423 patients including 321 male and 102 female patients with their age of 46-78 years，who didn’t receive LMWH or any other anticoagulant after discontinuation of anti-platelet therapy. Postoperative mortality，incidence of perioperative myocardial infarction （MI），operation time，amount of blood loss and transfusion，and incidence of postoperative acute renal injury were compared between the 2 groups. Results Intraoperative blood loss （296±94 ml vs. 249±81 ml，P=0.03），postoperative thoracic drainage （526±159 ml vs. 410±125 ml，P=0.02），blood transfusion （2.6±1.1 U vs. 1.4±0.9 U，P=0.04） and operation time （172±34 min vs. 154±41 min，P=0.04） of LMWH group were significantly larger or longer than those of the control group. There was no statistical difference in postoperative mortality（1.0% vs. 1.2%，P=1.00）or incidence of perioperative MI（4.4% vs. 3.8%，P=0.55）between the 2 groups. Conclusion For OPCAB patientswith stable ischemic heart disease，preoperative management without use of LMWH can decrease operation time and amountof blood loss and transfusion without increasing postoperative mortality or incidence of perioperative MI.
ObjectiveTo investigate the clinical efficacy of low molecular weight heparin on community-acquired pneumonia (CAP). MethodsA total of 78 patients with CAP admitted to hospital between January 2013 and March 2015 were randomly assigned into a conventional treatment group and a heparin treatment group. Both groups received anti-infection and symptomatic treatment, and the patients in heparin treatment group additionally received low molecular weight heparin by abdominal subcutaneous injection once daily for a course with seven days. The age, sex and severity of the disease were recorded. White blood cell (WBC) count and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured on and during admission. ResultsThe baseline information including age and sex, severity of illness, CRP, ESR and WBC counts on admission and the first treatment day had no difference between two groups (P > 0.05). CRP and ESR on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significantly more decreased than those in the conventional treatment group (P < 0.05). For the moderate and severe CAP patients, the level of CRP on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significant lower than those in the conventional treatment group (P < 0.05). ConclusionCombination therapy of low molecular weight heparin may improve the clinical efficacy of CAP.
目的:观察低分子肝素钙联合舒血宁(银杏叶提取物)治疗不稳定型心绞痛疗效。方法:选择符合诊断标准的不稳定型心绞痛患者88例。随机分为治疗组与对照组,对照组给予常规药物治疗,治疗组在常规治疗的基础上给予低分子肝素钙和舒血宁注射液治疗。结果:2周结束后治疗组各项观察指标较对照组明显改善,两组差异明显(Plt;005)。结论:低分子肝素钙联合舒血宁治疗不稳定型心绞痛效果显著。
【摘要】 目的 评价葛根素注射液（PI）联合低分子肝素（LMWH）治疗不稳定型心绞痛（UAP）的疗效和安全性。 方法 计算机检索中国生物医学文献数据库（CBM）、中国期刊全文数据库（CNKI）、中文科技期刊全文数据库（VIP-维普）、万方-数字化期刊全文库，纳入在常规治疗上加用PI和LMWH对比单纯常规治疗的随机对照试验（RCT），对纳入研究进行质量评价和Meta分析。 结果 共纳入21个RCT，均为C级文献。Meta分析结果显示，在临床症状疗效显效率、心电图疗效显效率和有效率指标方面，两组差异有统计学意义:RR（95%CI）分别为:1.63（1.48，1.79）、1.57（1.34，1.83）及1.28（1.10，1.49）。 结论 基于上述证据，在常规治疗UAP上加用PI和LMWH疗效优于常规治疗。【Abstract】 Objective To evaluate the effect of the puerarin injection (PI) combined with low molecular weight heparins (LMWH) on unstable angina pectoris (UAP). Methods Randomized controlled trials (RCT) of PI combined with LMWH treating UAP were gathered from CBM, CNKI, VIP, and Wanfang data bases; and study quality was evaluated and the Meta-analysis was carried out. Results A total of 21 RCT were identified, of which all were in graded C. According to Meta-analysis, the differences of the clinic excellent rate, electrocardiogram excellent rate and effective rate between the two groups were significant; the RR (95%CI) were: 1.63 (1.48, 1.79), 1.57 (1.34, 1.83), and 1.28 (1.10, 1.49). Conclusion Based on the evidence recently, PI and LMWH adding is better than ordinary treatment for UAP.
Abstract： Objective To compare the influence of different doses of low molecular weight heparin on blood coagulation system of patients who have received thoracic surgery. Methods Eightytwo patients (with lung cancer, esophageal cancer, thymoma, pleural endotheliomas or other diseases) who were treated in Tongji Hospital of Huazhong University of Science and Technology from January 2009 to March 2010 were divided into three groups, based on the time of hospitalization. In the control group, there were 24 patients including 10 females and 14 males with an average age of 43.5±21.3 years. No low molecular weight heparin was given after operation. There were 32 patients in group I, including 14 females and 18 males, with an average age of 45.2±18.6 years. An amount of 0.2 ml (2 125 U) low molecular weight heparin was subcutaneously injected daily during the first 7 days after operation. In group Ⅱ, there were 26 patients including 11 females and 15 males with an average age of 43.8±20.1 years. An amount of 0.4 ml (4 250 U)low molecular weight heparin was subcutaneously injected daily during the first 7 days after operation. The differences of preoperative and postoperative coagulation factors including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), D dimer (D-D), platelet count (PLT) and anti-Ⅹa activity were observed. Results The preoperative average values of PT, APTT, Fib, D-D, PLT of all the three groups were in the normal range and showed no significant difference (Pgt;0.05). For all three groups, after operation, PT prolonged, APTT shortened, the amount of Fib, D-D increased, PLT reduced on the 3rd day and then increased on the 7th day and anti-Ⅹa activity increased, all of which showed a significant difference from preoperative values (Plt;0.05). The amount of Fib in group Ⅱ was significantly lower than that in group Ⅰ after operation (the 5th day after operation: 4.7±2.5 g/L vs. 7.0±3.3 g/L, Plt;0.05); the amount of D-D in group Ⅱ was significantly lower than that in the control group (the 5th day after operation: 891.3±891.3 μg/L vs. 1 583.2±984.7 μg/L, Plt;0.05) and group Ⅰ (the 5th day after operation: 891.3±891.3 μg/L vs. 1 452.6±1 052.9 μg/L,Plt;0.05); and the anti-Ⅹa activity of group Ⅱ was significantly higher than that in group Ⅰ (the 5th day after operation: 0.54±0.05 U/ml vs. 0.29±0.04 U/ml, Plt;0.05). Conclusion In a certain weight range, fixeddose (4 250 U) of low molecular weight heparin is able to improve postoperative hypercoagulable state and avoid the occurrence of venous thromboembolism without increasing risk of complications like bleeding.