ABSTRACT
【Objective】 To compare the therapeutic effects of low molecular weight heparin sodium and sodium citrate on hemodialysis(HD) patients at high risk of bleeding. 【Method】 A total of 96 patients at high risk of bleeding on maintenance hemodialysis from May 2018 to May 2020 were enrolled and divided randomly into control group(n=48) and observation group(n=48). Patients in control group received systemic anticoagulation with heparin, and patients in observation group adopted regional citrate anticoagulation of in vitro dialyzer. The indexes of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), D-dimer, service time of filters and the dialysis efficiency, as well as the complication occurrences of clotting events, bleeding, metabolic alkalosis and hypocalcaemia were compared between the two groups. 【Results】 No significant difference was found in coagulation indicators (ACT, PT, Fg, APPT and D-dimer) before and after hemodialysis in observation group(P>0.05), but those in control group were prolonged significantly (P0.05). The incidence of filter clotting (0.0%), dialyzer pipeline clotting (0.0%) and bleeding (2.1%) in observation group were less than those in control group (8.3%, 6.2%, 14.6%, respectively) (P0.05). 【Conclusion】 Regional anticoagulation with citric acid in vitro is safe for patients on maintenance hemodialysis at high risk of bleeding, and can greatly prolong service time of filters, reduce bleeding and thrombocytopenia rates, bring less effects to coagulation function in vivo.
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Objective To investigate the efficacy and safety of citrate anticoagulation for continuous renal placement therapy (CRRT) in patients at high risk of bleeding. Methods Forty-seven patients who needed to CRRT and were admitted into the department of critical care medicine from January 2015 to October 2016 were enrolled in this study. According to the patient′s actual condition, they were divided into citrate groups (24 cases) and saline group (23 cases). Patients in saline group were given saline wash. The efficacy and safety were compared between the two groups. The filter lifetime, after treatment the activated partial thromboplastin time (APTT), hemoglobin (Hb), blood gas indexes were compared between the two groups. Results The citrate group used 76 filters while the 0.9% sodium chloride group used 87 filters. The average filter lifetime in citrate group was (22.4 ± 12.7) h which was longer than (8.6±3.3) h in 0.9%sodium chloride group (t=9.79, P<0.01). The incidence of coagulation in extracorporeal circulation was 3.9%(3/76) which was lower than 16.1%(14/87) in 0.9%sodium chloride group(χ2=5.20, P<0.05). Conclusions Regional citrate anticoagulation is a safe and effective option for CRRT in patients at high risk of bleeding.
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Objective To retrospectively analyze the platelet count and related factors in bleeding patients with hematonosis,and to calculate the risk of bleeding when the platelet count is at each exposure level.Methods Retrospective analysis of patients from Department of Hematology Inpatients in Nanjing Drum Tower Hospital,Nanjing First Hospital and Nanjing Jiangning Hospital from July 2013 to June 2017 was collected.And the risk of bleeding for different hematonosis was calculated.Results The tolerance of the 5 categories of hematonosis to low platelet counts is compared:AA and ITP can tolerate lower levels of platelet count;MDS and AML(except M3) are more prone to bleeding;ALL is the most susceptible to bleeding.Conclusion When platelet resources are scarce,priority should be given to ALL,MDS and AML patients,in order to ensure the safety of critically ill patients.For patients with AA and ITP,the platelet infusion threshold may be reduced appropriately,in oder to reduce the incidence of platelet transfusion refractoriness.
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Objective To observe the bleeding risk of short-term intensive statin therapy after coronary artery bypass grafting. Methods A total of 240 patients treated with coronary artery bypass grafting were randomly divided into group A(experimental group)and group B(control group). All pa-tients were normalized to conventional treatment and they were given low molecular weight heparin for an-ticoagulant therapy during the perioperative period. Patients in group A were given 40 mg of atorvastatin before surgery,and 40 mg of atorvastatin every night for one month after the surgery. Patients in group B were given 10 mg of atorvastatin every night during the treatment. One month after the operation,platelet aggregation rate and bleeding events of patients were compared. Results There were significant differ-ences in maximum platelet aggregation rate[(14. 5 ± 3. 7)% vs(38. 1 ± 7. 4)% ,P < 0. 05],inhibition rate of platelet aggregation[(79. 5 ± 4. 3)% vs(50. 8 ± 10. 2)% ,P < 0. 05],and incidence of postopera-tive bleeding[27. 5% vs 12. 5% ,P < 0. 05]between group A and B,respectively. Conclusion Short-term intensive statin therapy can increase the bleeding risk after coronary artery bypass grafting.
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Objective: To explore the correlation between antithrombotic strategy and its prognostic value in coronary artery disease (CAD) patients combining with atrial ifbrillation (AF) after percutaneous coronary intervention (PCI). Methods: A total of 570 CAD patients with AF received PCI in our hospital from 2012-01 to 2013-12 were retrospectively analyzed by CHADS2 and HAS-BLED Score system. According to CHADS2 Results: Compared with Low risk of stroke group, the patients in High risk of stroke group had the worse prognosis and higher rate of MACCE occurrence,P0.05. The major bleeding events in patients with warfarin were a little higher than those without warfarin,P>0.05. The minor bleeding events were increased in both Low risk stroke group asP Conclusion: Warfarin medication may obviously decrease the occurrence rates of MACCE and ischemic events in high risk of stroke patients, while in low risk patients, warfarin could not further decrease the occurrence of MACCE and ischemic events. Warfarin could increase the risk for minor bleeding in both low risk and high risk of stroke in CAD patients combining with AF after PCI.
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The most serious and frequent complication of intracranial arteriovenous malformations(AVMs) is intracranial hemorrhage. To identify clinical and angiographic characteristics of AVM which positively correlates with hemorrhagic presentation, we retrospectively analyzed 61 consecutive cases with intracranial AVMs. The following charateristics correlated positively with hemorrhagic presentation of AVMs male sexuality(P=0.059, borderline significance), history of hypertension(p<0.05), nidal dimeter<3cm(p<0.05), deep venous drainage(p<0.05), presence of intranidal aneurysm(P<0.05). Detailed analysis of the clinical and angiographic factors associated with risk of bleeding from AVMs may be the important prognostic implications for the treatment of patients with these leions.