ABSTRACT
OBJECTIVE To investigate the clinical efficacy of Gushen antai pills combined with heparin sodium in the treatment of antiphospholipin antibody （ACA）-positive recurrent abortion. METHODS A total of 203 ACA-positive recurrent abortion patients were randomly divided into control group （n＝101） and combination treatment group （n＝102）. Control group was additionally treated with heparin sodium on basis of basic treatment， and combination treatment group was additionally treated with Gushen antai pills on the basis of control group. Serum samples were collected from patients， the levels of interleukin 6 （IL- 6）， tumor necrosis factor α （TNF-α）， cyclooxygenase 2 （COX-2）， β-human chorionic gonadotropin （β-HCG） and ACA were detected by enzyme-linked immunosorbent assay. The antibody-negative conversion rate was calculated， the clinical efficacy of the patient was observed， and the occurrence of adverse drug reactions was recorded. RESULTS After treatment， the pregnancy success rate and antibody-negative conversion rate of combination treatment group were significantly higher than those in the control group （P＜0.05）， and the abortion rate was significantly lower than that in the control group （P＜0.05）. Compared with before treatment， serum levels of IL-6， TNF-α and ACA in 2 groups were decreased significantly （P＜0.05）， while the levels of COX-2 and β-HCG were increased significantly （P＜0.05）； the changes of above indexes in combination treatment group were more significant（P＜0.05）. There was no statistical significance in the incidence of adverse drug reactions between 2 groups（P＞0.05）. CONCLUSIONS Gushen antai pills can maintain high expression of β-HCG， reduce the level of ACA and improve immune microenvironment in patients with ACA-positive recurrent abortion by increasing the serum level of COX-2 and decreasing the serum level of IL-6， so as to increase the success rate of pregnancy.
ABSTRACT
Objective To study and investigate the efficacy of alteplase combined with low molecular weight heparin sodium in the treatment of patients with submaximal pulmonary embolism and its influence on related indicators, and to guide clinical medication. Methods Eighty patients with large pulmonary embolism treated in our department from August 2013 to August 2017 were randomly divided into observation group and control group, with 40 cases in each group. The control group was treated with subcutaneous injection of low molecular weight heparin sodium. In combination with oral anticoagulation with warfarin, the observation group was treated with alteplase on the basis of the control group. After 1 week of continuous treatment, the clinical efficacy was compared between the 2 groups, and pulmonary function and arterial partial pressure of oxygen (PaO2) were compared before and after the treatment. The partial pressure of carbon dioxide (PaCO2) was used to compare the levels of serum B-type natriuretic peptide (BNP) , troponin Ⅰ (cTnⅠ) , homocysteine (Hey) , Ddimer (D-D) , and bleeding before and after the treatment in both groups. Results The total effective rate was97.50％ in the observation group, which was significantly higher than that in the control group of 75.00％ (P <0.05). There was no significant difference in terms of FEV1％, FEV1/FVC, PaO2 and PaCO2 between the two groups before the treatment (P> 0.05) , but FEV1％, FEV1/FVC, PaO2 in the observation group were significantly higher than those in the control group after the treatment, and PaCO2 was significantly lower (P <0.05); There was no significant difference regarding to serum BNP, cTnl, Hey and D-D levels between the two groups before the treatment (P> 0.05) , but after the treatment, the indexes of the observation group were significantly lower than those of the control group (P < 0.05). There was no statistical difference in the incidence of bleeding between the two groups (P> 0.05). Conclusion Alteplase combined with low-molecular-weight heparin sodium in the treatment of the next large-area pulmonary embolism can improve the efficiency of treatment, lung function and the prognosis, but will not inc-rease the risk of bleeding. It could be widely used in clinical practice.
ABSTRACT
OBJECTIVE:To promote the safe use of Heparin sodium injection for children. METHODS:According to litera-ture retrieve,questionnaire survey and field investigation,Health care failure mode and effect analysis method(HFMEA)was ad-opted to search for the failure modes of Heparin sodium injection for children,and preventive strategies were established and imple-mented based on these failure modes. Its effects were evaluated by comparing the error rate and risk priority number rating (RPN value)before and after the implementation. RESULTS:Totally 5 risk points of Heparin sodium injection requiring immediate inter-vention were obtained from RPN value,including wrong dose of Heparin sodium injection in prescribing,pharmacists'unclearness for the calculation method of the dose of Heparin sodium injection in dispensing,and nurses'no performing of double check sys-tem before infusion in administration,etc. After implementing related countermeasures,related error of Heparin sodium injection was decreased from 8 cases to 1 case,and error rate was declined from 3.76% to 0.51%(P<0.01). The RPN values of 5 failure modes were decreased from 112.08,91.56,115.78,94.52,99.23 to 28.02,23.91,27.71,23.63,20.55,respectively. CONCLU-SIONS:HFMEA can prospectively conduct systematical analysis for Heparin sodium injection for children. Implementing related countermeasures based on the current situation of our hospital can reduce the related error of Heparin sodium injection and promote the medication safety of children.
ABSTRACT
Objective To investigate the effect of different anticoagulant drugs on the changes of coagulation index and the incidence of hemorrhage in hemodialysis patients.Methods 40 patients with hemodialysis were selected as study objects,according to the random number table method they were divided into three groups,20 cases received heparin in A group,10 cases received low molecular heparin in B group;10 cases received argatroban in C group.At the same time,10 healthy persons were selected as control group.The activated glass bead clotting time (gbACT),blood velocity (CR),platelet function (PF),prothrombin fragment 1+2 (PF1+2) and the surface of platelet alpha granule membrane protein (GMF-140) were observed and analyzed in all patients.Results Compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine in A group were significantly increased,which were (31.1±5.5)sig/min,(3.1±0.5),(478.2±74.3)pmol/L,(36.9±6.6)pmol/L,respectively,gbACT was significantly prolonged [(196.1±27.3)s].In A group,compared with before taking to machine,the CR,PF,PF1+2 and the GMF-140 before taking off machine were significantly decreased,which were (10.6±3.2)sig/min,(1.8±0.4),(400.1±85.5)pmol/L,(30.9±6.8)pmol/L,respectively,gbACT was significantly prolonged[(252.5±50.4)s],there were statistically significant differences (F=112.64,28.38,81.40,18.11,21.63 0.05,all P<0.05);B group compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine were significantly increased,which were (29.5±6.6)sig/min,(2.9±1.2),(475.5±97.0)pmol/L,(37.5±7.0)pmol/L,respectively,gbACT was significantly prolonged[(193.9±32.8)s].In B group,the CR and PF1+2 before taking off machine were significantly decreased,which were (22.3±6.8),(407.8±90.3)pmol/L,respectively,gbACT was significantly prolonged [(207.5±31.5)s],there were statistically significant differences (F=9.11,57.81,5.99,16.37,all P<0.05);C group compared with the control group,the CR,PF,PF1+2 and GMF-140 before taking to machine were significantly increased,which were (26.1±3.3)sig/min,(2.5±0.5),(443.5±64.1)pmol/L,(32.2±8.3)pmol/L,respectively,before taking off machine,the CR[(23.7±4.1)] was higher than (18.5±3.6) of the control group,there were statistically significant differences (F=11.14,3.04120.30,8.63,all P<0.05).40 hemodialysis patients were successfully treated without the occurrence of elevated venous pressure during and after treatment pipeline no or slight residual blood,puncture time and no significant prolongation.Conclusion Unfractionated heparin has strong anti-clotting effect,during and after hemodialysis has greater risk of bleeding,dalteparin has anticoagulant effect,but there is greater risk of bleeding during hemodialysis,the use of argatroban helps to improve the condition of bleeding.
ABSTRACT
OBJECTIVE:To observe therapeutic efficacy and safety of low-molecular-weight-heparin-sodium combined with dy-drogesterone in the treatment of threatened abortion. METHODS:Medical information of 72 patients with threatened abortion were analyzed retrospectively and divided into control group(36 cases)and observation group(36 cases). Control group was given Dy-drogesterone tablet with initial dose of 40 mg,one day later every 12 h 10 mg/time. Observation group was additionally given ab-dominal subcutaneous injection of Low-molecular-weight-heparin-sodium injection 5000 U,once a day,on the basis of control group. Both groups were treated for a week. Clinical efficacies of 2 groups were observed,and lumbar acid,vaginal bleeding,ab-dominal pain time,total treatment time,neonatal birth weight were also observed. The levels of hs-CRP,fibrinogen,D-dimer and platelet,the occurrence of ADR were observed before and after treatment. RESULTS:The total response rate of observation group was significantly higher than that of control group(91.7%vs. 80.6%),the backache,vaginal bleeding,abdominal pain time and to-tal treatment time of observation group were significantly shorter than those of control group,the neonatal birth weight and gesta-tional age of observation group were significantly more than those of control group,with statistical significance(P0.05);after treatment,the levels of hs-CRP,fibrinogen,D-dimer and platelet in 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,with statistical significance (P0.05). CONCLUSIONS:Based on routine treatment,low-molecu-lar-weight-heparin-sodium combined with dydrogesterone shows good therapeutic efficacy and safety for threatened abortion.
ABSTRACT
Objective There are few studies on the application of low molecular weight heparin (LMWH) in the therapy of women with recurrent spontaneous abortion (RSA) pregnant by assisted reproductive technology (ART).The article aimed to explore the clinical research of LMWH in therapy of women with RSA pregnant by ART.Methods 126 women with RSA pregnant by ART were enrolled and they were diagnosed and treated in Reproductive Medicine Center in the Affiliated Hospital of Guangdong Medical University from January 2010 to February 2016.According to the patient′s agreement on LMWH treatment, 60 patients in agreement with LMWH treatment were divided into 2 groups: LMWH+IUI group(n=30) and LMWH+ IVF-ET group(n=30).66 patients in disagreement with LMWH treatment were also divided into 2 groups: IUI group(n=32) and IVF-ET group(n=34).Comparison was made in patients from 4 groups concerning pregnancy success rate, live birth rate, pregnancy time involving RSA and incidence of pregnancy complications.At the same time, the occurrence of adverse reactions during the use of LMWH was also observed.Results The pregnancy time involving RSA in LMWH+IUI group significantly increased compared with IUI group([82.67±9.10]d vs [48.17±8.68]d)(P<0.05).The pregnancy success rate and live birth rate in LMWH+ IVF-ET group were both higher than those of IVF-ET group (66.7% vs 35.29%, 85.00% vs 50.00%)(P<0.05) and significant difference was also found in the incidence of RSA, the pregnancy time involving RSA, and the morbidity of gestational hypertension between groups(P<0.05).The results of D2D at 4 weeks of pregnancy in LMWH+IUI group([0.65±0.07]mg/L) and LMWH+ IVF-ET group([0.625±0.06]mg/L) were lower than those of LMWH group ([0.76±0.12]mg/L) and LMWH group([0.77±0.06]mg/L).The result of D2D at 6 weeks of pregnancy in LMWH+IUI group was lower than those of IUI group and IVF-ET group, and D2D in LMWH+ IVF-ET group was lower compared with IVF-ET group(P<0.05).The results of D2D in all the four groups increased with the pregnancy weeks(P<0.05).The prothrombin time(PT) at 4 weeks of pregnancy in LMWH+IUI group, IUI group and LMWH+ IVF-ET group ([12.53±0.38]s, [12.38±0.65]s, [12.47±0.58]s) was significantly higher at pre-pregnancy([12.33±0.52]s, [12.30±0.68]s, [12.22±0.64]s) and 6 weeks of pregnancy([12.13±0.62]s, [12.05±0.60]s, [12.03±0.54]s) (P<0.05).Among 60 cases treated with LMWH, small area ecchymoma were found in 11 cases and the incidence was 18.33%(11/60), only two cases reported with uncomfortable light pain in the location of subcutaneous injection.Conclusion Low-dose LMWH is safe and effective in the therapy of pregnant women with RSA through ART.
ABSTRACT
Objective To evaluate the curative effect of urokinase combined with low molecular heparin sodium in managing arteriovenous fistula embolism. Methods Toally 48 patients with arteriovenous fistula embolism treated from January 2014 to October 2015 were selected for the study, where 22 were assigned into control group and 26 as trial group according to the registration time. The former group were treated with urokinase and the latter with urokinase combined with low molecular heparin sodium. The rate of recanalization, the rate of thrombosis recurrence, and the adverse reactions were compared between the two groups. Results The recanalization rate in the trial group was higher than that in the control group (P<0.05). The rate of thrombosis recurrence in the trial group was significantly lower than that the control group. There was no statistical difference in adverse reactions between the groups. Conclusion The thrombolytic effect of urokinase combined with low molecular heparin sodium is superior to that of urokinase alone, with a higher rate of recanalization.
ABSTRACT
Objective To observe the effect of drug combinations on the blood flow after reduction of the testicular torsion in rabbits.Methods From October 2014 to June 2015,36 male rabbits (weighing 1.8-2.4 kg,10-14 months of age) were randomly divided into experimental group and control group,18 in each group.Produced by surgical testicular torsion model (720° counterclockwise rotation of the left side testicle),every rabbit was accepted surgery reset after 9 hours and found all twisted testicles were dark.After fomentation with warm salt water,all the testicles were observed no significant improvement in colors,and no fresh blood flow after opening tunica albuginea,then all the testicles were retained and fixed.Low molecular dextran(5 ml/kg,ear marginal vein injection,1/d),papaverine(1.5 mg/kg,intramuscular,3/d) and low molecular weight heparin sodium (200 IU/kg,subcutaneous,l/d) were applied to promote testicular revascularization for 5 days in experimental group,and penicillin (40 000 U/kg,intramuscular,1/d) for 7 days.Control group was only given penicillin (40 000 U/kg,intramuscular,1/d) to prevent wound infection.Then Color Doppler ultrasound was used to observe the testicular blood flow siganals that were divided into 0,1,2,3 classes.Class 2 and class 3 could be considered as testicular survival.After each scrotum was opened,according to color,texture of testicle and whether the fresh blood flowing out when tunica albuginea was opened,to determine whether the testicle was alive.The testicle was ruddy,flexible,and fresh blood was observed,which could prove testicular survival.Results In experimental group,the testicular blood flow siganals:0 class 4 cases,1 class 3 cases,2 class 4 cases,3 class 7 cases.In control group,the testicular blood flow siganals:0 class 9 cases,1 class 2 cases,2 class 4 cases,3 class 3 cases.Surgical exploration found 11 cases of testicular survival in experimental group and 7 cases in control group,which was significantly difference (P ＜ 0.05).Conclusions The combined application of low molecular dextran,papaverine,low molecular weight heparin sodium can promote the recovery of testicular blood after reduction of testicular torsion,and improve testicular survival rate.
ABSTRACT
Objective:To establish a trace chromogenic substrate method for the determination of anti-FIIαactivity in compound heparin sodium cream .Methods: The anti-FIIαactivity in compound heparin sodium cream was determined by a trace chromogenic substrate method according to the completely random design of experiment based on the amount reaction principle of 4*4 parallel lines in the biological test statistics method .Results:The calibration curve was linear within the range of 0.005 04 IU· ml-1-0.021 IU· ml-1(r=0.992).The average recovery was 101.6% with RSD of 2.76% (n=9).Conclusion: The method is accurate, reliable and reproducible , and can be used for evaluating the quality of compound heparin sodium cream .
ABSTRACT
ObjectiveTo study the effect of low molecular weight heparin sodium (LMWHS) therapy for exertional heat stroke (EHS) patients with pre-disseminated intravascular coagulation (pre-DIC).Methods A prospective randomized controlled trial (RCT) was conducted. Thirty-six patients with EHS with pre-DIC admitted to Department of Critical Care Medicine of 180th Hospital of Chinese PLA from April 2012 to November 2014 were divided into heparin sodium group (n = 20) and LMWHS group (n = 16) in accordance with the random number table. All patients received bundle treatment after being admitted to the hospital, including rapid cooling, fluid resuscitation, organ support (mechanical ventilation, hemopurification if necessary), supplement of pro-coagulation factors, etc. The patients in heparin sodium group were treated with continuous heparin sodium 12 500 U throughout 24 hours with intravenous pump for 5 days, and the patients in LMWHS group were given LMWHS 2 500 U subcutaneously, twice a day for 5 days.The incidence of DIC, incidence of bleeding and mortality of two groups were compared.The platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and D-dimer of each patient between pre and post treatment times were compared.Results No significant difference was found in the incidence of DIC and mortality between LMWHS group and heparin sodium group (31.2% vs. 30.0%,χ2 =0.007,P = 0.936; 6.2% vs. 5.0%,χ2 = 0.026,P = 0.871). Incidence of bleeding during treatment in LMWHS group was significantly lower than that in heparin sodium group (12.5% vs. 45.0%,χ2 = 4.425,P = 0.035). After treatment,PLT in both LMWHS group and heparin sodium group was significantly increased compared with that before treatment (×109/L: 140.5±17.5 vs. 110.5±16.5, 152.6±21.5 vs. 120.0±20.0, bothP 0.05). No significant difference was found in PT and Fib between pre and post treatment in all the patients.Conclusion When LMWHS was applied in EHS patients in pre-DIC stage, it could not only prevent DIC as efficiently as heparin sodium, but also results in lower incidence of bleeding. So LMWHS is safer.
ABSTRACT
Objective To establish an ion chromatography method to determine the content of galactosamine in heparin sodium sample. Methods The content of galactosamine was determined by the ratio of response value of galactosamine and glucosamine.The determination was performed on an Dionex ICS, and the separation was carried out on a Amino acids capture column (30 mm ×3 mm), Series protect column (30 mm × 3 mm)and analytical column CarboPac PA20 (150 mm ×3 mm).The mobile phase was 14 mM potassium hydroxide solution at a flow rate of 0.4 mL/min; the column tempertature was at 30℃; the injection volume was 10μL.Results Glucosamine hydrochloride had good linearity within the range of 1.013 -16.211μg/mL(Y=2.303 4X+0.824 2,r=0.998 3), the average accuracy was 92.7%, and RSD was 3.2%(n=9), the limit of detection was 0.101 3μg/mL, and the limit of quantitation was 0.337 7μg/mL.D-Galactosamine hydrochloride had good linearity within the range of 0.010 2 -0.162 5 g/mL, (Y=31.157X-0.114 4,r=0.999 3).The accuracy was 102.1%, RSD was 2.4%(n=9).The limit of detection was 0.001 0μg/mL, and the limit of quantitation was 0.003 4μg/mL.The determination of galactosamine in 3 batches of heparin sodium raw material was not detected, (0.02 ±2.1)%, (0.03 ±1.5)%, respectively, which were all lower than the limit value (1%) of United States Pharmacopeia regulation.Conclusion The method for the determination of galactosamine in total hexose amine is successfully developed , which could be used as reference for improvement of the quality standard of heparin sodium.
ABSTRACT
OBJECTIVE: To apply the heparin sodium molecular weight reference standard calibrated in the first study period to GPC method and assesse the GPC method.
ABSTRACT
OBJECTIVE: To calibrate the molecular weight of reference standard of heparin sodium.
ABSTRACT
OBJECTIVE: To understand the quality status and problems of domestic heparin products and evaluate the suitability of statutory standard and test methods. METHODS: The statutory methods were adopted to test the samples. Many testing methods were established or improved on the basis of domestic and international standards and literature review and field research, including ion chromatography, capillary electrophoresis, mutiangle laser light scatter (MALLS), reverse phase chromatography, size exclusion chromatography, micro-chromogenic substrate methods, etc. RESULTS: The national evaluation test in two consecutive years of 2009 and 2010 showed that the majority of the samples complied with the 2005 edition of Chinese Pharmacopoeia. But this standard lacked control of impurities, and the limits of some items were not suitable. A few samples contained heparin-like impurities; phenol was added as preservatives arbitrarily. The assay method of anti-factor X a and anti-factor II a activity had high specificity, which was better to control the potency of heparin. Ethanol residues in the raw material of some samples exceeded the standard limit. The control of nucleic acid and protein was good. The determination of polarimetry and osmolality reflected some problems. Through this study, the quality specification of heparin in the 2010 edition of Ch. P had been improved a lot. CONCLUSION: Domestic heparin products have better quality at present. The quality specification of the raw material and injection of heparin in the 2010 edition of Chinese Pharmacopoeia is relatively perfect and close to European Pharmacopoeia and the United States Pharmacopoeia. Our capability of quality test of heparin has been substantially improved. Consequently, we have taken part in several international collaborative studies and won international voice in the quality control of heparin products.
ABSTRACT
Objective To explore the effects of low-concentration heparin sodium (LCHS) on preventing thrombophlebitis in patients with peripherally inserted central catheter (PICC). Methods Totally 287 patients who received PICC from 2007 to 2009 in our department were divided into LCHS group ( n = 128 ), in which the patients had no coagulation disorders or other blood diseases and the used drugs were compatible with heparin sodium, and control group ( n = 159). In the LCHS group, LCHS ( 10 U/ml) was used for irrigation and sealing of the catheter with positive pressure. In the control group, 0. 9% normal saline was used for the same procedures. Changes of the clinical manifestations of phlebitis and the values of plasma fibrinogen in both two groups were observed.Results In LCHS group, 21 patients had obvious clinical manifestations of phlebitis, among whom 8 patients met the diagnostic criteria of thrombophlebitis. On the contrary, in control group, 38 patients had obvious clinical manifestations of phlebitis ( P ＜ 0. 05 ), among whom 31 patients met the diagnostic criteria of thrombophlebitis ( P ＜0. 001 ). The changes of plasma fibrinogen were also significantly different between these two groups ( P ＜ 0. 001 ).Conclusion LCHS can prevent thrombophlebitis in patients with PICC who have no coagulation disorder or other blood diseases and the used drugs are compatible with heparin sodium.
ABSTRACT
OBJECTIVE:To observe efficacy and safety of reteplase combined with low-molecular heparin sodium intravenous thrombolysis in the treatment of early cerebral infarction.METHODS:102 cases of early acute cerebral infarction from Jan.2007 to Aug.2009 were received intravenous thrombolytic therapy.52 cases were treated with reteplase combined with low-molecular heparin sodium as observation group and 50 cases were treated with reteplase as control group.The neurological deficit scores(NIHSS) values at 1,7 and 14 d before and after treatment were compared between 2 groups.The complication of 2 groups were evaluated after treatment.RESULTS:The NIHSS score in observation group were decreased significantly as compared with control group,there were significant difference(P0.05).CONCLUSION:Intravenous administration of 10 MU reteplase combined with 5 000 U?12 h-1 low-molecular heparin sodium is superior to reteplase alone in the treatment of acute cerebral infarction.Reteplase combined with low-molecular heparin sodium does not increase the risk of bleeding in key site of patients(including the elderly).
ABSTRACT
BACKGROUND: Treatment with heparin has been an area of great controversy among neurologists. The goal of this study was to compare the actual usage patterns of intravenous heparin according to the stroke subtype, location, severity of the stroke, different hospitals, and various departments. METHODS: The records of 1204 patients with acute ischemic stroke admitted to 10 teaching hospitals between January 2000 and December 2000 were reviewed. The patients were divided into two groups of whether or not they were given intravenous heparin. Cases of acute ischemic stroke were subdivided according to the TOAST classification. Patients with NIH Stroke Scale scores were categorized as having mild, moderate, and severe stroke. Terminal hospital stays were subdivided further by department: internal medicine, neurology, neurosurgery, rehabilitation medicine, and others. RESULTS: 512 patients (42.5%) were treated with heparin. The usage of heparin in the case of large artery atherosclerosis occupied 46%, small vessel occlusion 31 percent, cardioembolism 73%, other determined etiology 33%, and undetermined etiology 46%. Heparin was used to treat 46% of the patients with a lesion of anterior circulation, 49% of posterior circulation, and 38% of both anterior and posterior circulation. Heparin was more frequently used for moderate and severe strokes compared to mild strokes. CONCLUSIONS: The utilization of intravenous heparin was more frequent in treatment of the cardioembolism subtype and moderate-to-severe strokes. Practice variation according to the hospitals and discharge departments were manifested.