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Objective To investigate the effects of tranexamic acid (TXA) on perioperative blood loss,D-Dimer and fibrinogen (FIB) in total knee arthroplasty (TKA).Methods A prospective study,from December 2016 to November 2017 patients with end-stage knee osteoarthritis underwent unilateral TKA were randomly divided into two groups.Patients in treatment group received two doses of 15 mg/kg TXA by intravenous inffusion 1 hour pre-operation and before the release of tourniquet;the control group was replaced with the same amount of saline.The preoperative and 3 days post-operation hemoglobin,hematocrit value,drainage,blood transfusion were recorded.The D-Dimer and FIB were dynamically monitored before operation and 1,3,7,14 d after the operation.And there were also observations for whether they had deep vein thrombosis and both lower limbs of all patients were examined by the color Doppler ultrasonography 14 days after operation.Results The drainage and the total blood loss in treatment group was significantly less than in control group (P ＜ 0.01,P ＜ 0.05).The volume of both allogeneic and autologous blood transfusion in treatment group were significantly less than those in the control group (P ＜0.01).The ratio of allogenic blood transfusion was 14.6％ (6/41) in treatment group,38.1％ (16/42) in control group (P ＜ 0.01).D-dimer at 1,3d post-operation in treatment group was significantly lower than that in the control group (P ＜0.05),but the difference was getting smaller at 7,14d post-operation (P ＞0.05).FIB at any time point between the two groups was no significant difference (P ＞ 0.05).There was no symptomatic deep venous thrombosis (DVT) in all of the three groups within 14 days.Conclusions The TXA infused intravenous can significantly decrease drainage,the total blood loss and blood transfusion without increasing risk for DVT in TKA.but early post-operation TXA could affect the level of D-dimer,thus affecting the value of early warning of DVT.
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Objective To investigate the value of serum D-dimer in evaluating the severity and the prognosis of patients with acute spontaneous subrachnoid hemorrhage.Methods The clinical data of 157 patients with acute spontaneous subrachnoid hemorrhage were collected,and the level of D-dimer in elbow vein serum were measured.The severity of the disease was judged by Hunt-Hess classification,and the patients,brain CT scans were scored according to the modified Fisher scale.The patients were followed up for 3 months.Based on the modified RANKIN scale (mRS scale),patients were divided into unfavorable prognosis group (3≤ mRS ≤5) and good prognosis control group (1 ≤ mRS ≤2).Results In the 157 cases of spontaneous subrachnoid hemorrhage patients,there were 45 cases in the unfavorable prognosis group and 112 cases in the good prognosis control group.The level of D-dimer in the unfavorable prognosis group was significantly higher than the level of control group and there were significant differences between them (P ＜ 0.01).By the Spearman correlation analysis,the level of D-dimer was positively correlated with Hunt-Hess score (r =0.831,P ＜0.01),and it was also positively correlated with unfavourable prognosis mRS scale (r =0.834,P ＜0.01).Furthermore,regression analysis showed that high level of D-dimer was an independent risk factor for the poor prognosis of patients (OR =1.011,95％ CI:1.007-1.016,P ＜ 0.01).Through the receiver operating characteristic curve (ROC) analysis of the D-dimer in patients with poor prognosis,the area under ROC curve was 0.964 (95％ CI:0.93-0.98,P ＜ 0.01),sensitivity and specificity were 88.9％ and 99.1％,respectively.The cut-off point of D-dimer content was 739 μg/L.Conclusions The level of D-dimer in patients with acute spontaneous subrachnoid hemorrhage was closely related to the severity of the diseases,and high level of D-dimer was an independent risk factor for the prognosis of patients.
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Objective To investigate the level of the red blood cell (RBC) distribution width and other related indicators to predict the prognosis in patients with chronic heart failure elderly.Methods Retrospective analysis was performed in the patients with chronic heart failure elderly which died in our hospital (experimental group) and 100 patients were selected randomly that with heart failure elderly being improved by treatment (control group).The difference was compared in the level of the RBC distribution width (RDW),high-sensitivity C-reactive protein (hs-CRP),homocysteine (Hcy),D-dimer (DD),and amino-terminal pro-brain natriuretic peptide (NT-proBNP) in two groups.Results The level of RDW,hsCRP,Hcy,DD,and NT-proBNP in experimental group were significantly higher than that in control group (P ＜0.01).Conclusions Chronic heart failure was common clinical critically ill in the elderly.There were important clinical significance and important predictors to detect the levels of RDW,hs-CRP,Hcy,DD,and NT-proBNP in predicting prognosis and evaluating the effect of treatment.
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Objective To compare plasma D-dimmer (D-D) levels of hospitalized patients and healthy controls,and to investigate D-D level changes in different age groups and receiver operating characteristic (ROC) curve analysis were used to analyze the clinical value of diagnosis of venous thromboembolism (VTE) by plasma D-dimer in different ages.Methods Totally 5798 healthy cases and 3756 cases of hospitalized patients were used for this study.Blood samples were collected and plasma D-dimer levels were analyzed.Results No significant difference was found in D-D level between the 50-year old hospitalized patients and healthy controls.D-D level of more than 50-year-old patient groups studied were significantly higher.D-D level was positively related to occurrence of VTE rate (r =0.9189,P ＜0.05).The sensitivity and specificity of D-D diagnosis of VTE in 50-year-old hospitalized patients were the highest,with the increase of age,the sensitivity and specificity of D-D diagnosis of VTE were decreased.Conclusions Plasma D-dimer levels were increased with age,The sensitivity of D-dimer was significantly decreased in the diagnosis of VTE of the elderly.The comprehensive indices should be used in the diagnosis of VTE.
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Objective To observe the effects of preoperative acute hypervolemic hemodilution (AHH) on coagulation and fibrinolysis on the elderly patients undergoing hepatic carcinectomy.Methods Thirty ASA Ⅰ～Ⅱ liver cancer patients over sixty years old undergoing scheduled elective hepatic carcinectomy were random divided into AHH group ( n = 15) and control group ( n = 15).AHH was performed by infusing 15 ～20ml/kg 6% Voluven ( 130/0.4) in a rate of 30ml/min on patients in AHH group,and the patients in control group were infused routinely lactated Ringer's solution.Blood samples were collected for measuring coagulation function and platelet activation before anesthesia (T1) ,30 minutes after AHH (T2),1 hour ( T3 ), immediately (T4) and 24 hours (T5) after operation in group AHH, and the similar procure was used in control group.Results There was significant difference in the volume of allergenic blood transfusions between the two groups(20% vs 53.3%, P ＜0.05).PT and APTT in both groups prolonged significantly after T2, but they all remained in normal range.TT and DD had no significant changes between the two groups.SFMC and F1 + 2 increased in both groups, but it had no significant changes.PAC-1 and CD62P expressions of group AHH were significantly lower T2, T3 ,respectively ( 1.37 ±0.4) %, (1.28 ±0.4) %, than those at T1 [( 1.96 ± 0.6) %] ( P ＜ 0.05 ).Compared with control group, CD62P was significantly lower in AHH group at T2 and T5.Conclusion It is safe to take AHH of Hct 25% to 30% during hepatic carcinectomy for elderly liver cancer patients without cardiac and pulmonary disease.And it could decrease allergenic blood transfusions, with no apparently influence on coagulation function.