Risk-adjusted perioperative bridging anticoagulation reduces bleeding complications without increasing thromboembolic events in general and visceral surgery.

BACKGROUND: Perioperative bridging of oral anticoagulation increases the risk of bleeding complications after elective general and visceral surgery. The aim of this study was to explore, whether an individual risk-adjusted bridging regimen can reduce bleeding events, while still protecting against thromboembolic events. METHODS: We performed a quality improvement study comparing bridging parameters and postoperative outcomes before (period 1) and after implementation (period 2) of a new risk-adjusted bridging regimen. The primary endpoint of the study was overall incidence of postoperative bleeding complications during 30 days postoperatively. Secondary endpoints were major postoperative bleeding, minor bleeding, thromboembolic events, postoperative red blood cell transfusion, perioperative length-of-stay (LOS) and in-hospital mortality. RESULTS: A total of 263 patients during period 1 and 271 patients during period 2 were compared. The included elective operations covered the entire field of general and visceral surgery. The overall incidence of bleeding complications declined from 22.1% during period 1 to 10.3% in period 2 (p < 0.001). This reduction affected both major as well as minor bleeding events (8.4% vs. 4.1%; p = 0.039; 13.7% vs. 6.3%; p = 0.004). The incidence of thromboembolic events remained low (0.8% vs. 1.1%). No changes in mortality or length-of-stay were observed. CONCLUSION: It is important to balance the individual thromboembolic and bleeding risks in perioperative bridging management. The risk adjusted bridging regimen reduces bleeding events in general and visceral surgery while the risk of thromboembolism remains comparably low.

Systematic review and meta-analysis of the safety and effectiveness of low molecular heparin for severe acute pancreatitis.

BACKGROUND: Because the effect of low molecular heparin (LMH) on acute ulcer and bleeding complications in patients with severe acute pancreatitis (SAP) is unclear, we investigated the safety and efficacy of early intervention with LMH in patients with SAP. METHODS: Using the keywords "heparin", "low molecular weight heparin", "pancreatitis", and "severe acute pancreatitis", we searched PubMed, Medline, CNKI, etc. And select the reference documents of the comparative study of traditional treatment and low molecular weight heparin intervention. RevMan was used for the meta-analysis. RESULTS: A total of 8 references were included in the study, and most of them were low risk bias (medium and high quality). Meta-analysis shows that, The MHS between the two groups is statistically heterogeneous. (Chi2=19.59, I2=95%, P<0.00001), Fixed-effects model (FEM) analysis showed that the MHS of experimental subjects was obviously shorter than that of controls (Z=3.24, P=0.001); The acute physiology and chronic health score (APACHE II) of the two groups were heterogeneous (Chi2=7.24, I2=72%, P=0.03); No heterogeneity was found in the amount of bleeding (Chi2=5.83, I2=31%, P=0.21), FEM analysis showed the number of complications in the experimental group was significantly less than that in the control group (Z=2.70, P=0.007). DISCUSSION: LMH intervention can dramatically reduce the average hospital stay and complications of patients with SAP, improve treatment efficacy, and has high safety.

Markedly increased risk of postoperative bleeding complications during perioperative bridging anticoagulation in general and visceral surgery.

BACKGROUND: Increasing numbers of patients receiving oral anticoagulants are undergoing elective surgery. Low molecular weight heparin (LMWH) is frequently applied as bridging therapy during perioperative interruption of anticoagulation. The aim of this study was to explore the postoperative bleeding risk of patients receiving surgery under bridging anticoagulation. METHODS: We performed a monocentric retrospective two-arm matched cohort study. Patients that received perioperative bridging anticoagulation were compared to a matched control group with identical surgical procedure, age, and sex. Emergency and vascular operations were excluded. The primary endpoint was the incidence of major postoperative bleeding. Secondary endpoints were minor postoperative bleeding, thromboembolic events, length of stay, and in-hospital mortality. Multivariate analysis explored risk factors of major postoperative bleeding. RESULTS: A total of 263 patients in each study arm were analyzed. The patient cohort included the entire field of general and visceral surgery including a large proportion of major oncological resections. Bridging anticoagulation increased the postoperative incidence of major bleeding events (8% vs. 1%; p < 0.001) as well as minor bleeding events (14% vs. 5%; p < 0.001). Thromboembolic events were equally rare in both groups (1% vs. 2%; p = 0.45). No effect on mortality was observed (1.5% vs. 1.9%). Independent risk factors of major postoperative bleeding were full-therapeutic dose of LMWH, renal insufficiency, and the procedure-specific bleeding risk. CONCLUSION: Perioperative bridging anticoagulation, especially full-therapeutic dose LMWH, markedly increases the risk of postoperative bleeding complications in general and visceral surgery. Surgeons should carefully consider the practice of routine bridging.

Effects of heparin and derivatives on podocytes: An in vitro functional and morphological evaluation.

Unfractionated heparin (UFH) and low molecular heparin derivatives (LMWH) display numerous biological properties in addition to their anticoagulant effects. However, due to the physicochemical heterogeneity of these drugs, a better understanding concerning their effects on human cells is clearly needed. Considering that heparins are mainly excreted by the kidney, we focused our attention on the effect of UFH and LMWH on human podocytes by functional and morphological/phenotypic in vitro analyses. We demonstrated that these products differentially modulate the permeability of podocyte monolayer to albumin. The functional perturbations observed were correlated to significant cellular morphological and cytoskeletal changes, as well as a decrease in the expression of proteins involved in podocyte adherence to the extracellular matrix or intercellular interactions. This point confirms that UFH and the different LMWHs exert specific effects on podocyte permeability and underlines the need of in vitro tests to evaluate new biological nonanticoagulant properties of LMWH.

Aspirin and the prevention of venous thromboembolism following total joint arthroplasty: commonly asked questions.

The number of arthroplasties being performed increases each year. Patients undergoing an arthroplasty are at risk of venous thromboembolism (VTE) and appropriate prophylaxis has been recommended. However, the optimal protocol and the best agent to minimise VTE under these circumstances are not known. Although many agents may be used, there is a difference in their efficacy and the risk of bleeding. Thus, the selection of a particular agent relies on the balance between the desire to minimise VTE and the attempt to reduce the risk of bleeding, with its undesirable, and occasionally fatal, consequences. Acetylsalicylic acid (aspirin) is an agent for VTE prophylaxis following arthroplasty. Many studies have shown its efficacy in minimising VTE under these circumstances. It is inexpensive and well-tolerated, and its use does not require routine blood tests. It is also a 'milder' agent and unlikely to result in haematoma formation, which may increase both the risk of infection and the need for further surgery. Aspirin is also unlikely to result in persistent wound drainage, which has been shown to be associated with the use of agents such as low-molecular-weight heparin (LMWH) and other more aggressive agents. The main objective of this review was to summarise the current evidence relating to the efficacy of aspirin as a VTE prophylaxis following arthroplasty, and to address some of the common questions about its use. There is convincing evidence that, taking all factors into account, aspirin is an effective, inexpensive, and safe form of VTE following arthroplasty in patients without a major risk factor for VTE, such as previous VTE. Cite this article: Bone Joint J 2017;99-B:1420-30.

Risk Evaluation of Abnormal Liver Function Associated with LMWH in 76 PTE Patients of Our Hospital / 中国药学杂志

OBJECTIVE: To explore the clinical regularities and risk factor of abnormal liver function associated with LMWH in pulmonary thromboembolism patients. METHODS: Clinical date of pulmonary thromboembolism patients in use of LMWH was collected and analyzed from January 2008 to December 2016. RESULTS: 97 cases were enrolled. Of them, there were 76 cases were assessed as probable or possible. Single factor analysis showed the the levels of Scr (P=0.000), ALT (P=0.000), AST (P=0.000), γ-GGT (P=0.000), ALP (P=0.023), co-infection (P=0.024) and Ccr (P=0.026) had statistically significant difference. Multivariate analysis indicated that co-infection (OR=1.982, P=0.022) and high level of Scr (OR=1.045, P=0.000) were the independent risk factors of abnormal liver function associated with LMWH in PTE. CONCLUSION: The incidence of abnormal liver function due to LMWH in PTE patients is high. With high level of Scr and/or co-infection patients are high-risk persons of abnormal liver function. It is necessary to dynamically evaluate the liver function during hospitalization. Symptomatic treatment can be significant if the liver function become abnormal.

Meta-analysis of Efficacy and Safety of Rivaroxaban for Treatment of Deep Venous Thrombosis / 中国药学杂志

OBJECTIVE: To evaluate the efficacy and safety of rivaroxaban in the treatment of deep venous thrombosis(DVT). METHODS: PubMed, Embase, Cochrane Library, Web of Science, Clinical Trials, CNKI, CBM and WANFANG database were systematically searched. All databases had been searched from up to August 2016. All randomized controlled trials (RCTs) of rivaroxaban therapy in patients with deep venous thrombosis were selected. Meta-analysis was carried out by using RevMan 5.3 software. The incidence of recurrent DVT, recurrent VTE, DVT, pulmonary embolism(PE), major bleeding, clinical relevant non-major bleeding(CRNMB) and all-cause mortality after the treatment were compared and the results were presented with risk ratio (RR) with 95% confidence interval (CI). RESULTS: Total 5 RCTs of 4 737 cases were included in this study, including 1 605 cases accepted rivaroxaban (treatment group), other of 3 132 cases accepted other drugs (control group). The results of Meta-analysis were as follows the incidence of recurrent DVT in the rivaroxaban group was lower than that in the unfractionated heparin/low molecular heparin+ vitamin K antagonists (UFH/LMWH+VKA) group (P=0.002). There was no significant difference in the incidence of pulmonary embolism, venous thromboembolism, major bleeding, CRNMB and all-cause mortality between the treatment and control group (P>0.05). CONCLUSION: In the treatment of DVT, rivaroxban shows better efficacy than that of traditional anticoagulant therapy (UFH/LMWH+VKA) and it will not increase the risk of adverse events such as bleeding and death.

Impact of rehabilitation training combined with low molecular heparin calcium on functional recovery and venous thrombosis of postoperative period of hip fracture in the elderly / 中国基层医药

Objective To study the impact of rehabilitation training combined with low molecular heparin calcium on functional recovery and venous thrombosis of postoperative period of hip fracture in the elderly.Methods 86 elderly patients with hip fracture surgery were divided into the control group(43 cases)and observation group (43 cases)according to random number table method.The control group was given low molecular heparin calcium, and the observation group was given rehabilitation training combined with low molecular heparin calcium.After four weeks,the hip functional recovery and venous thrombosis occurrence were observed in the two groups.The levels of blood rheology indicators such as blood high shear viscosity,shear viscosity,low shear viscosity,erythrocyte aggrega-tion index and coagulant function index of thrombin time and D -dimer were detected.Results The scores of hip joint pain,joint function,joint mobility,deformity and Harris score in the observation group were higher than those in the control group,the differences were statistically significant(t =3.713,3.224,3.345,1.861 and 8.087,all P <0.05).The incidence rate of venous thrombosis in the observation group was 6.89%,which was lower than 23.26%in the control group,the difference was statistically significant (χ2 =4.440,P =0.035).After 4 weeks treatment,the levels of the whole blood high shear viscosity,shear viscosity,low shear viscosity and erythrocyte aggregation index in the observation group were lower than those in the control group,the differences were statistically significant (t =2.092,2.590,1.716 and 2.590,all P <0.05).After treatment,the level of D -dimer in the observation group was lower than that in the control group,and the prothrombin time in the observation group was higher than that in the con-trol group,the differences were statistical significance(t =7.510 and 2.151,all P <0.05).Conclusion The rehabil-itation training combined with low molecular heparin calcium can promote hip joint function recovery of postoperative period of hip fracture in the elderly,reduce the incidence of venous thrombosis,improve blood rheology and blood coagulation function indicators.

Effect of rivaroxaban in the patients with actue moderate risk pulmonary thromboembolism with deep vein thrombosis of lower limbs / 实用医学杂志

Objective To explore the efficacy and safety of rivaroxaban in the treatment of acute intermediate-risk pulmonary thromboembolism (PTE) complicated by deep vein thrombosis (DVT) of lower limbs.Methods The clinical data on 60 patients with acute intermediate-risk PTE with DVT of lower limbs who had been treated from January 2010 to March 2015 in Hunan Provincial People's Hospital were retrospectively analysed.60 patients were divided into rivaroxaban group and control group (low molecular heparin and sequential warfarin),30 in each group.Results Echocardiogrphy results showed that the right ventricular maximum short axis diameter,right to left ventricular maximum short axis diameter ratio and pulmonary artery systolic pressure significantly decreased,but the left ventricular maximum short axis diameter significantly increased after treatment on days 10,20,and 30 in rivaroxaban group and the control group,and there was no significant difference between the two groups (P ＞ 0.05 for all comparisons).NT-proBNP level was significantly reduced after treatment on days 10,20,and 30,whilePO2 value was significantly increased after treatment on days 10 and 20,and no statistical significance between the two groups (P ＞ 0.05 for all comparisons).D-dimer was obviously higher on day 10 and lower on days 20 and 30 in rivaroxaban group than that in the control group.Conclusions Treatment withrivaroxabanfor acute intermediate-risk PTE with DVT of lower limbs is effective and safe,worthy of clinical implementation and application.

Effects of targeted care combined with low molecular weight heparin on the incidence of deep venous thrombosis of lower extremities after cesarean section / 中国生化药物杂志

Objective To explore effects of the nursing care combined with low molecular weight heparin on the lower extremity deep venous thrombosis after cesarean section incidence. Methods 192 patients who underwent cesarean section from October 2015 to October 2016 in Yongkang maternal and child health hospital, excluding the relevant taboos, according to the different nursing methods, were divided into the control group (n=96) and the study group (n=96). Two groups of patients after 24 h of cesarean section were treated with low molecular weight heparin calcium 5000 IU subcutaneous injection, once a day, continuous treatment for 5 days; the control group was given routine cesarean section nursing after the operation; the study group was given targeted nursing (psychological guidance, preoperative guidance, postoperative care, dietary guidance, exercise guidance, and environmental care). Results The incidence of deep venous thrombosis of patients (2.08%) in the study group was significantly lower than (9.38%) in the control group with statistical significance (P<0.05); the plasma D dimer in the study group was significantly lower than the control group with statistical significance (P<0.05); nursing satisfaction rate of patients in the study group was (95.83%) higher than (81.25%) of the control group with statistical significance (P<0.05). Conclusion The combination of targeted care plus low molecular weight heparin could improve the satisfaction of nursing and the quality of life, reduce the incidence of postoperative deep vein thrombosis. It is worthy of clinical application.

Effects of targeted care combined with low molecular weight heparin on the incidence of deep venous thrombosis of lower extremities after cesarean section / 中国生化药物杂志

Objective To explore effects of the nursing care combined with low molecular weight heparin on the lower extremity deep venous thrombosis after cesarean section incidence. Methods 192 patients who underwent cesarean section from October 2015 to October 2016 in Yongkang maternal and child health hospital, excluding the relevant taboos, according to the different nursing methods, were divided into the control group (n=96) and the study group (n=96). Two groups of patients after 24 h of cesarean section were treated with low molecular weight heparin calcium 5000 IU subcutaneous injection, once a day, continuous treatment for 5 days; the control group was given routine cesarean section nursing after the operation; the study group was given targeted nursing (psychological guidance, preoperative guidance, postoperative care, dietary guidance, exercise guidance, and environmental care). Results The incidence of deep venous thrombosis of patients (2.08%) in the study group was significantly lower than (9.38%) in the control group with statistical significance (P<0.05); the plasma D dimer in the study group was significantly lower than the control group with statistical significance (P<0.05); nursing satisfaction rate of patients in the study group was (95.83%) higher than (81.25%) of the control group with statistical significance (P<0.05). Conclusion The combination of targeted care plus low molecular weight heparin could improve the satisfaction of nursing and the quality of life, reduce the incidence of postoperative deep vein thrombosis. It is worthy of clinical application.

Efficacy and Safety of Combination of Yinxin Damo Injection and Low Molecular Heparin on Deep Venous Thrombosis in Orthopedics Operation: A Meta-analysis / 医药导报

Objective Evaluation of efficacy and safety of combination of Yinxin Damo injection and low molecular heparin for deep venous thrombosis (DVT) in orthopedics operation.Methods Randomized controlled trials of combination of Yinxin Damo injection and low molecular heparin intervention study of DVT in orthopedics operation were searched from the Cochrane Library,clinicaltrials,gov,PubMed,EMBASE,CNKI,Wanfang database,VIP database,and Chinese biomedical database (CBM).According to the Cochrane Handbook 5.1,Meta analysis was performed by Revman 5.3 software.Results A total of 4 studies included 358 patients.The results of Meta-analysis showed that,compared with control group,incidence of DVT was significantly reduced (P =0.01),value of D-D significantly decreased (P ＜0.000 01) and value of PT increased (P =0.04),and increased value of APTT (P =0.07) in combined group.Heterogeneous sources of PT and APTT were analyzed,and the results after excluding literature 7,as compared with the control group,APTT and PT were significantly increased in combined group (P ＜ 0.000 1).Conclusion Based on the current clinical evidence,combination of Yinxin Damo injection and low molecular heparin treatment for DVT of orthopedics operation patients is effective and safe,but there is certain heterogeneity between the studies,therefore it is necessary to design a randomized controlled trial of high quality,large scale and multicenter to research.

The effect of low molecular heparin and Galectin-3on the cell migration and proliferation of vascular endothelial cells / 安徽医科大学学报

Objective To explore the effect of the association of low molecular heparin and Galectin-3 on the cell migration and cell proliferation of vascular endothelial cell from mesenchymal stem cells.Methods Depending on the administration, this study was divided into four groups: low molecular weight heparin group, adding 20 mg/L low molecular weight heparin into the cells;Galectin-3 group, adding 5 mg/L Galectin-3 into the cells;combination group, adding 20 mg/L low molecular weight heparin and 5 μg/ml of Galectin-3 into the cells;control group, equal volume of PBS buffer into the cells.The proliferation of vascular endothelial cell was to be detected by EdU incorporation,the cell growth cycle of vascular endothelial cell was to be detected by flow cytometry,and the cell migration of vascular endothelial cell was to be detected by scrath test.Then to investigate the effect of different conditions on the migration and proliferation of vascular endothelial cell.Results The OD490 of MWH group, Galectin-3 group, combined group and control group were (0.285±0.018), (0.297±0.041), (0.351±0.016), and (0.233±0.005) respectively, which indicates that the combined group could increase the cell proliferation significantly(P<0.05).Cultured for 24 hours, the cell migration rate was(42.02±7.62), (45.82±3.96), (68.53±11.22),and (34.21±3.99), suggesting that combined group have the largest cell migration(P<0.05).Conclusion The association of low molecular heparin and Galectin-3 could improve the cell migration and cell proliferation of vascular endothelial cell from esenchymal stemcells significantly.

Effect of low molecular weight heparin combined with psychological intervention on prevention of deep venous thrombosis of lower extremity after operation for varicose great saphenous vein / 中国生化药物杂志

Objective To investigate the clinical efficacy of low molecular weight heparin combined with psychological intervention in the prevention of deep venous thrombosis (DVT) in patients with varicose great saphenous vein. Methods Two patients underwent surgical varicosis of great saphenous vein saphenous vein ligation and stripping surgery group, with low molecular weight heparin to prevent deep venous thrombosis, the study group with low molecular weight heparin combined with psychological intervention, prevention and control of postoperative deep venous thrombosis, the incidence of records of two groups of patients with postoperative lower extremity deep vein thrombosis. Results The incidence of deep vein thrombosis (2.04％) in the study group was significantly lower than that in the control group (14.29％) (P<0.05), suggesting that the study group had better effect on prevention of deep vein thrombosis after operation. Conclusion The combination of psychological intervention and low molecular weight heparin can achieve more ideal prevention effect of deep vein thrombosis after operation of great saphenous varicose vein, which is beneficial to protect the quality of life and life safety of patients.

Observation on the effect of psychological intervention combined with alendronate sodium and low molecular heparin calcium on the treatment of senile osteoporotic fracture / 中国生化药物杂志

Objective To observe the clinical effect of psychological intervention combined with alendronate and low molecular heparin calcium on the treatment of senile osteoporotic fracture. Methods From February 2014 to March 2017, clinical data of 82 elderly patients with osteoporotic fracture in the first people's hospital in Jiande were retrospectively analyzed. All the patients were randomly divided into the control group and the experimental group with 41 cases in each group. The control group patients were given alendronate sodium and low molecular heparin calcium; At this basis, the experimental group were received psychological nursing intervention. The effect in the two groups was compared. Results After treatment, bone mineral density (BMD) index and pain scores in the two groups were significantly improved. BMD and pain scores in the experimental group were significantly better than those in the control group (P<0.05). The total effective rate was 95.12% (39/41) and the complication rate was 17.07% (7/41) in the experimental group, while in the control group were respectively 70.73% (29/41), 36.59% (15/41), the differences were statistically significant (P<0.05). Conclusion Psychological intervention combined with alendronate sodium and low molecular heparin on the treatment of senile osteoporotic fracture has significant effect, can effectively improve the clinical symptoms of patients, reduce the incidence of complications, with clinical application value.

Efficacy of early nutrition support combined with glutamine and low molecular heparin in elderly patients with severe pneumonia / 重庆医学

Objective To investigate the efficacy of early nutrition support combined with glutamine and low molecular hepa‐rin in elderly patients with severe pneumonia and its influence on immune function regulation and RAGE .Methods Totally 148 eld‐erly patients with severe pneumonia in ICU of our hospital from October 2012 to May 2015 were selected and randomly divided into the treatment group 1 (55 cases) ,treatment group 2 (55 cases) and control group(38 cases) according to the randomized digital ta‐ble .The control group was given the routine treatment .Based on the control group ,the treatment group 1 was treated with the early nutrition support combined with glutamine .On the basis of the treatment group 1 ,the treatment group 2 adopted low molecular heparin .The APACHEⅡ score ,PaCO2 ,SaO2 ,and PaO2 before and after treatment were compared among three groups .The levels of PT ,APTT ,FIB and D‐D were detected in three groups .The immune function indexes and RAGE level were compared among three groups .Results The APACHEⅡ score ,PaCO2 and RAGE level after treatment in two treatment groups were lower than those in the control group ,while SaO2 ,PaO2 and immune function indexes levels were higher than those in the control group ,more‐over the APACHEⅡscore ,PaCO2 and RAGE level in the treatment group 2 were lower than those in the treatment group 1 ,while SaO2 ,PaO2 and immune function level were higher than those in the treatment group 1 ,the differences were statistically significant (P<0 .01) .The levels of PT ,APTT ,FIB and D‐D after treatment in the treatment group 2 were lower than those in the treatment group 1 and control group(P<0 .01) .The total effective rates in the treatment group 1 and 2 were 96 .36% and 98 .18% respec‐tively ,which were higher than that in the control group ,moreover the obviously effective rate in the treatment group 2 was 85 . 45% ,which was superior to the control group and treatment group1 ,the differences were statistically significant (P<0 .01 or P<0 . 05) .Conclusion Early nutrition support combined with glutamine and low molecular heparin in treating elderly severe pneumonia can decrease the APACHEⅡscore ,improve the coagulation function ,enhance the immune function and decreases the RAGE level .

Curative effect of urokinase combined with low molecular heparin sodium on arteriovenous fistula embolism / 现代临床护理

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.

The effect of Xuesaitong injection on the platelet activity in the patient underwent hip ;orthopedics operation / 国际中医中药杂志

Objective To observe the effect of Xuesaitong injection on the platelet activity in the patient underwent hip orthopedics operation. Methods A total of 80 patients underwent hip orthopedics operation were enrolled from our Hospital. The patients were divided into the control group (n=40) and the observation group (n=40). The control group was treated with the low molecular weight heparin at 12 h before operation and after operation. The observation group was treated with Xuesaitong injection at 12 h before operation and after operation. The deep venous thrombosis (DVT) was diagnosed by color doppler ultrasound. The APTT and PT weredetected by the automated blood coagulation analyzer. The expression of TXB2 was determined by ELISA analysis. The CD62P was detected by the flow cytometry. Results At time of 10 days after operation, the APTT (26.83 ± 3.68 s vs. 32.06 ± 3.65 s, t=2.407), PT (10.84 ± 1.63 s vs. 12.82 ± 1.61 s, t=2.391), TXB2 (159.38 ± 31.75 ng/L vs. 194.23 ± 38.53 ng/L, t=2.388), CD62P (14.28%± 2.52%vs. 29.14%± 6.23%, t=6.415) were significantly lower in the observation group than those in the control group (P<0.01 or P<0.05). The incidence of DVT was 12.5%in the observation group, and 17.5%in the control group. There was no significant difference between the two groups (χ2=0.353, P=0.241). Conclusions The Xuesaitong injection can inhibit platelet activation and has preventive effect of DVT in patient underwent hip orthopedics operation with no bleeding complications.

The effect of different dosages of low molecular weight heparin on acute pulmonary embolism and inhibition of pulmonary intimal hyperplasiain immature rats / 临床儿科杂志

Objectives To investigate the effect of different dosages of low molecular weight heparin on acute pulmonary embolism and inhibition of pulmonary intimal hyperplasia in immature rats. Methods 90 male immature SD rats were randomly divided into ifve groups: sham group, pulmonary embolism group, low-low molecular heparin group (L-LMH), medium-low molecular heparin group (M-LMH) and high-low molecular heparin group (H-LMH). The model of acute pulmonary embolism was established through jugular vein injection with gel-foam solution. The rates in the L-LMH, M-LMH, H-LMH groups were treated with low molecular weight heparin by subcutaneous injection after surgery with a dosage of 0 . 005 ml/kg, 0 . 01 ml/kg, 0 . 02 ml/kg, twice a day. Animals in the control group were given saline injection. Arterial blood gas, pulmonary artery pressure (mPAP), right ventricular pressure (RVP), wall area/tube area, wall thickness/tube diameter, and the expression of PDGF-B and MCP-1 at gene and protein levels in lung tissue were detected on the 7 th ( 7 d), 14 th ( 14 d) and 28 th ( 28 d) after opration. Results There were signiifcant differences of PaO 2 among 5 groups on 7 d, 14 d and 28 d. PaO 2 in group M-LMH ( 105 . 1 ± 4 . 6 mm Hg) were signiifcantly higher than that of embolization group, L-LMH, but not H-LMH group at 28 d. mPAP of M-LMH group was lower than that in the other three intervention groups, but showed no signiifcant difference compared with sham group (P?>0 . 05 ). There were signiifcant differences of RVP on 7 d and 14 d. PDGF-B, MCP-1 of M-LMH group were signiifcantly lower compared with the other three intervention groups (P?0 . 05 ). Wall area/tube area, wall thickness/tube diameter scores of M-LMH group had no signiifcance differences compared with sham group on 28 d (P?>?0 . 05 ). Conclusion Medium dose of low molecular weight heparin could ameliorate the acute pulmonary embolism and inhibit the proliferation of pulmonary arteries in rats.

Heparin-induced thrombocytopenia in a non-heparin-naive patient: a case report.

INTRODUCTION: Administration of low molecular weight heparin (LMWH) is recommended for prophylaxis of venous thromboembolism in patients undergoing hip surgery. In this context, heparin-induced thrombocytopenia (HIT) type II is a complication of rare incidence but sometimes fatal outcome. CASE DESCRIPTION: A 52-year old obese patient undergoing antithrombotic therapy with Enoxaparin after hip surgery presented with a painful, swollen leg and thrombocytopenia on day eight after surgery. Medical history showed previous administration of Enoxaparin without complications 2 years ago. Further diagnostic investigation supplied evidence of multiple thromboembolic events and concomitant compartment syndrome. Administration of Enoxaparin was stopped immediately and treatment with Argatroban was initiated. Diagnosis of HIT was confirmed according to current guidelines. Despite interventional thrombectomy and fasciotomy, amputation of both lower limbs had to be performed due to ongoing necroses. After a 30-days-stay at the intensive care unit because of sepsis, respiratory and renal failure, clinical condition improved and the patient could be transferred for rehabilitation. DISCUSSION AND EVALUATION: HIT II is known as complication of administration of LMWH in the perioperative setting. Diagnosis results from clinical findings and platelet count. Argatroban is recommended as an alternative therapeutic anticoagulant in HIT II. Inflammation and surgical trauma are discussed as priming factors to increase risk of HIT II. CONCLUSIONS: Administration of LMWH may result in HIT II despite prior uneventful drug exposure. Except for immediate diagnosis, only consequent anticoagulation can stop the course of disease. Hence, interdisciplinary awareness is inevitable for early diagnosis and accurate therapy to prevent from a catastrophic clinical course.