Search

The Changes and Significance in Coagulative, Anticoagulant and Fibrinolytic System in SnakeBite Patients

目的:观察蛇伤患者凝血、抗凝和纤溶系统各项指标的变化并探讨其临床意义。方法:以36例蛇伤患者和32例健康体检者为研究对象,测定血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(Fg)、血管性血友病因子(vWF)、凝血酶调节蛋白(TM)、组织型纤溶酶原激活物(tPA)、纤溶酶原激活物抑制物1(PAI1)含量。结果:与正常对照组比较,蛇伤患者PT、APTT、vWF、TM、tPA、PAI1水平明显升高,Fg水平明显降低(Plt;001)。结论:蛇伤患者存在凝血、抗凝、纤溶系统的紊乱,早期使用抗蛇毒血清对于防治弥散性血管内凝血(DIC)和多器官功能障碍(MODS)的发生有积极意义。

Bivalirudin Anticoagulation for Cardiac Surgery

Heparin has long been a preferred anticoagulant during cardiovascular surgery, although limitations exist, including heparin-induced thrombocytopenia (HIT) and/or anti-platelet factor Ⅳ/heparin (anti-PF4/H) antibodies. Bivalirudin is a direct thrombin inhibitor, which can overcome the shortcoming of heparin. This article reviewed the application of bivalirudin in the field of cardiac surgery, its safety and effectiveness in various surgical treatments as well as summarized the standard protocol, doses, monitoring parameters and targets of bivalirudin for anticoagulation in cardiac surgery and mechanical circulation support. Bivalirudin as an alternative to heparin provides a new selection for anticoagulation in cardiac surgery.

Application progress of regional citrate anticoagulant technology in blood purification

In recent years, Regional citrate anticoagulation (RCA) technology has been widely used not only in adult blood purification, but also in children’s blood purification, and its advantages in patients with high bleeding risk, active bleeding and heparin-induced thrombocytopenia have been repeatedly confirmed. Therefore, this article reviews and analyzes the application of RCA in different blood purification modes at home and abroad in recent years. It is found that its anticoagulation is not only safe and effective, but also can prolong the life of filter and reduce bleeding complications, which is suitable for the practice of blood purification.

Advances in perioperative antithrombotic therapy for general surgery

Objective To summarize the general situation of perioperative venous thromboembolism (VTE) and summarize the perioperative antithrombotic strategies. Methods Domestic and international literatures and guidelines on antithrombotic therapy were collect and reviewed. Results VTE was common during the perioperative period. Reasonable assessment of each patient’s condition during the perioperative period, as well as reasonable use of anticoagulant, antiplatelet drugs, and hemostatic agents could reduce the incidence of VTE events during the perioperative period. Conclusions Clinicians need to properly assess the timing of the usage and discontinuation of antithrombotic drugs, weigh the risk of thrombosis and bleeding, develop a rational and scientific antithrombotic strategy based on the specific circumstances of each patient. Simultaneously, hemostatic agents need to be prescribed perioperatively to reduce the incidence of thromboembolic complications.

Prethrombotic state of chronic obstructive pulmonary disease patients with ventilator associated pneumonia and the efect of anticoagulation therapy

Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP)．Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases)．The VAP group were randomly subdivided into two groups：group A(conventional therapy group，n=13)，group B(conventional therapy+anticoagulation therapy group，n=12)．The D-dimer (DD)，fibfinogen(FIB)，pulmonary artery pressure(PAP)and the time of weaning were compared between these groups．Results In the COPD patients，the levels of DD，FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0．50±0．26)mg／L，(3．67 ±0．88) L，(31．71 ± 5．66)mm Hg vs(0．23±0．12)mg／L，(1．56±0．45) L，(15．28 ±2．84)mm Hg，respectively，all Plt; 0．05]．In the COPD patients with VAP，the levels of DD，the content of FIB，PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0．22±0．16)mg／L， (1．56±1．17)g／L，(16．00±2．48)him Hg，8．33％ and(4．00±1．41)d vs(O／41±0．09)mg／L，(3．66± 1．03) L，(28．00±0．85)mm Hg，15．4％ and(10．76±3．35)d，respectively，all Plt;0．05]． Conclusions Prethrombotic state exists in COPD patients with VAP．Aggressive anticoagulation on base of routine therapy，by ameliorating microcireulation，call shorten the time of weaning and reduce the mortalit in these patient

Clinical Analysis of Patients with Acute Pulmonary Embolism, Normal Blood Pressure, and Right Ventricular Dysfunction

Objective To analyze the clinical features of patients with acute pulmonary embolism ( APE) with normal blood pressure and right ventricular dysfunction. Methods 130 hospitalized patients with normotensive APE between January 2009 and January 2012 were retrospectively analyzed. The patients underwent transthoracic echocardiography to determine if they were complicated with RVD. The clinical features, risk factors, diagnosis, and treatment were analyzed and compared between the normotensive APE patients with or without RVD. Results 41 normotensive APE patients with RVD were as RVD group, and other 89 patients without RVD were as non-RVD group. The incidences of syncope ( 34.1% vs. 7.8% ) , tachycardia( 41.4% vs. 21.3% ) , P2 hyperthyroidism( 46.3% vs. 25.8% ) , jugular vein filling ( 12.1% vs. 1.1% ) , and cyanosis ( 26.8% vs. 8.9% ) were all significantly higher in the RVD group than those in the non-RVD group ( P lt; 0.05) . Computed tomography pulmonary angiography ( CTPA) revealed that the incidences of thromboembolism involving proximal pulmonary artery ( 58. 3% vs. 8. 3% ) and thromboembolism involving lobar pulmonary ( 77.8% vs.51.2% ) were also higher in the RVD group ( P lt; 0.001, P = 0.025 ) . In the RVD group, the patients were assigned to received thrombolysis plus anticoagulation therapy, or anticoagulation therapy alone. The clinical indicators ( heart rate, PaCO2 , AaDO2 , SPAP, TRPG) were all statistically improved after thrombolysis or anticoagulation treatment ( P lt;0.001) . But compared with the patients who underwent anticoagulation therapy alone, the cost of treatment and the incidence of minor bleeding were significantly higher, and the levels of AaDO2 , SPAP and TRPG were statistically lower in the patients with thrombolysis plus anticoagulation therapy. Conclusions For APE patients with central pulmonary embolism demonstrated by CTPA, syncope, and tachycardia, transthoracic echocardiograph should be performed as early as possible to confirm RVD diagnosis. For normotensive APE patients with RVD, anticoagulant treatment can achieve higher efficacy of costeffectiveness ratio.

Neodoxy of Superficial Thrombophlebitis

心脏机械瓣膜置换术后抗凝治疗的安全性

目的 探讨心脏机械瓣膜置换术后服用华法令的安全剂量及抗凝期间的注意事项。 方法 回顾性分析1999 年12 月至2010 年10 月皖南医学院附属弋矶山医院132 例行心脏瓣膜置换术后进行华法令抗凝治疗患者的临床资料，其中男73 例，女59 例；年龄27 ～ 78 岁；术后口服华法令抗凝，随访3 个月～ 10 年，分析华法令应用情况及其并发症发生情况。 结果 手术时间（240±96） min，体外循环时间（112±52） min，主动脉阻断时间（81±23） min。全组术后出现皮肤紫癜2 例，死亡2 例。随访117 例，随访率90%（117/130），随访期间月经期月经量过多导致贫血4 例，血尿3 例，反复鼻衄或牙龈出血共4 例，消化道出血1 例，脑出血1 例，下肢栓塞1 例，脑梗死1 例，均治愈或好转。 结论 心脏机械瓣膜置换术后正确服用华法令抗凝治疗，及时监测，注意各种干扰因素可以明显降低并发症的发生率。

Paroxysmal Acquired Coagulopathy Caused by Anticoagulant Rodenticides: A Report of Three Cases and the Literature Review

目的　分析反复发作的抗凝血类灭鼠药所致获得性凝血功能障碍的临床特点，探讨其诊治方案。方法　对2009年3月－2010年12月收治的3例抗凝血类灭鼠药所致获得性凝血功能障碍患者的临床表现、实验室检查和治疗转归进行分析，并复习相关文献。 结果　3例患者均以同时出现多部位出血为首发表现，经应用维生素K1、凝血酶原复合物、新鲜冰冻血浆、冷沉淀等治疗，患者病情好转，实验室指标恢复正常。停药（2、5周，3个月）后再次出现多部位出血，再给予维生素K1等治疗，病情可缓解。 结论　维生素K1可作为首选的治疗药物，且对反复发作的患者同样有效。为避免再发性出血，应维持治疗至少3个月。

Global hotspots and trends in atrial fibrillation anticoagulation research

ObjectiveTo analyze the global status, hotspots, and trends in atrial fibrillation anticoagulation research.MethodsWe searched Web of Science Core Collection to collect relevant literature on atrial fibrillation anticoagulation from 2006 to 2020. The visualization software CiteSpace and VOSviewer were used to analyze co-citation, co-occurrence, and emergence analysis on publishing organizations, journals, and keywords and to explore the research hotspots and frontiers.ResultsA total of 11764 related studies were retrieved. In recent years, research on anticoagulation of atrial fibrillation has become increasingly popular. Most of the published researches were from North America, and the primary institution was the University of Birmingham. Research hotspots mainly focused on warfarin, stroke prevention, new oral anticoagulants, antithrombotic and anticoagulants, and complicating diseases. The research frontiers were the new oral anticoagulants, and the antithrombotic management of atrial fibrillation with coronary heart disease.ConclusionsThe global hotspot in atrial fibrillation anticoagulant research is warfarin, stroke prevention, new oral anticoagulants, antithrombotic and antiplatelet therapy, and complicated diseases. The research focuses on the study of novel oral anticoagulants and the antithrombotic management of atrial fibrillation complicated with coronary heart disease.