目的探讨低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝在原发性肾病综合征(PNS)中的应用效果及安全性。方法回顾性选取2020年3月至2022年12月期间四川省凉山彝族自治州第一人民医院收治的188例PNS患者,根据肾穿刺活检病理结果及...目的探讨低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝在原发性肾病综合征(PNS)中的应用效果及安全性。方法回顾性选取2020年3月至2022年12月期间四川省凉山彝族自治州第一人民医院收治的188例PNS患者,根据肾穿刺活检病理结果及磷脂酶A2受体抗体分为膜性肾病组(n=73)与非膜性肾病组(n=115)。两组患者均根据血清白蛋白水平,采用低分子肝素钙或磺达肝癸钠序贯联合双嘧达莫抗凝。比较两组患者治疗前及治疗后4周、治疗后6个月的肾功能指标[白蛋白、尿素氮、血肌酐、肾小球滤过率(eGFR)和24 h尿蛋白定量(24 h PRO)],治疗前及治疗后4周的血栓弹力图指标[反应指数(R时间)、凝血时间(K时间)、血栓最大弹力度(MA)、凝血指数(CI)和α角],以及随访6个月记录血栓事件、出血事件。结果治疗后4周、6个月,两组的白蛋白、eGFR均较治疗前明显升高,尿素氮、血肌酐、24 h PRO均较治疗前明显降低,差异均有统计学意义(P<0.05),但两组治疗后各肾功能指标比较,差异均无统计学意义(P>0.05)。治疗后4周,两组患者的R时间、K时间均较治疗前明显延长,MA、CI值和α角均较治疗前明显降低,差异均有统计学意义(P<0.05),但两组患者治疗后4周的R时间、K时间、MA、CI值和α角比较,差异均无统计学意义(P>0.05)。膜性肾病组患者的血栓、出血事件发生率分别为6.85%、10.96%,均高于非膜性肾病组(0.87%、3.48%),但两组间血栓事件总发生率、出血事件发生率比较,差异均无统计学意义(P>0.05)。结论低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝有利于改善PNS患者的肾功能,缓解高凝状态,降低血栓栓塞事件发生率,且非膜性肾病患者获益较膜性肾病患者更明显,安全性更高。展开更多
Acute Coronary Syndrome (ACS) is one of the major causes of death worldwide, including unstable angina, ST-segment elevation myocardial infarction and NST-segment elevation myocardial infarction. ACS refers to a serie...Acute Coronary Syndrome (ACS) is one of the major causes of death worldwide, including unstable angina, ST-segment elevation myocardial infarction and NST-segment elevation myocardial infarction. ACS refers to a series of life-threatening heart diseases, which is caused by rupturing coronary plaque and releasing thrombin activation. Then thrombin is activated and generates plaque and thrombosis, which increases the risk of cardiac death and myocardial infarction. Aggressive and conservative treatment is available in clinic practice. Anticoagulant therapy is usually the first choice for conservative treatment and used in combination with dual antiplatelet drugs, which plays an important role in the treatment of acute coronary syndrome. Fondaparinux as a commonly used anticoagulant drug is both antithrombotic effectively and can reduce the risk of bleeding and coronary microvascular dysfunction in the pathogenesis of ischemic heart disease. However, it increased the rate of bleeding. People pay more attention to the role of long-term prognosis. Domestic and foreign researches contrast outcomes of acute coronary syndrome of fondaparinux and low molecular weight heparin.展开更多
BACKGROUND The contradictory process of coagulation and anticoagulation maintains normal physiological function,and platelets(PLTs)play a key role in hemostasis and bleeding.When severe thrombocytopenia and deep vein ...BACKGROUND The contradictory process of coagulation and anticoagulation maintains normal physiological function,and platelets(PLTs)play a key role in hemostasis and bleeding.When severe thrombocytopenia and deep vein thrombosis(DVT)occur simultaneously,the physician will be confronted with a great challenge,especially when interventional thrombectomy fails.CASE SUMMARY We describe a 52-year-old woman who suffered from myelodysplastic syndrome with severe thrombocytopenia and protein S deficiency with right lower extremity DVT.In this patient,the treatment of DVT was associated with numerous contradictions due to severe thrombocytopenia,especially when interventional thrombectomy was not successful.Fortunately,fondaparinux sodium effectively alleviated the thrombus status of the patient and gradually decreased the D-dimer level.In addition,no increase in bleeding was noted.The application of eltrombopag stimulated the maturation and differentiation of megakaryocytes and increased the peripheral blood PLT count.The clinical symptoms of DVT in the right lower extremities in this patient significantly improved.The patient resumed daily life activities,and the treatment effects were independent of PLT transfusion.CONCLUSION This is a contradictory and complex case,and fondaparinux sodium and eltrombopag may represent a good choice for the treatment of DVT in patients with severe thrombocytopenia.展开更多
目的对比磺达肝癸钠与依诺肝素钠对预防呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)住院患者肺血栓栓塞症(PTE)的疗效及安全性。方法选取2020年5月至2021年6月在我院PCCM住院的有药物预防PTE指征的患者(其中磺达肝...目的对比磺达肝癸钠与依诺肝素钠对预防呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)住院患者肺血栓栓塞症(PTE)的疗效及安全性。方法选取2020年5月至2021年6月在我院PCCM住院的有药物预防PTE指征的患者(其中磺达肝癸组23例及依诺肝素组71例),分别予磺达肝癸钠0.5 mL及依诺肝素钠0.4 m L,每天1次皮下注射,共7~12 d;观察两组患者抗凝前后血小板、D-二聚体、肝功能、肾功能、Padua评分、抗凝期间出血发生率以及出院后6月内PTE的发生率。结果两组间抗凝前后的血小板、D-二聚体、肝功能、肾功能等差异均无统计学意义(P>0.05);两组间Padua评分、住院费用、出血发生率(3/23 vs.10/71)及出院后6月内PTE的发生率(5/23 vs.17/71)差异无统计学意义(P>0.05)。两组组内抗凝后D-二聚体显著低于抗凝前(P<0.001),依诺肝素组抗凝后血小板减少、肌酐升高较抗凝前有统计学意义(t=2.858,P=0.006;t=-2.400,P=0.019),而磺达肝癸组抗凝前后血小板及肌酐无明显变化。结论磺达肝癸钠与依诺肝素钠在预防PTE方面疗效相似,住院期间发生出血风险及6月内发生PTE比率相当,磺达肝葵钠在引起血小板减少及肌酐升高方面较依诺吃肝素钠更有优势。展开更多
文摘目的探讨低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝在原发性肾病综合征(PNS)中的应用效果及安全性。方法回顾性选取2020年3月至2022年12月期间四川省凉山彝族自治州第一人民医院收治的188例PNS患者,根据肾穿刺活检病理结果及磷脂酶A2受体抗体分为膜性肾病组(n=73)与非膜性肾病组(n=115)。两组患者均根据血清白蛋白水平,采用低分子肝素钙或磺达肝癸钠序贯联合双嘧达莫抗凝。比较两组患者治疗前及治疗后4周、治疗后6个月的肾功能指标[白蛋白、尿素氮、血肌酐、肾小球滤过率(eGFR)和24 h尿蛋白定量(24 h PRO)],治疗前及治疗后4周的血栓弹力图指标[反应指数(R时间)、凝血时间(K时间)、血栓最大弹力度(MA)、凝血指数(CI)和α角],以及随访6个月记录血栓事件、出血事件。结果治疗后4周、6个月,两组的白蛋白、eGFR均较治疗前明显升高,尿素氮、血肌酐、24 h PRO均较治疗前明显降低,差异均有统计学意义(P<0.05),但两组治疗后各肾功能指标比较,差异均无统计学意义(P>0.05)。治疗后4周,两组患者的R时间、K时间均较治疗前明显延长,MA、CI值和α角均较治疗前明显降低,差异均有统计学意义(P<0.05),但两组患者治疗后4周的R时间、K时间、MA、CI值和α角比较,差异均无统计学意义(P>0.05)。膜性肾病组患者的血栓、出血事件发生率分别为6.85%、10.96%,均高于非膜性肾病组(0.87%、3.48%),但两组间血栓事件总发生率、出血事件发生率比较,差异均无统计学意义(P>0.05)。结论低分子肝素钙/磺达肝癸钠序贯联合双嘧达莫预防性抗凝有利于改善PNS患者的肾功能,缓解高凝状态,降低血栓栓塞事件发生率,且非膜性肾病患者获益较膜性肾病患者更明显,安全性更高。
文摘Acute Coronary Syndrome (ACS) is one of the major causes of death worldwide, including unstable angina, ST-segment elevation myocardial infarction and NST-segment elevation myocardial infarction. ACS refers to a series of life-threatening heart diseases, which is caused by rupturing coronary plaque and releasing thrombin activation. Then thrombin is activated and generates plaque and thrombosis, which increases the risk of cardiac death and myocardial infarction. Aggressive and conservative treatment is available in clinic practice. Anticoagulant therapy is usually the first choice for conservative treatment and used in combination with dual antiplatelet drugs, which plays an important role in the treatment of acute coronary syndrome. Fondaparinux as a commonly used anticoagulant drug is both antithrombotic effectively and can reduce the risk of bleeding and coronary microvascular dysfunction in the pathogenesis of ischemic heart disease. However, it increased the rate of bleeding. People pay more attention to the role of long-term prognosis. Domestic and foreign researches contrast outcomes of acute coronary syndrome of fondaparinux and low molecular weight heparin.
基金Supported by the Zhejiang Province Administration of Traditional Chinese Medicine,No.2017ZB034 and No.2020ZB096the Zhejiang University of Traditional Chinese Medicine School-Level Fund,No.2019ZG06the National Nonprofit Institute Research Grant for Institute of Basic Theory for Chinese Medicine,CACMS,No.YZ-202142.
文摘BACKGROUND The contradictory process of coagulation and anticoagulation maintains normal physiological function,and platelets(PLTs)play a key role in hemostasis and bleeding.When severe thrombocytopenia and deep vein thrombosis(DVT)occur simultaneously,the physician will be confronted with a great challenge,especially when interventional thrombectomy fails.CASE SUMMARY We describe a 52-year-old woman who suffered from myelodysplastic syndrome with severe thrombocytopenia and protein S deficiency with right lower extremity DVT.In this patient,the treatment of DVT was associated with numerous contradictions due to severe thrombocytopenia,especially when interventional thrombectomy was not successful.Fortunately,fondaparinux sodium effectively alleviated the thrombus status of the patient and gradually decreased the D-dimer level.In addition,no increase in bleeding was noted.The application of eltrombopag stimulated the maturation and differentiation of megakaryocytes and increased the peripheral blood PLT count.The clinical symptoms of DVT in the right lower extremities in this patient significantly improved.The patient resumed daily life activities,and the treatment effects were independent of PLT transfusion.CONCLUSION This is a contradictory and complex case,and fondaparinux sodium and eltrombopag may represent a good choice for the treatment of DVT in patients with severe thrombocytopenia.
文摘目的对比磺达肝癸钠与依诺肝素钠对预防呼吸与危重症医学科(pulmonary and critical care medicine,PCCM)住院患者肺血栓栓塞症(PTE)的疗效及安全性。方法选取2020年5月至2021年6月在我院PCCM住院的有药物预防PTE指征的患者(其中磺达肝癸组23例及依诺肝素组71例),分别予磺达肝癸钠0.5 mL及依诺肝素钠0.4 m L,每天1次皮下注射,共7~12 d;观察两组患者抗凝前后血小板、D-二聚体、肝功能、肾功能、Padua评分、抗凝期间出血发生率以及出院后6月内PTE的发生率。结果两组间抗凝前后的血小板、D-二聚体、肝功能、肾功能等差异均无统计学意义(P>0.05);两组间Padua评分、住院费用、出血发生率(3/23 vs.10/71)及出院后6月内PTE的发生率(5/23 vs.17/71)差异无统计学意义(P>0.05)。两组组内抗凝后D-二聚体显著低于抗凝前(P<0.001),依诺肝素组抗凝后血小板减少、肌酐升高较抗凝前有统计学意义(t=2.858,P=0.006;t=-2.400,P=0.019),而磺达肝癸组抗凝前后血小板及肌酐无明显变化。结论磺达肝癸钠与依诺肝素钠在预防PTE方面疗效相似,住院期间发生出血风险及6月内发生PTE比率相当,磺达肝葵钠在引起血小板减少及肌酐升高方面较依诺吃肝素钠更有优势。
