ObjectiveTo explore the protective effect of low-molecular-weight heparin calcium (LHC) combined with trimetazidine on intestinal smooth muscle of intestinal acute mesangial vein thrombosis (AMVT) in rats and it's mechanism of effect.
MethodsA total of 120 SD male rats were randomly divided into three groups, with 40 rats in each group. LHC group: after the AMVT model established, rats were subcutaneous injection the LHC (30 U/100 g) per 12 h until 72 h after surgery. LHC+trimetazidine group (LHCT group): after the AMVT model established, rats were subcutaneous injection the LHC (30 U/100 g) and tail vein injection the trimetazidine (10 mg/kg) per 12 h until 72 h after surgery. Normal saline group (NS group): after the AMVT model established, rats were subcutaneous injection the NS (0.2 mL/100 g) per 12 h until 72 after surgery. The AMVT model were established by blocking superior mesenteric vein of 8 cm and the edge vein arch. Vena cava blood samples and intestinal segments were collected sequentially at 6 h, 12 h, 24 h, 48 h and 72 h afrer surgery. The levels of malondialdehyde (MDA) and creatine kinase (CK) in the blood, and the level of ATP in the intestinal tissue samples were measured with ELISA. Intestinal tissue were taken from the rats for inestinal tissue section, stained with hematoxylin and eosin, examined under light microscopy and evaluated histopathologically using mesemeche scoring system at different time.
ResultsCompared with the LHC group and NS group, the levels of MDA and CK in blood and histopathology score of intestinal tissues in rats were significantly decreased, and the level of ATP significantly increased in LHCT group at different time point (P < 0.05).
ConclusionTrimetazidine can improve intestinal smooth muscle energy metabolism in the AMVT disease, comined with LHC early can avoid intestinal smooth muscle wall permeability coagulation necrosis and reduce the intestinal smooth muscle damage.
Objective To investigate the blood clotting dysfunction of invasive pulmonary aspergillosis(IPA)and the therapeutic effect of low molecular hepafin in a mouse model．Methods The neutropenic IPA mouse model was constructed by being given cyclophosphamide to depress immunologic function，and then intranasally challenged with Aspergillus fumigatus conidia．(1)Blood clotting function were assessed by bleeding time，clotting time，platelet count and antithrombase-III(AT-III)activity．Seventy-two mice were randomly assigned into 4 groups．Group A received only normal saline．group B received normal saline to substitute the cycloph0sphamide，and the rest equal to group D．Group C received normal saline to substitute the AspergiUus fumigatus conidia suspension，and the rest equal to group D．Group D(model group)received cyclophosphamide(intraperitoneally，150 mg／kg，d4，d1)and Aspergillus fumigatus conidia suspension(intranasally，40 μL／mouse，1．5×10∧5／mL，d0)．Six mice were randomly sacrificed in each group for analysis of blood clotting function per 24 h after inoculation for 3 times．(2)Therapeutic effect of low molecular heparin was determined by survival time of IPA mice．One hundred and eighteen mice were randomly assigned into 4 groups after challenged with 6×10 conidia／mouse and received one of the following regimens daily from dl to d7 after challenge，vehicle(group E，n=29)，low molecular heparin(group F，n=30，subcutaneous injection，1000 IU／kg，qd×7 d)，amphotericin B(group G，n=29，intraperitoneal，1 m kg，qd×7 d)，low molecular heparin plus amphotericin B(group H，n=30)．Mice survivals were recorded once daily to d21 after innoculation．Results (1)AT-III activity of group D decreased significantly 24 h after innoculation．Bleeding time and clotting time decreased significantly and AT—III activity decreased sequentially 48 h after innoculation．The platelet decreased significantly 72 h after innoculation，and bleeding time shoaened further．Clotting time was longer than that 0f 48 h．but still shorter than norm al and AT-III activity decreased sequentially．There were significant differences when comparing group D with group A，B and C(all Plt;0.01)．And there was no significant difference between group A，B and C(all Pgt;0．05)．(2)Survival analysis indicated that the therapeutic effect of low molecular hepafin plus amphotericin B was better than that of amphotericin B or low molecular heparin alone．No therapeutic effect was found in group F(group E vs group F，Pgt;0．05，both group E and group F compared with group H，P lt;0．01．Group H vs group G，P lt;0．05．Both group E and group F compared with group G，P lt;0．05)．Conclusions The results suggest that there is blood clotting dysfunction in IPA mice and AT—III activity may be an early index to monitor the disfunction．Compared with the therapeutic effect of amphoterinein B alone，low molecular hepafin plus amphoterincin B can prolong survival of neutropenic IPA mice
【摘要】 目的 評價葛根素注射液（PI）聯合低分子肝素（LMWH）治療不穩定型心絞痛（UAP）的療效和安全性。 方法 計算機檢索中國生物醫學文獻數據庫（CBM）、中國期刊全文數據庫（CNKI）、中文科技期刊全文數據庫（VIP-維普）、萬方-數字化期刊全文庫，納入在常規治療上加用PI和LMWH對比單純常規治療的隨機對照試驗（RCT），對納入研究進行質量評價和Meta分析。 結果 共納入21個RCT，均為C級文獻。Meta分析結果顯示，在臨床癥狀療效顯效率、心電圖療效顯效率和有效率指標方面，兩組差異有統計學意義:RR（95%CI）分別為:1.63（1.48，1.79）、1.57（1.34，1.83）及1.28（1.10，1.49）。 結論 基于上述證據，在常規治療UAP上加用PI和LMWH療效優于常規治療。【Abstract】 Objective To evaluate the effect of the puerarin injection (PI) combined with low molecular weight heparins (LMWH) on unstable angina pectoris (UAP). Methods Randomized controlled trials (RCT) of PI combined with LMWH treating UAP were gathered from CBM, CNKI, VIP, and Wanfang data bases; and study quality was evaluated and the Meta-analysis was carried out. Results A total of 21 RCT were identified, of which all were in graded C. According to Meta-analysis, the differences of the clinic excellent rate, electrocardiogram excellent rate and effective rate between the two groups were significant; the RR (95%CI) were: 1.63 (1.48, 1.79), 1.57 (1.34, 1.83), and 1.28 (1.10, 1.49). Conclusion Based on the evidence recently, PI and LMWH adding is better than ordinary treatment for UAP.
Objectives To explore the characteristics of thrombosis in critically ill patients with Omicron infection and the therapeutic value of prophylactic low molecular weight heparin (LMWH) treatment. MethodsA single center, retrospective cohort study included critically ill adult patients with Omicron variant of SARS-CoV-2 admitted to Peking University Third Hospital from December 7, 2022, to February 8, 2023. The patients were categorized into two groups based prophylactic LMWH. Propensity score (PS) matching was used to match patients (1: 1 ratio) based on the predefined criteria. General clinical information and laboratory parameters were compared. This study was retrospectively registered at Chinese Clinical Trail Registry (ChiCTR2300067434). ResultsFour hundred and fifty-two patients and 360 patients were included before and after PS matching. There were no statistical differences in mortality, the incidence of pulmonary embolism, arterial thrombosis or bleeding between the anticoagulation group and non-coagulation group before and after PS matching. There were 91 thrombotic events in 82 patients (18.14%), of which 54 cases (59.34%) were lower limb intermuscular vein thrombosis, 3 cases (3.30%) were pulmonary embolism, 14 cases (15.38%) were acute myocardial infarction and 3 cases (3.30%) were acute cerebral infarction. The thrombotic event resulted in the death of 5 patients. D-dimer increased in 385 cases (85.56%). On the 1st, 3rd, 6th and 9th day, the concentration of D-dimer in the anticoagulant group was higher than that in the non-anticoagulant group (P=0.006, 0.001, 0.024 and 0.006, respectively). ConclusionsAlthough thrombosis and coagulation disorders are still common complications of COVID-19, it is not the direct cause of most death in COVID-19 patients caused by Omicron. The role of prophylactic anticoagulation treatment for Omicron-infected patients needs further study.
Objective To analyze the effect of arteriovenous impulse system (AVIS) combined with lowmolecular-weight heparins calcium (LMWHC) for prophylaxis of deep vein thrombosis (DVT) following total knee arthroplasty (TKA). Methods From March 2006 to March 2008, 76 cases of osteoarthritis patients (76 knees) accepted TKA, including 25 males and 51 females with an average age of 66.6 years (range, 58-79 years). The affected knees were left side in 41 cases and right side in 35 cases. They were randomly divided into experimental group and control group before surgery. Then LMWHC and rehabil itation training were routinely given in two groups before and after surgery. However, only experimental group was treated with AVIS continually during the first four days and then two times a day for 30 minutes one time during 5-7 days. At 7 daysd after operation, color Doppler ultrasound was used to detect the occurrence condition of DVT. Results Five cases (13.16%) had thrombosis of calf and recovered after treated with urokinase and salvia in the experimental group. Eleven cases had thrombosis of calf and 3 cases had thrombosis of whole low extremities (36.84%), and improved after treated with urokinase and salvia in the control group. There was significant difference in DVT incidencerate between two groups (P lt; 0.05). No pulmonary embol ism or death was found in both groups. Conclusion AVIScan effectively accelerate the venous blood return velocity, a combination of AVIS and LMWHC has a better effect in theprevention of DVT following TKA.
ObjectiveTo systematically review the clinical efficacy of low molecular weight heparin (LMWH) in treating patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).
MethodsDatabases including PubMed, The Cochrane Library (Issue 10, 2013), EMbase, CBM, CNKI, VIP and WanFang Data were searched for the randomized controlled trials (RCTs) about LMWH in treating acute exacerbation of COPD from the establishment to October 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of the included studies. Meta-analysis was then performed using RevMan 5.2 software.
ResultsA total of 6 RCTs involving 501 patients were finally included. The results of meta-analysis showed that:compared with the control group, LMWH significantly improved levels of D-dimmer (MD=-0.28, 95%CI-0.50 to-0.05, P=0.02), reduced carbon dioxide partial pressure (PaCO2) (MD=-3.42, 95%CI-6.66 to-0.18, P=0.04), improved coagulation (PT) (MD=1.85, 95%CI 1.29 to 2.42, P < 0.000 01), and improved clinical symptoms and signs (RR=1.33, 95%CI 1.12 to 1.58, P=0.001), but it did not improve oxygen partial pressure (PaO2) (MD=0.28, 95%CI-3.04 to 3.61, P=0.87). During treatment, no severe adverse reaction occurred in both groups.
ConclusionLMWH could significantly improve symptoms caused by acute exacerbation of COPD. Due to limited quantity and quality of the included studies, the above conclusion needs to be confirmed by conducting more high quality RCTs with larger sample size.
Objective To evaluate the anticoagulant effects of low molecular weight heparin calcium versus fondaparinux sodium (FPX) after intertrochanteric fracture surgery using thromboelastography (TEG). Methods The patient who was hospitalized at the First People’s Hospital of Shuangliu District, requiring surgical intervention for intertrochanteric fracture was selected between September 2020 and September 2022. By using a random number table grouping method, the included patients were divided into the FPX group and the low molecular weight heparin calcium group. All patients underwent TEG was performed after admission, and on postoperative days 1, 3, and 7, and color doppler ultrasound of the lower limb vessels was conducted after admission and on postoperative day 7. The occurrence of deep vein thrombosis and TEG indicators were compared between the two groups. Results A total of 80 patients were included, with 40 patients in each group. There was no statistically significant difference in age, gender, and body mass index between the two groups (P>0.05). There was no statistically significant difference in the incidence of DVT between the FPX group and the low molecular weight heparin calcium group before surgery (9 vs. 7 cases) and after surgery (4 vs. 8 cases) (P>0.05). The fondaparinux group demonstrated a significantly higher K value compared to the low molecular weight heparin calcium group (P<0.05). Conversely, the MA value and CI value in the fondaparinux group were significantly lower than those in the low molecular weight heparin calcium group (P<0.05). There was no statistically significant difference in the other TEG parameters between the two groups (P>0.05). Conclusion The TEG findings suggest that the anticoagulant effect of FPX is more effective than that of low molecular weight heparin calcium following surgical treatment of intertrochanteric fractures.
Objective?During primary total knee arthroplasty (TKA), anticoagulant drugs are used for prevention of major venous thrombosis of lower limbs, and this often leads to the increase of perioperative blood loss. To retrospectively analyse the impact of low molecular weight heparin on hidden blood loss and transfusion rate after primary TKA by comparing with the use of aspirin.?Methods?Between October 2007 and August 2009, the clinical data from 286 patients undergoing primary TKA surgery were retrospectively analyzed. In accordance with different anticoagulation methods, the cases were divided into 2 groups, the trial group (n=166) and the control group (n=120). In the trial group, the patients received low molecular weight heparin (4 000-6 000 U/day) from 8-12 hours after TKA for 14 days; there were 27 males and 139 females with an average age of 66.1 years (range, 22-82 years); the body mass index (BMI) was 26.79 ± 3.87; and the locations were the left knee in 99 cases and the right knee in 67 cases with an average disease duration of 4.1 years (range, 1.8-8.6 years). In the control group, the patients received aspirin (150 mg/day) for 14 days; there were 21 males and 99 females with an average age of 64.9 years (range, 40-84 years); the BMI was 27.87 ± 3.62; and the locations were the left knee in 78 cases and the right knee in 42 cases with an average disease duration of 4.9 years (range, 1.5-8.2 years). There was no significant difference in the general data between 2 groups (P gt; 0.05).?Results?The incisions healed by first intention in all patients. Postoperative deep venous thrombosis occurred in 37 patients of the trial group and in 28 cases of the control group. All the patients were followed up 12-34 months (mean, 21.6 months). There were significant differences in the United States Hospital for Special Surgery (HSS) score of 2 groups between before surgery and after surgery (P lt; 0.05). The hidden blood loss was (40.55 ± 37.75) g/L in the trial group and (32.52 ± 40.13) g/L in the control group, showing significant difference (t=3.387, P=0.001); the dominant blood loss was (24.08 ± 14.63) g/L and (27.91 ± 18.47) g/L respectively, showing no significant difference (t= —1.899, P=0.059). The blood transfusion rates were 40.4% (67/166) in the trial group and 30.0% (36/120) in the control group, showing no significant difference (χ2=2.771, P=0.081); the transfusion volumes were (1.44 ± 4.03) U and (0.97 ± 3.50) U respectively, showing significant difference (t=2.071, P=0.039).?Conclusion?The low molecular weight heparin has effect on the hidden blood loss after primary TKA, which may increase postoperative blood loss and blood transfusion rate. The changes in hemoglobin should be monitored during the anticoagulant therapy, and the blood volume should be added promptly.
