ObjectiveTo summarize the pathogenesis, epidemiology, and risk factors of portal vein thrombosis after splenectomy, and combined with the latest advances in clinical prevention, diagnosis, and treatment of portal vein thrombosis after splenectomy, so as to provide some references for clinical prevention and treatment in the future.MethodLiteratures on portal vein thrombosis after splenectomy were collected and reviewed.ResultsThe incidence of portal vein thrombosis after splenectomy was high and its occurrence was the result of multiple factors. It was mainly related to the change of splenic venous blood flow mechanics after splenectomy. In terms of diagnosis, enhanced CT scan was the first choice. Currently, there was no consensus on treatment options, which mainly focused on individualized treatment and emphasized that preventive anticoagulant use of low-molecular-weight heparin may reduce the risk of portal vein thrombosis.ConclusionThe concept of tertiary prevention of portal vein thrombosis after splenectomy should be established, and individualized treatment should be adopted in combination with the patient’s condition.
Objective To observate the influencing factors on circuit life during continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA), so as to provide data support for further optimization of RCA anticoagulation strategy. MethodsPatients who underwent CRRT with RCA in West China Hospital of Sichuan University between March 2021 and April 2022 were retrospectively selected. Analyze the basic information of patients and the impact of relevant indicators before or within 12 hours of treatment on the circuit life. Results A total of 116 patients were included. Among the included patients, a total of 225 cases were treated with CRRT for 11 051.7 hours, the median circuit life was 57.0 (25.4, 72.0) h. 142 cases (63.1%) were terminated due to coagulation, the median circuit life was 30.3 (20.5, 52.8) h. The results of multivariate Cox regression analysis showed that pH value [hazard ratio (HR)=0.002, 95% confidence interval (CI) (0.0001, 0.127), P=0.003], the maximam postfilter ionized calcium [HR=0.039, 95%CI (0.004, 0.437), P=0.008], blood flow [HR=1.051, 95%CI (1.027, 1.075), P<0.001] and catheter dysfunction [HR=5.701, 95%CI (3.777, 8.605), P<0.001] were the four influential factors affected circuit life. Kaplan Meier survival curve showed that RCA had the best effect when the postfilter ionized calcium was in the range of 0.25 ~ 0.35 mmol/L. Conclusions During CRRT treatment of RCA, pH value, postfilter ionized calcium, blood flow and catheter function are the independent influencing factors of circuit life. The above parameters should be carefully monitored and optimized in the treatment process to minimize the risk of coagulation, prolong the circuit life and maintain the continuty of CRRT treatment. The postfilter ionized calcium was recommended to be maitained at 0.25-0.35mmol/L, pH value maintained above 7.38, blood flow no more than 145 mL/min and catheter maitained patency to ensure the adequate anticoagulation.
Objective To evaluate the efficacy and safety of in vitro anticoagulation with nafamostat mesilate in continuous renal replacement therapy (CRRT) in patients with sepsis complicated with acute kidney injury (AKI). Methods The study subjects were sepsis patients with AKI who underwent CRRT in West China Hospital of Sichuan University and were at high risk of bleeding. CRRT patients who received in vitro anticoagulation with nafamostat mesilate between July 2021 and January 2022 were included in the nafamostat group. The medical records of CRRT patients who did not use anticoagulants between January 2020 and December 2020 were retrospectively collected as a control group. The general situation, the lifespan of the first CRRT filter, the number of filters used within 72 hours of treatment, laboratory tests before and after treatment, and the occurrence of adverse reactions during treatment of the two groups of patients were analyzed. Results There were 42 patients in the control group and 21 patients in the nafamostat group. There was no statistically significant difference in age, gender, body mass index, mean arterial pressure, primary disease, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation Ⅱ score, or pre-treatment laboratory test results between the two groups of patients (P>0.05). Kaplan-Meier survival analysis showed that the lifespan of the first filter was longer in the nafamostat group than in the control group (hazard ratio=0.408, P<0.05). The number of filters used by the control group patients after 72 hours of treatment was greater than that of the nafamostat group patients (2.1±0.6 vs. 1.3±0.5, P<0.05). After 72 hours of treatment, serum creatinine levels [(99.4±15.7) vs. (127.6±20.5)] μmol/L], urea nitrogen [(4.5±1.9) vs. (6.8±2.3) mmol/L], cystatin C [(1.0±0.2) vs. (1.2±0.2) mg/L], uric acid [(86.5±15.3) vs. (105.3±20.3) μmol/L] in the nafamostat group were lower than those of the control group (P<0.05), and there was no statistically significant difference in the results of other laboratory tests (P>0.05). There was no statistically significant difference in adverse reactions between the two groups of patients (P>0.05). Conclusion For patients with sepsis complicated with AKI who undergo CRRT and are at high risk of bleeding, nafamostat mesilate may be a safe and effective anticoagulant for in vitro anticoagulation.
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.
Objective To evaluate the long-term anticoagulation outcomes of target international normalized ratio (INR) 1.60 to 2.20 and weekly dosage adjustment of warfarin in patients after mechanical heart valve replacement. Methods Outpatients after mechanical heart valve replacement at least 6 months were registered continually from July 2011 to July 2016 in department of cardiothoracic surgery at Zigong No.4 People's Hospital and West China Hospital. There were 1 690 females (70.62%) and 703 males (29.38%) with a median age of 47 years, ranging from 14 to 80 years. All patients were followed up for 6-61 months. Target INR was 1.60 to 2.20 and warfarin dosage were adjusted weekly. Unexpected bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were recorded and calculated to evaluate the outcome of anticoagulation management. Results A total of 2 393 patients with 26 521 INR values were included for data analysis. INR values varied from 0.90-8.39 (1.82±0.45) and required weekly doses of warfarin were 1.75-61.25 (21.72±7.39) mg. TTR of target INR and acceptable INR was 59.38% (1 449 514.0 days/2 441 060.0 days) and 73.57% (1 795 971.0 days/2 441 060.0 days), respectively. FTTR of target INR and acceptable INR were 50.71% (13 450 times/26 521 times), 65.25% (17 305 times/26 521 times). During the follow-up , anticoagulation-related complications included: cerebral infarction in 21 patients (complete recovery in 18 patients, physical activity disorder in 3 patients), cerebral hemorrhage in 4 patients (death in 1 patient, complete recovery in 3 patients), severe gastrointestinal bleeding in 3 patients (completely recovered) and uterine bleeding in 1 patient (surgical removal of the uterus). Conclusion Target INR 1.60–2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement is reasonable and safe.
On January 11, 2022, the European Society of Vascular Surgery (ESVS) completed its first update in the “European Society for Vascular Surgery 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs” since 2015. Based on the existing literatures and expert consensus, the guidelines added and revised the treatment strategies, postoperative monitoring, and postoperative anticoagulation of superficial venous insufficiency of the lower extremities and pelvic venous diseases. The new and modified parts will be interpreted.
Objective To discuss the application value in increasing the frequency of monitoring and ensuring the safety of anticoagulation therapy in patient self-monitoring (PST) and self-management (PSM) of portable coagulometer.
Method This non-randomized prospective controlled study was conducted in 100 patients receiving oral warfarin anticoagulation therapy after heart valve replacement and met the inclusion criteria in our hospital between March 2013 and April 2014 year. All the patients were divided into three groups including an outpatient follow-up group(outpatient group), a self-monitoring group and a self-management group. Meanwhile, the patients in the outpatient group visited professional institutions, performed international normalized ratio (INR) testing with central lab and adjusted the dosage of orally administered warfarin by the doctors. And the other two groups performed INR testing with CoaguChek XS portable coagulometer by themselves, and the patients in the self-management group performed management by themselves. The follow-up time was 6 months. The dates of time in therapeutic range (TTR), fraction of time in therapeutic range (FTTR) and anticoagulation complications in the three groups were analyzed and compared.
Results There was no significant difference in the INR results obtained from the follow-up time among the three groups (P=0.845) . TTR value of INR of the outpatient group, the self-monitoring group, and the self-management group was 45.9% (4368.0 days/9517.0 days), 61.2% (6057.0 days/9897.0 days), and 65.4% (2833.8 days/4333.0 days), respectively with a statistical difference among the three groups (P<0.001) . FTTR value of INR obtained from the outpatient group, the self-monitoring group, and the self-management group was 48.3% (99 times/205 times), 60.7% (164 times/270 times), and 64.9% (100 times/154 times) respectively. There was a statistical difference in the FTTR between the outpatient group and the self-monitoring group (P=0.007) , and also between the outpatient group and the self-monitoring group (P=0.002) . But there was no statistical difference between the self-monitoring group and the self-management group (P=0.392) . There were not any major bleeding and thrombosis complications in all study. And there was no statistical difference in the total complications, thrombosis, and bleeding complications rates between the outpatient group and the self-monitoring group, and also between the outpatient group and the self-management group (P>0.05) .
Conclusions The patients receiving oral anticoagulation after heart valve replacement or their care providers were able to perform PST and PSM. The use of portable coagulometer for self-monitoring and self-management can increase the frequency of anticoagulation monitoring and achieve better INR target value control. PST and PSM could achieve higher quality of anticoagulation management and life and without increasing the risk of oral anticoagulation than the traditional monitoring method. The monitoring frequency of once a month is reasonable for the patients receiving oral anticoagulation more than half a year after heart valve replacement.
Objective
To investigate whether the individualized anticoagulation therapy based on CYP2C9 and VKORC1 gene is superior to empirical anticoagulation therapy after artificial heart valve replacement surgery in Uygur patients.
Methods
From December 2012 to December 2015, 210 Uygur patients who underwent artificial heart valve replacement surgery at the First Affiliated Hospital of Xinjiang Medical University were randomly assigned to a genetic anticoagulation therapy group (group A, n=106, 41 females and 65 males, aged 44.7±10.02 years) or an empirical anticoagulation therapy group (group B, n=104, 47 females and 57 males, aged 45.62±10.01 years) according to the random number table. CYP2C9 and VKORC1 genotypes were tested in the group A and then wafarin of administration in anticoagulation therapy was recommended. Patients in the group B were treated with conventional anticoagulation. Patients in both groups were followed up for 1 month and coagulation function was regularly tested.
Results
The percentage of patients with INR values of 1.8-2.5 after 4 weeks warfarin anticoagulation treatment in the group A was higher than that in the group B (47.1% vs. 32.7%, P=0.038). The rate of INR≥3.0 in the warfarin anticoagulation therapy period in the group A was lower than that in the group B (21.6% vs. 26.5%, P=0.411). The time to reach the standard INR value and the time to get maintenance dose were shorter in the group A compared with the group B (8.80±3.07 d vs. 9.26±2.09 d, P=0.031; 14.25±4.55 d vs. 15.33±1.85 d, P=0.032). Bleeding occured in one patient in the group A and three patients in the group B (P=0.293). Embolic events occured in three patients in the group A and five patients in the group B (P=0.436).
Conclusion
Compared with the empirical anticoagulation, the genetic anticoagulation based on wafarin dosing model can spend less time and make more patients to reach the standard INR value. However there is no significant difference between the two groups in the ratio of INR≥3.0, bleeding and embolic events in the warfarin anticoagulation therapy.
ObjectiveTo compare the effect of catheter-directed thrombolysis (CDT) combined with anticoagulation (AC) and AC in the treatment of acute proximal deep venous thrombosis (APDVT) of the lower extremities. MethodsThe clinical data of 184 APDVT patients treated in Guizhou Provincial People’s Hospital from January 2017 to December 2022 were retrospectively collected. According to the treatment methods, the patients were divided into CDT group (n=82, CDT combined with AC) and AC group (n=102, AC alone). The prognosis indicators such as the incidence of bleeding events, the incidence of post-thrombotic syndrome (PTS), Villalta score, venous clinical severity score (VCSS) and chronic lower limb venous insufficiency questionnaire (CIVIQ) score were compared between the two groups. ResultsCompared with the AC group, the CDT group had a higher incidence of bleeding events [11.0% (9/82) vs. 2.9% (3/102)], a shorter time to detumescent [(2.8±1.2) d vs. (7.2±1.9) d], and lower VS score [3 (2,4) vs. 3 (2, 7)], VCSS score [2.0 (1.7, 4.0) vs. 3.0 (2.0, 5.2)] and postoperative venous patency score [1 (1, 2) vs. 2 (1, 3)], and higher CIVIQ score [80.0 (77.0, 86.0) vs. 71.5 (68.0, 78.0)], P<0.05. However, there were no significant differences in the incidence of PTS [28.2% (22/78) vs. 36.5% (35/96)] and thrombosis recurrence rate [9.0% (7/78) vs. 11.5% (11/96)] between the two groups (P>0.05). ConclusionCDT can relieve the symptoms and improve the quality of life of APDVT faster than AC, but it is necessary to strictly grasp the indications of thrombolysis to reduce the risk of bleeding.
Objective
To investigate the effects and feasibility of regional citrate anticoagulation continuous venous-venous hemodialysis(RCA-CVVHD) in acute hepatic & kidney injury after cardiovascular surgery.
Methods
Ten patients with acute kidney injury combined with acute hepatic injury after cardiovascular surgery were involved in this study. There were 5 males and 5 females at age of 35-69(58.2±12.7) years. All of them were treated by RCA-CVVHD. Blood samples were collected before treatment, 12 h, 24 h, 48 h, and 72 h after treatment.
Results
There was no statistical difference between post- and pre-treatment regarding with pH value (7.47±0.12 vs. 7.50±0.06 vs. 7.48±0.04 vs. 7.48±0.03 vs. 7.45±0.05, P>0.05) or BE value (0.91±9.97 mmol/L vs. 2.36±3.92 mmol/L vs. –0.22±3.09 mmol/L vs. 1.87±3.58 mmol/L vs. –1.05±1.12 mmol/L, P>0.05). There was a statistical difference in iCa (1.09±0.09 mmol/L vs. 1.15±0.08 mmol/L vs. 1.17±0.08 mmol/L vs. 1.24±0.09 mmol/L vs. 1.16±0.06 mmol/L), Na+ (149.44±6.84 mmol/L vs. 144.33±3.35 mmol/L vs. 143.13±3.52 mmol/L vs.141.25±5.52 mmol/L vs. 136.71±4.92 mmol/L), and tCa/iCa (2.07±0.11 vs. 2.10±1.12 vs. 2.17±0.69 vs. 2.23±1.05 vs. 2.30±0.11), respectively.
Conclusion
RCA-CVVHD used in patients with acute hepatic impairment is safe and feasible.
