Low Molecular Weight Heparin Calcium Research Articles

Meta-analysis of new intervention measures for preventing side effects of artificial joint replacement.

Intertrochanteric fracture of the femur occurs mostly among older people, and seriously affects daily life and quality of life. At present, physical intervention, drug treatment, routine intervention and rehabilitation training are widely used for prevention of side effects, but it is still inconclusive which intervention has the best effect. To compare the effects of new intervention measures for preventing side effects of artificial joint replacement. We searched the Chinese and English literatures for comparative studies on the prevention of side effects of new interventions for artificial joint replacement from July 2013 to June 2023 in China HowNet, PubMed, Wanfang, Weipu and other databases. Study quality was evaluated by improved Jadad scoring standard, and the effects of different interventions on preventing different complications were analyzed by meta-analysis of evidence-based medicine with Review Manager 5.0 software. Ten articles, including 869 cases, were finally included. The preventive effects of different interventions on the side effects of artificial joint replacement were studied, and valid data were extracted. There were two articles on the preventive effects of drug intervention, four on comparison of the preventive effects of combined and single interventions, and three on the preventive effects of physical intervention, rehabilitation training and routine intervention. Meta-analysis showed that the preventive effect of rivaroxaban was significantly better than low molecular weight heparin calcium [mean difference (MD) = -0.16, 95%CI: -0.28 to -0.04, P < 0.05]. The effect of combined intervention was significantly better than that of single intervention (MD = -0.08, 95%CI: -0.16 to -0.01, P < 0.001). Physical intervention was significantly better than routine intervention and rehabilitation training (MD = 0.26, 95%CI: 0.16-0.36, P < 0.001). Rivaroxaban combined with rehabilitation training is preferred for preventing deep vein thrombosis after artificial joint replacement. In the prevention of pulmonary embolism, rivaroxaban drug intervention is given priority. The effect of combined intervention is better than that of single intervention.

Apply Anticoagulants after Discharge not Benefit to the Incidence of Symptomatic Thrombus in High-Altitude Areas: A Retrospective Study.

Many guidelines indicate that continuous use of anticoagulant drugs reduces the incidence of venous thrombus (VT), but no studies show the effect on the incidence of symptomatic venous thrombus (SVT) in total knee arthroplasty (TKA) patients after discharge. This study aimed to investigate whether it is necessary to apply anticoagulants to TKA patients after discharge. Patients who met the exclusion criteria requirement, underwent TKA by the same surgical team and received anticoagulant therapy after the operation were eligible for the study. Finally, a total of 567 TKA patients were recruited as participants. The patients were divided into two groups. The patients in group A were taken low molecular heparin for 5-10 days after surgery, which included but was not limited to low molecular weight heparin calcium injection (0.4 mL, ih, Qd), calcium dioxin injection (0.6 mL, ih, Qd), or enoxaparin sodium injection (0.4 mL, ih, Qd), and the patients needed to continue oral anticoagulant drug (10 mg, po, Qd) for 7-21 days after discharge. The patients in group B only took low molecular heparin 5-10 days after surgery and no treatment after discharge. The baseline characteristics of patients, total complications of SVT include lower limb vascular pain (LLVP), lower limb vascular pain no fester (LLVPNF), lower limbs swelling (LLS), lower limb fester (LLF), and death by thrombosis (DT), bleeding and mortality following discharged were compared between two groups. The study showed that the incidence of SVT patients had no significant difference between the two groups (p = 0.489). Moreover, the incidence of LLVP (p = 0.265), LLS (p = 0.84), LLVPNF (p = 0.213), LLF (p = 0.907), DT (p = 0.907), death from other causes, and bleeding (p = 0.323) had no significant differences between the two groups. However, the incidence of SVT in patients with smoking (p = 0.0001 or 0.0011) or drinking (p = 0.0002 or 0.0001) was significantly increased. There is not enough evidence showing that the TKA patients given anticoagulants after discharge had benefits in decreasing the risk of SVT. Furthermore, smoking and drinking would significantly increase the risk of SVT in TKA patients.

Effect of hydrocolloid dressing combined with low molecular weight heparin and calcium on scar hyperplasia in burn patients with venous thromboembolism.

The purpose of this study is to investigate the effect of hydrocolloid dressing combined with low molecular weight heparin calcium on scar hyperplasia in burn patients with venous thromboembolism. A retrospective analysis was made on 98 patients with burns complicated with venous thromboembolism in Renmin Hospital, Hubei University of Medicine from January 2020 to April 2021. According to different treatment methods, they were divided into a control group (48 cases) and a research group (50 cases), who were given low molecular weight heparin calcium combined with routine treatment and hydrocolloid dressing on the basis of the control group. The wound healing time, dressing change times and infection symptom regression time in the study group were significantly lower than those in the control group (P < .05). After the intervention, the degree of wound pain in both groups was reduced, and the degree of wound pain in the study group was significantly lower than that in the control group, with statistical significance (P < .05). Fibrinogen, activated partial thromboplastin (APPT), D-dimer, fibrinolytic degradation products, prothrombin time and activated partial prothrombin time of the two groups were all improved. The degree of scar hyperplasia in both groups was improved, and the degree of scar hyperplasia in the study group was significantly better than that in the control group, and the difference was statistically significant (P>.05). Complications in the study group were lower than those in the control group, and the difference was statistically significant (P < .05). The hydrocolloid dressing combined with low molecular weight heparin calcium can effectively shorten the wound healing time and infection symptom regression time of burn patients with venous thromboembolism, reduce the number of dressing changes, reduce the degree of pain, have no influence on coagulation function, reduce the degree of scar, and reduce the incidence of complications.

Clinical Study of Low Molecular Weight Heparin Calcium Combined with Clopidogrel in the Treatment of Progressive Ischemic Stroke

To investigate the efficacy of low molecular weight heparin calcium combined with clopidogrel in treating progressive ischemic stroke is the objective of the study. 150 patients of progressive ischemic stroke in 3201 hospital were divided into observation group and control group, 75 patients in each group. In addition to conventional therapy, the control group was treated with low molecular weight heparin calcium while the observation group was treated with low molecular weight heparin calcium and clopidogrel. The efficacy of the two groups after drug treatment, National institutes of health stroke scale score, neuropathy disability score and serum C-reactive protein level before treatment, and 7 d and 14 d after treatment was compared and analyzed. The effective rate of observation group was 86.7 % and the control group was 76.0 %. Serum C-reactive protein levels were compared between the two groups before treatment (p>0.05). The C-reactive protein values were decreased in both groups, but the C-reactive protein values in observation group and 7 d and 14 d after treatment were reduced more obviously than control group (all, p<0.05). Low molecular weight heparin combined with clopidogrel can effectively treat progressive ischemic stroke and improve the neurological function of progressive ischemic stroke patients, which is worth of clinical application.

Padua prediction score-guided use of low-molecular-weight heparin calcium treatment for the prevention of venous thromboembolism in elderly patients with intracerebral hemorrhage: a clinical observation

This study used the Padua Prediction Score (PPS) to guide low-molecular-weight heparin calcium (LMWHC) treatment for the prevention of venous thromboembolism (VTE) in elderly patients with intracerebral hemorrhage (ICH). This study retrospectively analyzed 225 elderly patients who were admitted to the intensive care unit (ICU) between June 2016 and June 2022. Patients were divided into control (n = 124) and study (n = 101) groups. Control patients received routine prevention and treatment of VTE, while patients in the study group received PPS-guided LMWHC treatment for the prevention of VTE. Multiple analytical parameters were assessed including thromboelastography indices, coagulation function parameters, venous blood flow velocity, and the incidence of VTE and recurrent ICH. Thromboelastography indices, coagulation function parameters, and the venous blood flow velocity did not differ significantly between the control and study groups (p &gt; 0.05) before intervention and treatment. However, following PPS-guided LMWHC treatment, a significant improvement in these parameters was observed in the study group compared to the control group (p &lt; 0.05). Furthermore, the incidence of VTE was significantly lower in the study group (5.6%) than the control group (14.5%; p = 0.038). No significance differences in the incidence of recurrent ICH were observed (p &gt; 0.05). Our PPS data indicate that LMWHC treatment could significantly improve the coagulation function of elderly patients with ICH, as well as increase the venous blood flow velocity and prevent the occurrence of VTE.

Safety and preventive effects of rivaroxaban and low-molecular-weight heparin on deep vein thrombosis of lower extremity after total hip arthroplasty

Deep vein thrombosis (DVT) is a common complication of skeletal surgery, which can cause disability and death in severe cases. Here, we have compared the preventive effects of rivaroxaban and low molecular weight heparin on DVT of lower extremity after total hip arthroplasty and the safety. A total of 310 patients who received total hip arthroplasty from May 2014 to June 2016 were divided into a rivaroxaban group (n=153) and a low molecular weight heparin group (n=157). The rivaroxaban group was orally administered with rivaroxaban (10 mg, qd) 12 h after surgery for 30 consecutive days, and the other group was subcutaneously injected with low molecular weight heparin calcium injection (0.6 mL, ad) for 7 consecutive days. The incidence rate of lower extremity DVT, drainage blood volume, hemoglobin decline, as well as preoperative and postoperative 7-d prothrombin time (PT), activated partial thromboplastin time (APTT), platelet (PLT) count and D-dimer level of the two groups were compared. The two groups had similar incidence rates of lower extremity DVT, drainage blood volumes and extents of hemoglobin decline (P &gt;0.05). There were no significant differences in the preoperative and postoperative 7-d PT, APTT, PLT counts and D-dimer levels between the two groups (P &gt;0.05). Rivaroxaban and low molecular weight heparin show comparable preventive effects on lower extremity DVT after total hip arthroplasty. Results suggest that rivaroxaban is superior than the low molecular weight heparin in terms of convenient use (oral administration), good compliance and absence of dose adjustment.

Clinical Characteristics of Venous Thrombosis Associated with Peripherally Inserted Central Venous Catheter in Premature Infants.

Background: This study aimed to analyze clinical characteristics and risk factors for peripherally inserted central catheter (PICC) placement in premature infants. Materials: This study included seven premature infants who were hospitalized in the neonatal intensive care unit (NICU) of Peking University Third Hospital from 1 January 2014–30 June 2021, and suffered PICC-related venous thrombosis. The control group included premature infants (n = 56) matched (1:8) by the following: Did not experience venous thrombosis; born with a similar gestational age (±2 w), birth weight (±200 g); and received PICC catheterization in the same period (±4 w). Clinical neonatal data were collected through the hospital electronic medical record system and analyzed using SPSS version 23. Results: The incidence of PICC-related thrombus was 0.23% (7/3043. Univariate analysis revealed that, compared to the non-thrombotic group, mothers in the thrombosis group had autoimmune diseases (χ2 = 9.844, p = 0.030) and used anticoagulative drugs during pregnancy (χ2 = 8.036, p = 0.025). The corrected gestational age when PICC-related thrombosis occurred in the thrombosis group was 32 + 6 (30 + 1, 34 + 1) weeks. The average time from catheter placement to thrombosis was 5 (1, 12) days. Among infants, 85.7% (6/7) experienced deep vein thrombosis, of which four were in the lower extremity veins; three occurred within 2 days after central venous catheter extubation, and four occurred during central venous catheter indwelling. The clinical manifestations of thrombosis include skin edema, color changes, and skin temperature changes in the affected limbs. The seven neonates had normal coagulation at the time of thrombus diagnosis, but D-dimers significantly increased 1–2 days after thrombosis, returning to normal 5–8 days after thrombus. The thrombus persisted for 4.5 (3, 8) days. All seven neonates were treated with low molecular weight heparin calcium anticoagulation for 10 (3, 17) days and recovered completely. Conclusions: PICC-related thrombosis occurred within 1 week after catheter placement, and thrombosis more likely happened in infants whose mothers had autoimmune disease. When this high-risk factor exists and the patient has been intubated for 1 week and has sudden swelling in the intubated limb, venous ultrasound should be performed immediately to diagnose, and treatment should be provided in a timely manner to reduce adverse events.

Analysis of influencing factors of low molecular weight heparin calcium and pancreatic endocrine function in patients with acute pancreatitis.

article: Analysis of influencing factors of low molecular weight heparin calcium and pancreatic endocrine function in patients with acute pancreatitis - Minerva Gastroenterology 2022 September;68(3):349-52 - Minerva Medica - Journals

Evaluating the Role of Low Molecular Heparin to Prevent Anterolateral Thigh Flap Compromise in 2460 Head and Neck Defect Cases

Since thrombosis is the leading cause of free flap failure, anticoagulant agents appear to improve free flap survival by decreasing the probability of thrombus formation. This retrospective study primarily aimed to evaluate the outcomes and complications of anterolateral thigh flap (ALT) transfer in patients who were postoperatively treated with or without low molecular weight heparin (LMWH) calcium. This was a retrospective study. The sample comprised patients who underwent ALT transfer between January 2015 and January 2020 in the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital. The predictor variable was LMWH. The outcome variable was flap compromise. Other study variables were age, sex, defect location, hypertension, diabetes, number of vein anastomoses, alcohol history, radiation history, and hematoma. Descriptive, bivariate, and regression statistics were computed, and the P value was set at 0.05. The sample was composed of 2460 patients, comprising 2,234 males and 226 females, with a mean age of 50.5years (range, 19-79years). Based on the use of LMWH, the patients were divided into experimental and control groups. There were no significant differences in the clinical characteristics between the groups. Moreover, there were no significant differences in flap compromise or hematoma incidence between the groups. In the logistic regression model for flap compromise, the only factor found to be associated with flap compromise was hematoma (P<.0001). The use of LMWH in head and neck free flap transfer does not reduce the incidence of thrombosis and flap compromise.

Effect of Low Molecular Weight Heparin Calcium Combined with Argatroban on the Treatment, Vascular Endothelial Function, Inflammatory Factors and Serum Neurological Function in Patients with Acute Cerebral Infarction

Effect of Low Molecular Weight Heparin Calcium Combined with Argatroban on the Treatment, Vascular Endothelial Function, Inflammatory Factors and Serum Neurological Function in Patients with Acute Cerebral Infarction

The Efficacy of Tripterygium Glycosides Combined with LMWH in Treatment of HSPN in Children.

Objective This study aimed to explore the clinical efficacy and relevant mechanism of Tripterygium glycosides combined with low molecular weight heparin calcium (LMWH) in the treatment of Henoch–Schönlein purpura nephritis (HSPN) in children. Methods 64 cases of children patients with HSPN treated at Qilu Hospital (Qingdao) from January 2015 to May 2020 were selected and randomly divided into the control group and the observation group and 32 cases in each group. Conventional medical treatment was applied in the two groups, besides which the control group was given LMWH while the observation group was given Tripterygium glycosides based on the control group. The clinical efficacy and the indexes of clinical symptoms of the two groups were compared. Immune globulin level, fibrinogen content (FIB), prothrombin time (PT), platelet level (PLT), and activated partial thromboplastin time (APTT) level of the two groups were compared before and after the treatment. Results The total effective rate in the observation group was significantly higher than that of the control group, and the recurrence rate in the observation group was lower than that in the control group. After treatment, urine red blood cell count and 24 h urine protein were obviously better than those of the control group. There was no statistically significant difference in PT between the two groups of children before and after treatment. The levels of PLT and FIB in the two groups of patients after treatment were significantly lower than before treatment, and the PLT levels in the observation group were lower than those in the control group. Conclusion The combination of Tripterygium glycosides and LMWH had good clinical effects in the treatment of children with HSPN, and it could improve the clinical symptoms, the mechanism of which might be related to the increase of PT, a decrease of PLT, and the improvement of coagulation function.

The Clinical Efficacy of Maizhiling Combined with Low Molecular Weight Heparin in the Treatment of Deep Vein Thrombosis after Spinal Cord Injury

This research aims to discuss the clinical efficacy of Maizhiling combined with low molecular weight heparin calcium in the treatment of deep vein thrombosis after spinal cord injury, in the meantime to discuss the effects of the drug combination on coagulation function, hemodynamics and clinical safety. We chose 40 patients with deep vein thrombosis after spinal cord injury in our hospital as the study cohort divided them into control group (n=20) and observation group (n=20) randomly. The control group received low molecular weight heparin calcium subcutaneous injections while the observation group received low molecular weight heparin calcium intravenous infusion of low molecular weight heparin calcium and oral Maizhiling. Then make a contrast of the affected limbs detumescence time, lower limb circumference, coagulation parameters, overall response rate, incidence of complications and adverse drug reactions after treatment between both groups. After treatment, the observation group’s swelling time and the average difference of lower limb circumference were significantly reduced (p<0.01), prothrombin time, activated partial thromboplastin time and D-dimer both were significantly lower (p<0.01) and the clinical effective rate was higher (p<0.05). Both groups incidence of complications and adverse drug reactions have no significant difference (p>0.05). Low molecular weight heparin calcium combined with Maizhiling is effective on spinal cord injury deep vein thrombosis patients. The lower extremity swelling time is significantly shortened, the blood coagulation function and blood viscosity are improved, and the adverse drug incidence and complications are not increased. The combined use is used to treat patients with deep vein thrombosis. It is worth widely using in clinical practice.

Early diagnosis and precision treatment of right ovarian vein and inferior vena cava thrombosis following caesarean section: A case report.

Ovarian vein thrombosis (OVT) is a rare medical complication that is most often diagnosed in the post-partum period. OVT can lead to conditions, including sepsis, inferior vena cava (IVC), pulmonary emboli and mortality. The current study outlines a case of a patient who experienced pain in the lower abdomen and waist without fever postpartum following caesarean section (CS). Plasma FDP, D-Dimer and fibrinogen levels were markedly increased following CS and this was an indicator of the rapid progression of blood coagulation and fibrinolysis. Increased maternal lipid may be one of the risk factors for thrombosis. Based on the clinical presentation, a CT scan demonstrated thrombosis of the right ovarian vein and inferior vena cava, and a diagnosis of OVT and IVC thrombosis was subsequently made. In the current case, an anticoagulant therapy was started with a subcutaneous injection low molecular weight heparin calcium, an intravenous urokinase drip as a thrombolytic agent and implantation of inferior vena cava filters as a novel method of treatment for thrombosis. The patient was discharged from hospital 20 days following treatment in a good condition. The current study reports a case of OVT associated with IVC that was successfully managed without complication.

Effect of different doses of low molecular weight heparin on coagulation mechanism in thoracic cancer surgery

Objective To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery. Methods A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery (lung cancer, esophageal cancer, cardiac cancer) from February 2015 to October 2018. According to the Caprini risk assessment model, 101 patients with high risk of deep venous thrombosis were randomly assigned to groups A, B and C. Control group A (34 cases) did not use low molecular weight heparin; group B (34 cases) used prophylactic low molecular weight heparin calcium after operation; group C (33 cases) used therapeutic low molecular weight heparin calcium after operation. The platelet count (PLT), fibrinogen (FIB), prothrombin time (PT), D-dimer (D-D), postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation. Results The incidence of deep venous thrombosis (DVT) was 11.76% in group A, 2.94% in group B and 3.03% in group C, with significant difference between group B and C and group A (P 0.05). The levels of FIB and D-D after operation were significantly higher than those before operation (P<0.05), but the levels of indexes in group B and C were significantly lower than those in group A (P<0.05). Conclusions Low molecular weight heparin calcium does not increase bleeding and thoracic drainage, which is beneficial to improve the hypercoagulable state of patients and has good safety. However, the use of low molecular weight heparin calcium in different doses (prevention amount and treatment amount) has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index. Key words: Thoracic neoplasms; Thoracic surgical procedures; Heparin, low-molecular-weight; Blood coagulation tests

Traditional Chinese medicine versus regular therapy in Henoch-Sch\xf6nlein purpura nephritis in children: study protocol for a randomized controlled trial

BackgroundHenoch-Schönlein purpura nephritis (HSPN) is the most common secondary glomerular disease in children. Currently, the treatment for HSPN is always selected based on the Kidney Disease Improving Global Outcomes guidelines; however, this approach may lead to undertreatment, especially in patients with persistent proteinuria that does not reach nephrotic levels and/or hematuria and those with a pathological classification between grades 1 and 3 according to the International Study of Kidney Disease in Children. This study was performed to evaluate the curative effect and safety of a traditional Chinese medicine (TCM) integrated treatment program in this type of HSPN.MethodsThis multicenter, open-label, large-sample, randomized controlled trial was performed in China and included 500 children with HSPN exhibiting mild pathological patterns. The treatment group to control group ratio was 2:1, and each group was further stratified into two types, light and heavy, according to urinary protein quantification and pathological type. The treatment group received tripterygium glycosides (TGs), tanshinone IIa sodium sulfonate injection, and Chinese herbs selected based on syndrome differentiation in TCM. The heavy and light subgroups received treatment courses and dosages of TG. In the control groups, the light group received benazepril hydrochloride tablets, low molecular weight heparin calcium injection, dipyridamole tablets, and a Chinese medicine placebo, while the heavy group received the same treatment plus prednisone. All groups were treated for 3 months and then followed up for 9 months. The efficacy and safety of the treatments were then evaluated among the groups.DiscussionCurrently, few treatments are available for HSPN patients with mild pathological patterns indicating light to moderate proteinuria and/or hematuresis. In this large-sample study, we provide a new approach for HSPN that includes an integrated treatment program that incorporates TCM.Trial registrationClinical Trials.gov, NCT03591471. Re-registered on 19 July 2018.

Application value of continuous blood purification in pediatric intensive care unit: analysis of 203 cases

To explore the clinical application value of the continuous blood purification (CBP) technology in pediatric intensive care unit (ICU). A retrospective study was conducted. All CBP patients admitted to pediatric ICU of Children's Hospital of Nanjing Medical University from 2015 to 2017 were enrolled. The disease diagnosis, CBP treatment mode, catheter placement, anticoagulation way, treatment time and adverse reactions were summarized and analyzed. (1) A total of 203 children were included, male accounted for 59.1%; age 37 days to 14 years old, with an average of (4.52±3.60) years old; weight 3.3-68.0 kg, with an average of (21.38±13.77) kg. (2) There were a total of 660 CBP treatments, with an average of 3.25 times per person. The main treatment modes of CBP were plasma exchange (PE, 38.64%), and followed by continuous veno-venous hemodiafiltration (CVVHDF, 38.64%), hemoperfusion (HP, 16.51%) and continuous veno-venous hemofiltration (CVVH, 6.21%). (3) Central venous catheterization was mainly placed in the right internal jugular vein (90.64%), followed by the right femoral vein (5.42%) and the left femoral vein (3.94%). (4) Heparin sodium was the main anticoagulant in pipeline filters (84.73%), followed by low molecular weight heparin calcium (11.33%), sodium citrate and non-anticoagulant (both 1.97%). Mixed anticoagulants were used 21 children. (5) Primary diseases included poisoning (26.11%), liver failure (25.62%), sepsis (12.32%), shock after cardiopulmonary resuscitation (11.82%), acute respiratory distress syndrome (ARDS, 8.37%), central nervous system diseases (5.41%) and metabolic diseases (4.93%). The lowest efficacy of CBP was metabolic diseases, with mortality rate of 60.00%; followed by ARDS, shock after cardiopulmonary resuscitation, sepsis and liver failure, with mortality was 58.82%, 41.67%, 36.00% and 32.69%, respectively. The length of hospitalization stay of children with central nervous system diseases was (30.89±15.13) days. (6) Adverse events of CBP treatment included uncontrollable restlessness (2.88%), hypotension (1.82%), allergic rash (1.21%), catheterization and pipeline coagulation (1.21%), filter coagulation (1.06%), decreased heart rate and oxygen saturation (0.76%); CBP was stopped in 8 children due to cardiac arrest during the treatment. At present, the application of CBP technology in pediatric ICU is universal, and it is an important way to rescue critical illness.

Clinical characteristics and treatment of traumatic renal artery thrombosis

Objective To investigate the clinical characteristics, early diagnosis, and rational treatments of traumatic renal artery thrombosis or other traumatic emboli. Methods We summarized the clinical data of 10 patients with traumatic renal artery thrombosis or other traumatic emboli. Results Six of ten patients had left renal artery thrombosis, while four of the ten patients had right renal artery thrombosis.Ultrasonography reported a reduced blood flow signal in one patient, and then renal artery embolism was confirmed by enhanced CT.The other nine patients were directly definitely diagnosed as renal artery embolism by enhanced CT.Four patients were treated with low molecular weight heparin calcium, in whom the CT follow-up showed no obvious blood reperfusion in injured kidneys, but the renal function was in normal range.Renal hypertension occurred in two patients, and one of them received nephrectomy because of poorly controlled hypertension with medication. Conclusions Clinical symptoms, signs and laboratory examinations show no specific findings for diagnosis of traumatic renal artery thrombosis.The color Doppler ultrasound is a preliminary screening method for, and an enhanced CT scan is an effective method for, diagnosis of renal artery thrombosis.The early recovery of renal blood circulation is an evidence of effective treatment.Major concerns are supposed to focus on renal function and blood pressure during follow-up. Key words: Blunt injuries; Renal pedicle injury; Traumatic renal artery thrombosis

Application of sodium citrate in continuous renal replacement therapy

Objective To discuss the anticoagulation effects and safety of sodium citrate in continuous renal replacement therapy (CRRT) . Methods A total of 140 cases who underwent CRRT in the intensive care unit (ICU) of Zhejiang Provincial People′s Hospital from January 2014 to December 2016 were selected as research objects and divided into the heparin sodium group (n=56) , the low molecular weight heparin calcium group (n=48) and the sodium citrate group (n=36) according to the anticoagulation methods. The differences of anticoagulation effects, the average service life of the pipelines, the overall pipeline quantity, the total cost of blood purification, the blood transfusion amount during CRRT, total bilirubin (Tbil) , serum creatinine (Cer) , Na+, K+, prothrombin time (PT) , activated partial prothrombin time (APTT) , platelet count (PLT) before and after CRRT and the complications related to CRRT among the three groups were compared. Results The anticoagulation effect of the sodium citrate group was obviously better than that of the other two groups (χ2=18.809, P<0.05) . The average service life of the pipelines of the sodium citrate group was (29.3±5.4) h, which was obviously higher than that of the heparin sodium group (16.5±3.5) h and the low molecular weight heparin calcium group (24.8±4.1) h, and the intergroup difference was statistically significant (F=6.596, P<0.05) . The transfusion amount of red blood cells, plasma and platelets of the sodium citrate group was (12.3±2.8) U, (1 875.5±198.6) ml and (23.5±8.6) U, which was obviously lower than that of the heparin sodium group [ (16.5±5.6) U, (2 463.4±265.4) ml and (58.3±18.5) U] and the low molecular weight heparin calcium group [ (13.4±3.2) U, (1 954.4±214.5) ml and (32.6±11.5) U], and the intergroup differences were all statistically significant (F=4.563, 3.896, 7.456; P<0.05) . The Tbil, Cer, Na+ and K+ of all groups decreased after CRRT, and the differences were all statistically significant (P<0.05) . There were statistical significance in PT, APTT and PLT among the three groups (F=4.562, 4.153, 5.468; P<0.05) . The PLT of the sodium citrate group increased significantly after CRRT, with statistical difference (P<0.05) . The incidence rate of hemorrhages in skin, digestive tract, puncture point and trachea of the sodium citrate group was respectively 2.8%, 5.6%, 2.8% and 5.6%, which was obviously lower than that of the heparin sodium group (23.2%, 12.5%, 16.1%, 12.5%) and the low molecular weight heparin calcium group (6.3%, 10.4%, 8.3%, 8.3%) , and the differences were all statistically significant (χ2=6.678, 7.553, 6.849, 7.534; P<0.05) . The incidence rate of heparin induced thrombocytopenia (HIT) of the heparin sodium group was 8.9% (5/56) . Conclusions The anticoagulation effect of sodium citrate in CRRT is remarkable with less complications. It can significantly reduce the amount of blood transfusion and the cost of blood purification and is worth of promotion in clinical application. Key words: Continuous renal replacement therapy; Sodium citrate; Anticoagulation effect; Complications

The value of Sonoclot detection technology to guide the clinical medication of the perioperative anticoagulation and antiplatelet therapy in patients with acute myocardial infarction undergoing emergent PCI.

The value of Sonoclot detection technology to guide the clinical medication of the perioperative anticoagulation and antiplatelet therapy in patients with acute myocardial infarction (AMI) undergoing emergent percutaneous coronary intervention (PCI) was estimated. One hundred and twenty-eight patients were randomly divided into control group and observation group with 64 cases in each group. Control group adopted routine blood coagulation indexes, including prothrombin time, activated partial thromboplastin time, fibrinogen and plasma thrombin time, platelet count and platelet aggregation turbidity analysis; observation group adopted Sonoclot detection technology, including activated clotting time, coagulation rate and platelet function. Anticoagulant therapy selected was of low molecular weight heparin calcium perioperatively, intraoperative unfractionated heparin, and clopidogrel (75 mg) combined with aspirin enteric-coated tablets (100 mg) as antiplatelet drugs. The therapy was administered in accordance with blood coagulation results. The blood coagulation time, postoperative creatine kinase isoenzyme MB, cardiac troponin I and B-type natriuretic peptide levels in the observation group are significantly lower than those in the control group (P<0.05) though the operating time and specifications of the stenting did not show any significant difference (P>0.05). The incidence of recurrent myocardial infarction, microembolism, acute and subacute thrombosis and bleeding events in the observation group are significantly lower than those in the control group (P<0.05). In the control group, there is no difference in the coagulation indexes of the patients with thrombosis events or bleeding events or no event (P>0.05). Whereas, in the observation group, there is significant difference in coagulation indexes of the patients with thrombosis events or bleeding events or no event (P<0.05). In conclusion, Sonoclot detection technology instructs emergent PCI treatment in AMI patients to shorten the detection time of blood coagulation, reduce the degree of myocardial injury, reduce the incidence of perioperative thrombosis and bleeding events. Furthermore, it has great value in guiding the clinical medication of anticoagulation and antiplatelet therapy.

Hepatocellular carcinoma with inferior vena caval and right atrial tumor thrombi and massive pulmonary artery embolism: A case report.

The aim of the present study was to report the case of a 55-year-old female patient with a sizeable (7.1×6.2 cm) hepatocellular carcinoma (HCC), who succumbed to massive pulmonary artery embolism. The main symptoms included sudden thoracodynia, dyspnea and transient coma. The initial diagnosis was HCC according to the typical abdominal ultrasound and triple-phase abdominal computed tomography (CT) findings, chronic hepatitis B infection and elevated α-fetoprotein levels (1,036 µg/l; normal, 0-20 µg/l). Two days following admission, the patient developed recurrent chest pain and shortness of breath. The electrocardiogram and myocardial enzyme levels were normal, but the D-dimer level was elevated to 7,210 µg/l (normal, 0-550 µg/l). Magnetic resonance angiography and a contrast-enhanced chest CT confirmed that the inferior vena cava and right atrium were invaded by tumor thrombi; the bilateral pulmonary embolism was also suspected to be formed by tumor thrombi. The final diagnosis was HCC with inferior vena caval and right atrial tumor thrombi, as well as massive pulmonary embolism. Anticoagulation therapy with low-molecular weight heparin calcium was administered; however, the patient succumbed to pulmonary embolism in <2 months.