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 investigate the hotspots and frontiers and to reveal research trends of cirrhosis with portal vein thrombosis (PVT) by visual analysis.MethodsWe explored the distributions, key citations and research trends of articles on cirrhosis with PVT published from 1991 to 2020 by citation analysis, co-word analysis, and burst detection by information visual software CiteSpace.ResultsThe quantity of articles on cirrhosis with PVT had been increasing over time. The management of PVT remained the hotspots, while the efficacy and prognosis of anticoagulation of PVT as well as the risk factors and underlying mechanisms of PVT had been frontiers in recent years.ConclusionsAnticoagulation and risk factors have been hotspots and frontiers in recent years.
Objective To investigate the risk factors and the prevention and cure methods of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Methods From March 2004 to July 2008，twentythree patients with ischemic stroke after mechanical heart valve replacement had been researched(ischemic stroke group). One hundred and twenty patients who had undergone mechanical heart valve replacement were randomly chosen in the same period as control group. Gender, age, the dose of warfarin , anticoagulation intensity(INR), INR review interval, left atrial diameter and heart rhythm were compared between the two groups, and the risk factors of ischemic stroke were analyzed by logistic regression analysis. Results (1) Patients in ischemic stroke group all discharged from hospital after treatment, and they were followed up for 1 month-3 years after discharged. All the patients’ neurological complications improved obviously, and no recurrent embolism and severe hemorrhage was found. (2) There was no statistical significance between two groups in gender, age and the dose of warfarin（Pgt;0.05）. (3) Nonconditional logistic regression analysis on influence factors showed that atrial fibrillation（P=0.000）, left atrial enlargement（P=0.002）, low anticoagulation intensity（P=0.012） and longtime INR review interval（P=0.047）were the risk factors of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Conclusions (1)The prognosis of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement is better than that of intracranial hemorrhage, and the occurrence of ischemic stroke is related to many risk factors. (2)The influences of risk factors should be minimized in order to avoid ischemic stroke. (3) Early low intensity anticoagulation therapy is safe and effective for patients with ischemic stroke after heart valve replacement.
目的:心房纖顫是老年最常見的心律失常之一,并且帶來了如外周血管血栓形成、肺梗死、腦卒中等并發癥。口服抗凝治療是預防該類并發癥的有效手段,但監測繁瑣、有藥物不良反應風險等。本實驗為尋找有效的房顫管理模式,設計了社區管理模式,并與專科管理模式進行對照,以研究社區管理模式是否適合老年房顫患者的管理。方法:納入在我院就診的老年房顫患者107名,隨機分入社區管理組及專科管理組,其中專科管理組患者在珠海市人民醫院門診常規就診,而社區管理組在所屬社區進行治療。對照比較在抗凝達標率、華法林相關不良反應事件發生率(出血、血栓事件)、及費用方面的差異。結果:與專科管理組比較,社區管理組在抗凝達標率(分別為612%,642%,Pgt;005)、出血及血栓事件(P值分別為0133,0279)發生率方面無明顯統計學差異,但是在總體費用方面存在著統計學差異(Plt;0001)。結論:老年房顫患者華法林抗凝治療在社區管理有著與專科管理相似的可行性、安全性及有效性,并且有費用方面的優勢。
目的 分析反復發作的抗凝血類滅鼠藥所致獲得性凝血功能障礙的臨床特點，探討其診治方案。方法 對2009年3月－2010年12月收治的3例抗凝血類滅鼠藥所致獲得性凝血功能障礙患者的臨床表現、實驗室檢查和治療轉歸進行分析，并復習相關文獻。 結果 3例患者均以同時出現多部位出血為首發表現，經應用維生素K1、凝血酶原復合物、新鮮冰凍血漿、冷沉淀等治療，患者病情好轉，實驗室指標恢復正常。停藥（2、5周，3個月）后再次出現多部位出血，再給予維生素K1等治療，病情可緩解。 結論 維生素K1可作為首選的治療藥物，且對反復發作的患者同樣有效。為避免再發性出血，應維持治療至少3個月。
Objective Influence factors of the stable warfarin dose in the early period after mechanical prosthetic valve replacement were analyzed to guide the anticoagulation therapy for these patients. Methods A total of 288 patients within 6 months after mechanical prosthetic valve replacement in West China Hospital were followed up and registered at outpatient department from July 2012 to April 2014, including basic information (name, sex, age, height, weight, etc.), general clinical data (cardiac function, heart rate, surgery pattern, etc.) and related data about anticoagulation therapy. The target international standardized ratio (INR) range was 1.60 to 2.20 and the acceptable INR was 1.50 to 2.30. The sex, age, height, body weight, body mass index (BMI), body surface area (BSA) and related clinical factors were analyzed to find the relationship with the dose of warfarin. Results Sex was found to have a significant effect on the stable warfarin dose (P<0.05). Women needed a lower stable warfarin dose than men during the early anticoagulation therapy. There was no significant difference in the stable warfarin dose of patients with different ages, rhythms, NYHA classification, surgery pattern and diseases before operation; but the stable warfarin dose was lower in the patients with radiofrequency ablation during valve replacement procedures than the patients with single valve replacement (P<0.05). There was an association between age, height, weight, BMI, BSA and the stable warfarin dose withR2 of 1.2%, 3.2%, 3.5%, 1.1%, 4.2%, respectively and they could explain 6.1% of variability in warfarin dose. Conclusion During early anticoagulation therapy in patients with mechanical prosthetic valve replacement, it is necessary to consider the effects of various preoperative factors, drug factors and demographic factors on warfarin dose. Even though there is an association between age, height, weight, BMI, BSA and the stable warfarin dose, which can only explain 6.1% of variability in warfarin dose, thus cannot guide the postoperative anticoagulation of these patients.
摘要:目的： 分析肺動脈血栓栓塞癥（PTE）的臨床特征、診斷方法及治療。提高診斷率和治愈率,改善預后。 方法 ：回顧分析我院過去七年間收治的25例PTE患者的危險因素、臨床表現、輔助檢查、治療情況等臨床資料。 結果 ：PTE的危險因素有深靜脈血栓、高齡、心肺疾病、長期臥床等慢性基礎疾病以及近期手術、外傷史等。其臨床表現各異,D-二聚體、CT肺動脈造影（CTPA）敏感性高。 結論 ：PTE臨床表現多樣,D-二聚體可作為篩選檢查首選;CTPA可作為無創檢查之首選。確診后正確及時治療可使預后顯著改善。Abstract: Objective: to analyze the clinical character\ methods of diagnosis and therapies of pulmonary thrombus embolism, to improve the precisions of diagnosis and therapy, to make prognosis better. Method : 25 patients of pulmonary thrombus embolism admitted in our hospital in the past seven years, were analyzed by risk factors, clinical manifestation accessory examination and therapies. Result : risk factors of pulmonary thrombus embolism included thrombus in venue profound, senility the diseases of heart and lung, keeping in the bed for a long time, above clinic diseases, operation and trauma in the near future their clinical manifestations were different, the sensitivity of dipolymer and CT pulmonary arteriography were high. Conclusion : clinical manifestations of pulmonary thrombus embolism were various, dipolymer may be regarded as the firster to diagnbose pulmonary thrombus embolism, CT pulmonary arteriography may be regarded as the first non-traumatogenic examination to diagnose pulmonary thrombus emboklism. After the diagnosis, correct therapies in time can greatly improver prognosis.
Blood pump is the core component of artificial ventricular assist device, and thrombosis is a severe complication of blood pump in clinical application. Methods of controlling and reducing thrombosis include materials surface modification, structure and parameters optimization of blood pump, and others. The typical symptoms of thrombosis and the hazard of various types of blood pump, the formation mechanism and primary factors for thrombosis, and the simulation prediction models for thrombosis were reviewed in this paper.
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.