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Clinical observation of the efficacy of low-molecular-weight heparin calcium in prophylaxis of the deep venous thrombosis following the gynecological tumor surgery.
Wei, N, Qi, Y, Yang, H, Guo, L
Pakistan journal of pharmaceutical sciences. 2018;(6(Special)):2835-2839
Abstract
Present study is conducted to investigate the efficacy and safety of application of low-molecular-weight heparin calcium in the prophylaxis of deep venous thrombosis (DVT) following the laparoscopic surgery for gynecological tumors, so as to provide reference for the selection of anti-coagulant procedure in clinical practice. A total of 180 patients who underwent the laparoscopic surgery for the gynecological tumors in this hospital between January 2015 and December 2017 were enrolled in this study, and according to the anti-coagulant procedure, they were divided into two groups, i.e. the control group and the observation group, with 90 patients in each group. In the control group, 90 patients were free from the anti-coagulant agent or drugs affecting the coagulant functions, while those in the observation group received the subcutaneous injection of low-molecular-weight heparin calcium for consecutive 5 days. Then we compared the serological indicators, prothrombin time (PT), cross-section diameter of the lower limb, hemodynamic indicator and the incidence rate of complications. Following postoperative 5 days, the levels of fibrinogen and D-dimer in the observation group were (2.66±0.72) g/L and (0.61±0.17) μg/mL, significantly lower than those in the control group, and the differences had statistical significance (t=4.667, P=0.019; t=3.967, P= 0.029). At 3 d and 5 d after operation, PTs in the observation group were (13.74±3.92) s and (13.84±3.13) s, also superior to the control group (t=3.031, P=0.042; t=3.553, P =0.034). In the observation group, the cross-section diameter of lower limb and blood flow rate were (20.22±3.51) cm and (0.93±0.17) m/s, respectively, which were better than the control group, and the difference had statistical significance (t=4.412, P=0.021; t =4.724, P=0.019). In the observation group, the incidence rate of complications was only 3.33%, significantly lower than 10.00% in the control group (c2 =6.158, P=0.004). The application of the low-molecular-weight heparin calcium for anti-coagulation in the prophylaxis of the DVT following the laparoscopic surgery of gynecological tumor can better ameliorate the hemodynamics of patients, and prevent the formation of DVT.
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[Possibilities and results of using clopidogrel (Listab) in comprehensive treatment of patients with crural deep veins thrombosis].
Gavrilenko, AV, Voronov, DA
Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery. 2015;(1):91-4; 96-8
Abstract
The authors carried out a prospective non-randomized controlled study including patients undergoing conservative treatment for acute thrombosis of crural deep veins with a stable course of the disease. A total of 60 patients discharged from hospital for further outpatient follow up and treatment were subdivided into two groups: Group I (study group, "Listab" group) composed of 35 patients who immediately began taking prescribed clopidogrel ("Listab") at a dose of 75 mg a day, and Group II (first control group, "VKA" group) comprising 25 patients receiving vitamin K antagonists (VKA) at various doses according to the generally accepted recommendations. We retrospectively formed Group III consisting of 21 patients (second control group, "ASA or VKA" group) who despite initial prescription of VKA either received them interruptedly and only for a short time after discharge from hospital or took preparations of acetylsalicylic acid (ASA) alone. The cumulative index of freedom from negative clinical outcomes after 12 months of follow up in the "Listab" group amounted to 0.9143, in the "VKA" group to 0.9600, and in the "ASA or VKA" group to 0.7619. The cumulative index of freedom from negative clinical and/or ultrasound outcomes after 12 months of follow up amounted to 0.8571, 0.8400, and 0.6190, respectively. In the "Listab" group the relative incidence of adverse events while taking the drug as calculated per 100 patient-months amounted to 1.79 and in the "VKA" group to 2.95. Administration of Listab was associated with the best patient compliance as compared to other drugs (VKA and ASA). The proportion of patients reporting regular taking of the drug in the "Listab" group amounted to 91.4%. A conclusion was drawn that in patients with crural deep vein thrombosis with a stable course of the acute period of the disease Listab may be used effectively and safely in comprehensive ambulatory treatment of patients having low adherence to taking VKA and to regular laboratory monitoring of the coagulation level (or if such monitoring is impossible), as well as in cases of high risk of haemorrhage while taking VKA. The final determination of the possibility of using clopidogrel-containing drugs and their place in treatment of the pathology concerned requires larger clinical trials.
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Hepatocellular carcinoma with portal vein tumor thrombus: treatment with transarterial chemoembolization combined with sorafenib--a retrospective controlled study.
Zhu, K, Chen, J, Lai, L, Meng, X, Zhou, B, Huang, W, Cai, M, Shan, H
Radiology. 2014;(1):284-93
Abstract
PURPOSE To determine the safety and efficacy of transarterial chemoembolization (TACE) combined with sorafenib (hereafter, TACE-sorafenib) in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). MATERIALS AND METHODS This study was approved by the institutional review board, and the requirement for informed consent was waived. The medical records of consecutive patients with HCC and PVTT who underwent TACE-sorafenib or TACE alone from January 2010 to December 2012 were retrospectively evaluated. Sorafenib (400 mg) was administered twice daily. Outcomes of patients who underwent TACE-sorafenib were compared with outcomes of patients who underwent TACE by using the Kaplan-Meier method according to types of PVTT PVTT in the main portal vein (type A), PVTT in the first-order portal vein branch (type B), and PVTT in second- or lower-order portal vein branches (type C). RESULTS Ninety-one patients were included in the analysis; 46 patients underwent TACE-sorafenib and 45 underwent TACE. TACE-sorafenib showed significant survival benefits compared with TACE in patients with type B (median survival, 13 months vs 6 months; P = .002) or type C (median survival, 15 months vs 10 months; P = .003) PVTT. TACE-sorafenib and main PVTT were the independent prognostic factors for survival at uni- and multivariate analysis. Liver function after TACE-sorafenib worsened only in patients with main PVTT. Sorafenib-related adverse events of grade 3 or higher occurred in 16 patients (35%). CONCLUSION TACE-sorafenib side effects were acceptable, and this treatment may improve overall survival in patients with HCC with first-order or lower-branch PVTT when compared with patients who underwent TACE alone.
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[Effects of Tuina and Chinese patent drug Shuxuetong injection on deep venous thrombosis and functional rehabilitation after total knee arthroplasty].
Hu, JL, Ouyang, GL, Han, DP, Xia, Q, He, Y, Huang, Z, Zhu, F, Sun, ST
Zhong xi yi jie he xue bao = Journal of Chinese integrative medicine. 2011;(10):1088-93
Abstract
OBJECTIVE To evaluate the efficacy of Tuina and Chinese patent drug Shuxuetong injection in preventing patients undergoing total knee arthroplasty from deep venous thrombosis and in functional rehabilitation. METHODS A total of 120 patients with diagnosed rheumatoid arthritis in the Department of Orthopaedic Surgery, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine in China were enrolled for this study. The patients underwent total knee arthroplasty and were divided into treatment group (n=60) and control group (n=60) after surgery. Patients in the control group received conventional rehabilitation training, including using a continuous passive motion machine and training of muscle contractions of the lower limb. Patients in the treatment group were administered Shuxuetong injection and Tuina based on the conventional rehabilitation training. The course of treatment lasted for 2 weeks. Hospital for Special Surgery (HSS) knee score, rate of deep venous thrombosis and range of motion of the knee joint were evaluated before and after treatment. RESULTS There was no significant difference in HSS knee score and range of motion as compared before and after treatment in two group (P>0.05). The rate of deep venous thrombosis of the treatment group was 13.33%, which was lower than 20% of the control group (P<0.05). CONCLUSION Tuina combined with Shuxuetong injection treatment can prevent deep venous thrombosis in patients with rheumatoid arthritis after total knee arthroplasty.
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Effect of a low-dose oral contraceptive on venous endothelial function in healthy young women: preliminary results.
Giribela, CR, Rubira, MC, Melo, NR, Plentz, RD, Angelis, Kd, Moreno, H, Consolim-Colombo, FM
Clinics (Sao Paulo, Brazil). 2007;(2):151-8
Abstract
BACKGROUND A possible increase in the incidence of venous thromboembolic events has been reported among users of third generation oral contraceptives. The objective of this study was to evaluate the effect of a low dose oral contraceptive (15 microg ethinyl estradiol/60 microg gestodene) on the venous endothelial function of healthy young women. METHODS Prospective case control study using the dorsal hand vein technique. Venous endothelial function was evaluated at baseline and after 4 months in the oral contraceptive users group (11 women) and in a control group (9 women). After preconstriction of the vein with phenylephrine, dose-response curves for acetylcholine and sodium nitroprusside were constructed. RESULTS In the contraceptive users group, a reduction occurred in the maximum venodilation response to acetylcholine and sodium nitroprusside after 4 months of oral contraceptive use, but this difference was not statistically significant (P > 0.05). No significant changes were detected in maximum venodilation responses to acetylcholine and sodium nitroprusside at the 4-month time point in the control group. CONCLUSION This study found no significant impairment of endothelium-dependent or independent venodilation in healthy young women following oral contraceptive use. Further studies are necessary using the same methodology in a larger sample over a longer follow-up period.
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Abrupt versus gradual withdrawal of vitamin K antagonist treatment in patients with venous thromboembolic disease: assessment of hypercoagulability and clinical outcome.
de Groot, MR, Njo, TL, van Marwijk Kooy, M, Büller, HR
Clinical laboratory. 2000;(11-12):575-81
Abstract
BACKGROUND It is yet unclear whether vitamin K antagonist treatment should be stopped abruptly or gradually after an episode of venous thromboembolism. The mode of withdrawal might influence a potential development of a hypercoagulable state, which could influence the risk for recurrent disease. METHODS We prospectively studied 37 consecutive patients in whom acenocoumarol was discontinued either abrupt (18) or gradually (19) (2/3 and 1/3 of the initial dose for one week). Blood sampling was performed at various time points up to 18 days after complete withdrawal and was analysed for INR, prothrombin fragment F1 + 2 and D-dimer. All patients were clinically followed-up for the assessment of the association between hypercoagulability and occurrence of disease such as recurrent venous thromboembolism or malignancy. RESULTS An approximately fourfold increase was observed (median increase from 0.3 to 1.3 nmol/l) in the F1 + 2 levels after both abrupt and gradual withdrawal and in the D-dimer concentrations in the abrupt withdrawal group (0.10 to 0.44 mg/l), while those in whom acenocoumarol was discontinued gradually showed a less pronounced increase of the D-dimer levels (0.11 to 0.29 mg/L) (not significant). During follow-up one recurrent venous thromboembolic event occurred in each group, and a diagnosis of cancer was made four times. All these patients had the highest D-dimer concentrations measured in the entire study group. CONCLUSIONS This study indicates the potential for a hypercoagulable state after acenocoumarol discontinuation, which was not prevented by tapering the acenocoumarol dose. D-dimer, measured 2 to 3 weeks after acenocoumarol withdrawal, might be an important tool to identify patients at risk for recurrent venous thromboembolism and/or for the presence of an underlying malignancy.