Lung cancer patients have increased risk of thromboembolism (TE) due to various factors such as by hypercoagulability, tumor thrombosis, decrease of ambulation, and chemotherapy etc. Among these factors, chemotherapy associated TEs have been reported, although the causes and pathomechanisms of TEs were not clear. Recently, reports proposed the potential role of platelets in endothelial damage by the chemotherapeutic agents. We have experienced a case of pulmonary TE after systemic chemotherapy with gemcitabine and cisplatin. The patient complained aggravated exertional dyspnea after chemotherapy and diagnosed as pulmonary TE by computerized tomogram. After anticoagulation and interruption of the chemotherapy, improvement of exertional dyspnea and resolution of the pulmonary TE were observed
Cisplatin* ; Drug Therapy* ; Dyspnea ; Humans ; Lung Neoplasms* ; Lung* ; Pulmonary Embolism* ; Thromboembolism ; Thrombophilia ; Thrombosis ; Walking

In this study, we reported a young male patient with acute chest pain who was diagnosed as myocardial infarction. The regular medication was performed following coronary intervention. Under such condition, this patient had 3 times myocardial infarction within a half month. The laboratory results showed that there might be a state of hypercoagulability. Aspirin combined with clopidogrel and other treatment were administrated. Meanwhile, the examination demonstrated that there was aspirin-resistant in the patient. The antiplatelet drug and extended anticoagulation therapy were carried out. There was no further myocardial infarction, and no coronary arteries stenosis was found in the re-examination angiography. Aspirin resistance and hypercoagulability should be considered when patients occurred the repeated myocardial infarction after regular medication and coronary intervention. Replacement of the antiplatelet treatment or combination with anticoagulant therapy is necessary in similar patient to avoid the sever consequence.
Aspirin/therapeutic use* ; Clopidogrel/therapeutic use* ; Drug Therapy, Combination ; Humans ; Male ; Myocardial Infarction/drug therapy* ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors/therapeutic use* ; Thrombophilia/drug therapy* ; Treatment Outcome

INTRODUCTIONPregnancies in women with thrombophilia are associated with a higher risk of obstetric complications. We systematically reviewed the findings of relevant randomised controlled trials (RCTs) with the aim of investigating the effectiveness of low-molecular-weight heparins (LMWHs) in pregnant women with inherited thrombophilic disorders and its effect on the incidence of live births in these patients.

METHODSThe MEDLINE-PubMed and Cochrane CENTRAL databases from 2000 to 2010 were searched using a combination of keywords, including low-molecular-weight heparin, enoxaparin, pregnancy, live birth and thrombophilia. Studies were included if they were RCTs assessing the effect of anticoagulant treatment on live birth rates in women with a history of miscarriage without apparent causes other than thrombophilic disorder. Interventions included LMWH, with or without aspirin, aspirin alone or placebo controlled for the prevention of adverse pregnancy outcome.

RESULTS43 articles with seven RCTs were retrieved following the initial search, of which four studies had to be excluded as they assessed thromboembolic events as the final outcome (n = 1), focused on idiopathic recurrent miscarriages (n = 1), compared efficacy and safety of two doses of enoxaparin (n = 1), and examined patients with or without thrombophilic disorder (n = 1). Pooled data from the remaining three RCTs showed no significant difference in the improvement of live birth rates following LMWH interventions (p = 0.15).

CONCLUSIONAt present, the use of LMWH in women with inherited thrombophilia with recurrent pregnancy loss is not indicated. Large randomised placebo-controlled trials are further needed to prove the effectiveness of LMWH in these patients.

Female ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Pregnancy ; Pregnancy Complications, Hematologic ; drug therapy ; Pregnancy Outcome ; Thrombophilia ; complications ; drug therapy ; Treatment Outcome

PURPOSE: To assess the distribution of births and spontaneous abortions, first-trimester abortion (FTA) and mid-trimester abortion (MTA), in untreated (n=128) and low molecular weight heparin (LMWH) treated pregnancies (n=50) of the same women with inherited thrombophilias and adverse pregnancy outcome (APO) in previous pregnancies. We particularly investigated the impact of LMWH on reducing the pregnancy complications in two thrombophilia types, "Conventional" and "Novel". MATERIALS AND METHODS: 50 women with inherited thrombophilia (26 Conventional and 24 Novel) and APO in previous pregnancies were included in the study. Conventional group included factor V Leiden (FVL), prothrombin G20210A (PT) mutations and antithrombin (AT), protein S (PS), and protein C (PC) deficiency, while the Novel group included methylentetrahydrofolate-reductase (MTHFR), plasminogen activator inhibitor-1 (PAI-1), and angiotensin converting enzyme (ACE) polymorphism. APO was defined as one of the following: preterm birth (PTB), fetal growth restriction (FGR), preeclampsia (PE), intrauterine fetal death (IUFD), placental abruption (PA) and deep venous thrombosis (DVT). RESULTS: There was no difference in distribution of births and spontaneous abortions between Conventional and Novel thrombophilia in untreated pregnancies (χ2=2.7; p=0.100) and LMWH treated pregnancies (χ2=0.442; p=0.506). In untreaed pregnancies thrombophilia type did not have any impact on the frequency of FTA and MTA (χ2=0.14; p=0.711). In birth-ended pregnancies LMWH treatement reduced the incidence of IUFD (p=0.011) in Conventional and FGR, IUFD, and PTB in Novel thrombophilia group. CONCLUSION: The equal impact of two thrombophilia types on the pregnancy outcomes and a more favorable effect of LMWH therapy on pregnancy complications in Novel thrombophilia group point the need for Novel thrombophilias screening and the future studies on this issue should be recommended.
Adult ; Anticoagulants/*therapeutic use ; Female ; Heparin, Low-Molecular-Weight/*therapeutic use ; Humans ; Infant, Newborn ; Polymorphism, Genetic ; Pregnancy ; Pregnancy Complications/*drug therapy/genetics ; *Pregnancy Outcome ; Thrombophilia/*drug therapy/genetics ; Young Adult

PURPOSETo compare the effects and side-effects of fondaparinux sodium and low molecular weight heparin in patients with hypercoagulability accompanied with traumatic infection.

METHODSThirty-six patients with post-traumatic infections in our hospital intensive care center were diagnosed with hypercoagulability from February 2012 to February 2013. These patients were randomly divided into 2 groups. In group F (18 patients), the patients were treated with fondaparinux sodium, 2.5 mg, 1/d for 11 d. In group L (18 patients), the patients were treated with low molecular weight heparin, 4100 U, 1/12 h for 11 d. The incidence of deep vein thrombosis, bleeding events and multiple organ dysfunction syndrome (MODS) and mortality of two groups after anticoagulation therapy were analyzed. Fibrinogen, D-dimer level and activity of antithrombin III were measured by the coagulation analyzer.

RESULTSThe incidence of deep vein thrombosis, MODS incidence and mortality were not significantly different between the two groups. The rate of bleeding evens in group F was lower than group L (p < 0.05). Antithrombin III got an upward trend after anticoagulant therapy, in which it was higher in group F than in group L on the 5th d and 11th d (p<0.05). Fibrinogen levels were gradually increased, and there was no significant difference between two groups (p>0.05). D-dimer was significantly decreased after anticoagulant therapy for 5 d (p<0.01), and there were significant differences between two groups on the 5th d and 7th d (p<0.05). It showed no significant difference on the 11th d (p>0.05).

CONCLUSIONFondaparinux sodium and low molecular weight heparin can effectively improve coagulopathy in patients with traumatic infection. Compared with low molecular weight heparin, fondaparinux sodium may reduce the risk of bleeding events in patients with hypercoagulability accompanied by traumatic infection.

Adult ; Aged ; Female ; Fibrin Fibrinogen Degradation Products ; analysis ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Infection ; complications ; Male ; Middle Aged ; Multiple Organ Failure ; epidemiology ; Polysaccharides ; therapeutic use ; Thrombophilia ; drug therapy ; Venous Thrombosis ; epidemiology ; Wounds and Injuries ; complications