PURPOSE: Comatose elderly patients with acute neurological illness have a great risk of deep vein thrombosis (DVT). In this study, the incidence of DVT and the effectiveness of early initiation of treatment were evaluated in those patients. MATERIALS AND METHODS: Total 323 patients were admitted to our ward due to neurological diseases in one year, and 43 patients, whose Glasgow Coma Scale was < or =11 and who was older than > or =60 years, were included in this study. D-dimer was measured on admission and day 7, and lower-extremity ultrasonography was performed on day 7. When DVT was positive, heparin treatment was initiated, and further evaluation of pulmonary embolism (PE) was conducted. Vena cava filter protection was inserted in PE-positive patients. Incidence of DVT and PE, alteration of D-dimer value, and effect of heparin treatment were analyzed. RESULTS: DVT was positive in 19 (44.2%) patients, and PE was in 4 (9.3%). D-dimer was significantly higher in DVT-positive group on day 7 (p<0.01). No DVT were identified in patients with ischemic disease, while 66.7% of intracerebral hemorrhage and 53.3% of brain contusion patients were DVT positive. Surgery was a definite risk factor for DVT, with an odds ratio of 5.25. DVT and PE disappeared by treatment in all cases, and no patients were succumbed to the thrombosis. CONCLUSION: Patients with hemorrhagic diseases or who undergo operation possess high risk of DVT, and initiation of heparin treatment in 7 days after admission is an effective prophylaxis for DVT in comatose elderly patients without causing bleeding.
Acute Disease ; Aged ; Anticoagulants/adverse effects/therapeutic use ; Antifibrinolytic Agents/therapeutic use ; *Coma ; Female ; Fibrin Fibrinogen Degradation Products/therapeutic use ; Hemorrhage/*epidemiology ; Heparin/adverse effects/therapeutic use ; Humans ; Incidence ; Japan/epidemiology ; Lower Extremity ; Male ; Middle Aged ; Nervous System Diseases/epidemiology ; Neurosurgical Procedures/*adverse effects ; Pulmonary Embolism/*complications/epidemiology/prevention & control ; Risk Factors ; Venous Thrombosis/epidemiology/*etiology/prevention & control

BACKGROUND: Currently, the hypertension (HTN) patients undergo appropriate medical treatment, and traditional risk factors are highly controlled. Therefore, potential risk factors of atherosclerotic vascular diseases (AVD) and venous thromboembolisms (VTE) in HTN should be reconsidered. We investigated thrombophilic genetic mutations and existing biomarkers for AVD or VTE in HTN patients receiving treatment. METHODS: A total of 183 patients were enrolled: AVD with HTN (group A, n=45), VTE with HTN (group B, n=62), and HTN patients without any vascular diseases (group C, n=76). The lipid profile, homocysteine (Hcy) levels, D-dimers, fibrinogen, antithrombin, lupus anticoagulant, and anti-cardiolipin antibody (aCL) were evaluated. Prothrombin G20210A, Factor V G1691A, and methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C were analyzed. RESULTS: All patients revealed wild type prothrombin G20210A and Factor V G1691A polymorphisms. The frequency of MTHFR polymorphisms was 677CT (n=84, 45.9%); 677TT (n=46, 25.1%); 1298AC (n=46, 25.1%); and 1298CC (n=2, 1.1%). The MTHFR 677TT genotype tended to increase the odds ratio (OR) to AVD events in HTN patients (OR 2.648, confidence interval 0.982-7.143, P=0.05). The group A demonstrated significantly higher Hcy levels (P=0.009), fibrinogen (P=0.004), and platelet counts (P=0.04) than group C. Group B had significantly higher levels of D-dimers (P=0.0001), platelet count (P=0.0002), and aCL (P=0.02) frequency than group C. CONCLUSIONS: The MTHFR 677TT genotype and Hcy level could be potential risk factors associated with development of AVD in HTN patients receiving treatment. D-dimer and aCL might be useful to estimate the occurrence of VTE in them.
Adult ; Aged ; Antihypertensive Agents/therapeutic use ; DNA/analysis ; Factor V/genetics ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Genotype ; Homocysteine/blood ; Humans ; Hypertension/*complications/drug therapy ; Lipids/blood ; Male ; Methylenetetrahydrofolate Reductase (NADPH2)/genetics ; Middle Aged ; Odds Ratio ; Platelet Count ; Polymorphism, Single Nucleotide ; Prothrombin/genetics ; Real-Time Polymerase Chain Reaction ; Republic of Korea ; Risk Factors ; Vascular Diseases/*etiology/genetics ; Venous Thrombosis/*etiology/genetics

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

OBJECTIVETo explore the therapeutic effect of qi benefiting blood activating method (QB-BAM) on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with blood stasis syndrome (BSS) by observing its effect on plasma fibrinogen (Fg) and D-dimer (D-D) levels.

METHODSSixty AECOPD patients with BSS were randomly assigned to the treated group and the control group, 30 in each group. All patients received conventional therapy for AECOPD. Those in the treated group were additionally injected with Shengmai Injection and Tanshinone IIA Injection. Clinical efficacy and indices including levels of Fg, D-D, PaO2, and PaCO2 were measured and compared before and after treatment.

RESULTSThe effective rate was 93.3% (28/30 cases) in the treated group, higher than that of the control group [73.3% (22/30 cases) , P < 0.05]. There was no significant difference in all indices between the treated group and the control group before treatment (P >0.05). After treatment all indices were significantly improved in the two groups (P < 0.01). But in the treated group levels of Fg and D-D decreased more and levels of PaO2 increased more (P < 0.01). Plasma levels of Fg and D-D levels were negatively correlated with PaO2 (r = -0.493, r = -0.438, P < 0.01) before treatment, and also negatively correlated with PaO2 (r = -0.452, r = -0.325, P < 0.01, P < 0.05) after treatment, but they were not significantly correlated with PaCO2 before and after treatment (P >0.05).

CONCLUSIONSQBBAM could play a therapeutic role in improving prethrombotic states of AECOPD patients with BSS. Plasma levels of Fg and D-D were related to the severity of AECOPD.

Acute Disease ; Drugs, Chinese Herbal ; therapeutic use ; Fibrin Fibrinogen Degradation Products ; Fibrinogen ; Hemostatics ; Humans ; Plasma ; Pulmonary Disease, Chronic Obstructive ; drug therapy ; Qi

OBJECTIVETo observe the protection of Qingyuan Shenghua Decoction (QSD) on multiple organs of sepsis patients after bone trauma, and to preliminarily explore its mechanism.

METHODSTotally 60 sepsis patients after bone trauma were randomly assigned to the treatment group and the control group according to random digit table, 30 in each group. All patients received routine Western medical treatment. Patients in the treatment group additionally took QSD or were nasally fed with QSD, one dose per day for 1 week. Changes of WBC, oxygenation index (PaO2/FiO2), serum creatinine (SCr), total bilirubin (TBIL), aspartate aminotransferase (AST), fibrinogen (FIB), D-dimer (DD), activated partial thromboplastin time (APTT), pro-calcitonin (PCT), C-reactive protein (CRP), heart rate (HR), mean arterial pressure (MAP), intra-abdominal pressure, scores for Acute Physiology and Chronic Health Evaluation II (APACHE II), sequential organ failure assessment (SOFA) scores were observed before treatment and on day 1, 3 and 7 after treatment.

RESULTSCompared with the control group at the same time point, MAP increased at post-treatment day 1 and 3; CRP, APTT, HR, SCr, TBIL, AST, intra-abdominal pressure at post-treatment day 3 obviously decreased in the treatment group (P < 0.05, P < 0.01). WBC, SOFA scores, PCT, CRP, APACHE II, APTT, D-D, HR, SCr, TBIL, AST and intra-abdominal pressure significantly decreased; FIB, MAP and PaO2/FiO2 obviously increased at post-treatment day 7 (P < 0.05, P < 0.01).

CONCLUSIONQSD had good protective effect on multiple organ function in sepsis patients after bone trauma, and its mechanism might be related with effectively clearing endotoxin, alleviating inflammatory reactions, and fighting against coagulation dysfunction.

APACHE ; Blood Coagulation ; Bone Diseases ; complications ; C-Reactive Protein ; metabolism ; Calcitonin ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Fibrin Fibrinogen Degradation Products ; metabolism ; Humans ; Inflammation ; Partial Thromboplastin Time ; Protein Precursors ; metabolism ; Sepsis ; drug therapy ; etiology

OBJECTIVETo observe the effect of xuebijing Injection (XI) on perioperative coagulation and inflammatory reaction in senile patients receiving total hip arthroplasty (THA).

METHODSTotally eighty patients receiving THA at Luoyang Orthopedics Hospital, 65 to 85 years old, were randomly assigned to the control group (40 cases) and the treatment group (40 cases). All patients received routine perioperative therapies. Those in the treatment group received XI (adding 50 mL XI in 100 mL normal saline, 30 min each time). XI was continually injected after THA, twice daily for 3 successive days. Blood samples were harvested on the morning of the 2nd admission day (TO), immediately after operation (T1), on the morning of the 3rd day after operation (T3), and on the morning of the 5th day after operation (T4) to detect prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), levels of FIB and D-dimer (D-D), changes of white blood cell (WBC), neutrophils (N), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and IL-6. Complications of surgery were compared between the two groups.

RESULTSThere was no statistical difference in operation time, intraoperative blood loss, and blood transfusion between the two groups (P >0.05). Compared with TO in the same group, WBC, N, CRP, ESR, IL-6, PT, TT, and D-D all increased in the control group at T1-T4 (P < 0.05); APTT increased at T1-T2 (P <0.05); FIB increased at T1-T3 (P <0.05). WBC, N, IL-6, PT, and D-D all increased in the treatment group at T1-T3 (P <0.05); CRP and ESR increased at T1-T4 (P < 0.05); TT increased at T1-T2 (P <0.05); APTT and FIB increased at T1 (P <0.05). Compared with the control group at the same time period, WBC, N, CRP, and IL-6 all decreased in the treatment group at T1-T4 (P <0.05), ESR decreased at T3-T4 (P <0.05); PT and TT decreased at T1-T3 (P <0.05); FIB and D-D decreased at T2-T4 (P<0.05). The occurrence of each complication was significantly lower in the treatment groups than in the control group.

CONCLUSIONXI could improve the perioperative high coagulation state of senile THA patients, inhibit inflammatory reactions, and reduce complications.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; Blood Coagulation ; drug effects ; C-Reactive Protein ; Dementia ; Drugs, Chinese Herbal ; therapeutic use ; Fibrin Fibrinogen Degradation Products ; Humans ; Hydrocarbons, Chlorinated ; Inflammation ; Injections ; Interleukin-6 ; Partial Thromboplastin Time

OBJECTIVE: To observe the changes of plasminogen activator inhibitor-1 and D-dimer during continuous blood purification (CBP) and related factors. METHODS: Sixteen patients who were diagnosed with multiple organ dysfunction syndrome (MODS) were randomly divided into 2 groups: 8 patients received standard continuous blood purification with heparin anticoagulation, and the other 8 received CBP without anticoagulation. Ten normal blood samples were collected from healthy volunteers as controls. All patients underwent CBP for 8 h. Blood was taken from those patients at 0, 15, 60, 120 and 480 min during the CBP. Plasma plasminogen activator inhibitor-1, D-dimer and serum TNF-α and IL-1β were measured by ELISA. RESULTS: Plasma levels of PAI-1 and D-dimer were increased significantly compared with those in the control group (P<0.05). Plasma level of PAI-1 was reduced (P<0.05) and D-dimer was increased (P<0.05) after the CBP. The level of plasma PAI-1 in the heparin group was significant reduced compared with the group of CBP without anticoagulation (P<0.05). There was negative correlation between the level of PAI-1 and the dosage of heparin used during a CBP session in the heparin group (r=-0.746, P<0.001). CONCLUSION The level of PAI-1 and D-dimer is higher in patients with MODS than that in the normal controls. After the CBP treatment, there is significant decrease in PAI-1 and increase in D-dimer in both groups. Heparin used during CBP can reduce PAI-1 which intensifies its function of anticoagulation.
Anticoagulants ; therapeutic use ; Fibrin Fibrinogen Degradation Products ; analysis ; Heparin ; therapeutic use ; Humans ; Interleukin-1beta ; blood ; Plasminogen Activator Inhibitor 1 ; blood ; Renal Dialysis ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo investigate the correlation of baseline plasma D-dimer levels and clinicopathological features and tumor VEGF expression in non-small cell lung cancer(NSCLC) patients, and to evaluate the value of D-dimer in predicting survival time.

METHODSA retrospective review of the clinicopathological data of 290 NSCLC patients confirmed pathologically in Tianjin Cancer Hospital from July 2007 to April 2009 was performed. The correlations between plasma baseline D-dimer levels and clinicopathological characteristics and progonosis were analyzed.

RESULTSFor 290 NSCLC patients with low ( ≤ 0.3 µg/ml) and high (>0.3 µg/ml) D-dimer levels, the median survival times were 54.0 months and 46.2 months, respectively (P < 0.05), and for the patients with stages I, II, IIIA, IIIB and IV NSCLC, the median survival times were 58.1, 40.6, 26.7 and 23.5 months, respectively (P < 0.05). In the operable patients (stages I, II and IIIa) with low and high D-dimer levels, the median progression-free survivals (PFS) were 35.0 and 11.0 months, respectively (P < 0.05). Furthermore, the median PFSs were 57.2 months and 19.6 months, respectively, in these operable patients without and with lymph node metastasis (P < 0.05).

CONCLUSIONSHigh levels of baseline plasma D-dimer may indicate advanced disease stage, larger tumor size, lymph node metastasis and stronger tumor angiongenesis to some extent, and may be useful in prediction of survival time in NSCLC patients of different stages.

Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; blood ; drug therapy ; pathology ; surgery ; Cisplatin ; therapeutic use ; Disease-Free Survival ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Follow-Up Studies ; Humans ; Lung Neoplasms ; blood ; drug therapy ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Paclitaxel ; Pneumonectomy ; methods ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Taxoids ; therapeutic use ; Tumor Burden ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo evaluate the clinical efficacy and safety of sequential treatment with alprostadil and beraprost sodium for chronic renal failure caused by chronic glomerulonephritis.

METHODSSixty-three patients with chronic renal failure due to chronic glomerulonephritis, after receiving a 2-week-long conventional treatment, were randomly divided into alprostadil group (n=20, with alprostadil injection at 10 µg/d for 2 weeks), sequential treatment group (n=21, with alprostadil injection at 10 µg/d for 2 weeks and oral beraprost sodium at 20 µg three times a day for 12 weeks), and strengthened sequential treatment group (n=22, with alprostadil injection at 20 µg/d for 2 weeks and a double dose of oral beraprost sodium for 12 weeks). Urinary albumin excretion rate (UAER), cystatin C (Cys C), blood urea nitrogen, creatinine, fibrinogen, D-dimer, prothrombin time (PT), and platelets were tested before and after the treatment, and the changes in urinary albumin discharge rate, serum creatinine, and glomerular filtration rate were determined.

RESULTSThe patients in strengthened sequential treatment group showed a significantly decreased change rate of urinary albumin discharge rate (P<0.01) than those in the other two groups. In the two sequential treatment groups, especially the strengthened treatment group, the change rate of glomerular filtration rate increased significantly compared with that in alprostadil group (P<0.01). Strengthened sequential treatment resulted also in significantly decreased increment of serum creatinine compared that in the other 2 groups (P<0.01). After 14 weeks of treatment, fibrinogen and D-dimer were decreased in all the 3 groups (P<0.05) to a comparable level between the 3 groups (P>0.05), and prothrombin time (PT) or platelet showed no significant changes (P>0.05).

CONCLUSIONSequential treatment with alprostadil and beraprost sodium can improve the glomerular filtration rate and decrease urine albumin excretion rate, serum creatinine increase rate, and lower blood fibrinogen and D-dimer levels, thus delaying the progression of chronic renal failure caused by chronic glomerulonephritis. This therapy shows a dose-related effect with good clinical safety.

Adolescent ; Adult ; Aged ; Alprostadil ; therapeutic use ; Blood Urea Nitrogen ; Chronic Disease ; Creatinine ; blood ; Drug Therapy, Combination ; Epoprostenol ; analogs & derivatives ; therapeutic use ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Fibrinogen ; metabolism ; Glomerular Filtration Rate ; Glomerulonephritis ; complications ; Humans ; Kidney Failure, Chronic ; blood ; drug therapy ; etiology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors ; therapeutic use ; Platelet Count ; Prothrombin Time ; Urological Agents ; therapeutic use ; Young Adult

Anticoagulants ; therapeutic use ; Blood Coagulation Tests ; Blood Component Transfusion ; methods ; Disseminated Intravascular Coagulation ; blood ; diagnosis ; etiology ; therapy ; Female ; Fibrin Fibrinogen Degradation Products ; analysis ; Fibrinolysis ; Fibrinolytic Agents ; therapeutic use ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Infant, Newborn ; Intensive Care Units, Pediatric ; Male ; Platelet Count ; Predictive Value of Tests ; Sepsis ; complications