In order to enhance the anticoagulant properties of decellularized biological materials as scaffolds for tissue engineering research via heparinized process, the decellularized porcine liver scaffolds were respectively immobilized with heparin through layer-by-layer self-assembly technique (LBL), multi-point attachment (MPA) or end-point attachment (EPA). The effects of heparinization and anticoagulant ability were tested. The results showed that the three different scaffolds had different contents of heparin. All the three kinds of heparinized scaffolds gained better performance of anticoagulant than that of the control scaffold. The thrombin time (TT), prothrombin time (PT) and activated partial thromboplastin time (APTT) of EPA scaffold group were longest in all the groups, and all the three times exceeded the measurement limit of the instrument. In addition, EPA scaffolds group showed the shortest prepared time, the slowest speed for heparin release and the longest recalcification time among all the groups. The decellularized biological materials for tissue engineering acquire the best effect of anticoagulant ability in vitro via EPA heparinized technique.
ObjectiveTo summarize the pathogenesis, epidemiology, and risk factors of portal vein thrombosis after splenectomy, and combined with the latest advances in clinical prevention, diagnosis, and treatment of portal vein thrombosis after splenectomy, so as to provide some references for clinical prevention and treatment in the future.MethodLiteratures on portal vein thrombosis after splenectomy were collected and reviewed.ResultsThe incidence of portal vein thrombosis after splenectomy was high and its occurrence was the result of multiple factors. It was mainly related to the change of splenic venous blood flow mechanics after splenectomy. In terms of diagnosis, enhanced CT scan was the first choice. Currently, there was no consensus on treatment options, which mainly focused on individualized treatment and emphasized that preventive anticoagulant use of low-molecular-weight heparin may reduce the risk of portal vein thrombosis.ConclusionThe concept of tertiary prevention of portal vein thrombosis after splenectomy should be established, and individualized treatment should be adopted in combination with the patient’s condition.
The patients with mechanical prosthetic valve replacement need anticoagulant therapy for all their life. The incidence of thromboembolism and anticoagulation-related bleeding events still account for major postoperative complications after mechanical heart valve replacement. Most of the complications happen in the first half year after operation. Therefore, early anticoagulation therapy is very important. Of course, so far most guidelines focus stating their opinions on long-term anticoagulant therapy. However, there is no consensus about anticoagulant therapy in the early period of postoperation. In this review, we summarize early anticoagulant therapy of the patients with mechanical heart valve replacement through consulting domestic and abroad relevant research in recent years and give an overview of the present situations of early anticoagulant therapy.
Safe and effective anticoagulation is the key to successful blood purification. Compared with traditional systemic anticoagulation, regional citrate anticoagulation (RCA) has the advantages of prolonging the life of extracorporeal circulation and reducing bleeding complications. However, the complex protocol, the disorder of electrolyte and acid-base status and the accumulation risk in special populations have dissuaded many clinicians. This review starts with the clinical monitoring of RCA, then analyzes the causes and treatments of complications. The risk assessments in special populations were also introduced in order to the widely promotion of RCA in critically ill patients.
Objective To investigate the effects and feasibility of regional citrate anticoagulation continuous venous-venous hemodialysis(RCA-CVVHD) in acute hepatic & kidney injury after cardiovascular surgery. Methods Ten patients with acute kidney injury combined with acute hepatic injury after cardiovascular surgery were involved in this study. There were 5 males and 5 females at age of 35-69(58.2±12.7) years. All of them were treated by RCA-CVVHD. Blood samples were collected before treatment, 12 h, 24 h, 48 h, and 72 h after treatment. Results There was no statistical difference between post- and pre-treatment regarding with pH value (7.47±0.12 vs. 7.50±0.06 vs. 7.48±0.04 vs. 7.48±0.03 vs. 7.45±0.05, P>0.05) or BE value (0.91±9.97 mmol/L vs. 2.36±3.92 mmol/L vs. –0.22±3.09 mmol/L vs. 1.87±3.58 mmol/L vs. –1.05±1.12 mmol/L, P>0.05). There was a statistical difference in iCa (1.09±0.09 mmol/L vs. 1.15±0.08 mmol/L vs. 1.17±0.08 mmol/L vs. 1.24±0.09 mmol/L vs. 1.16±0.06 mmol/L), Na+ (149.44±6.84 mmol/L vs. 144.33±3.35 mmol/L vs. 143.13±3.52 mmol/L vs.141.25±5.52 mmol/L vs. 136.71±4.92 mmol/L), and tCa/iCa (2.07±0.11 vs. 2.10±1.12 vs. 2.17±0.69 vs. 2.23±1.05 vs. 2.30±0.11), respectively. Conclusion RCA-CVVHD used in patients with acute hepatic impairment is safe and feasible.
Objective To investigate the effects of normal saline flushing and its frequency on extracorporeal circuit lifespan and solute removal in continuous renal replacement therapy (CRRT) without anticoagulation. Methods Patients undergoing continuous veno-venous hemodiafiltration (CVVHDF) without anticoagulation between June and September 2021 were prospectively collected. The patients were randomly divided into three groups by envelope method, namely 30 min-flushing group (flushing every 30 minutes for extracorporeal circulation), 2 h-flushing group (flushing every 2 hours for extracorporeal circulation), and non-flushing group (no flushing for extracorporeal circulation during treatment). All patients were treated with Prismaflex V8.0 CRRT machine and matched AN69ST-ST150 extracorporeal circuit, through either femoral or internal jugular venous double-lumen catheter. CVVHDF was adopted, the blood pump rate was 200 mL/min, and the rates of replacement fluid and dialysate were both 1 000 mL/h. The replacement fluid was pre-post dilution. Extracorporeal circuit lifespan, treatment time delayed by flushing, overall treatment time of CRRT, actual treatment time of CRRT, proportion of actual treatment time achieved, delayed daily treatment time, and small molecule solute removal efficiency before and after treatment were recorded. Results A total of 83 patients were included, including 24 in the 30 min-flushing group, 30 in the 2 h-flushing group, and 29 in the non-flushing group. There were significant differences in the indexes of extracorporeal circuit lifespan and various treatment time indicators among the three groups (P<0.05). Compared with the 2 h-flushing group and the non-flushing group, the 30 min-flushing group significantly shortened the extracorporeal circuit lifespan, delayed more treatment time by flushing, and delayed the longest daily treatment time (P<0.05). The proportion of actual treatment time in the non-flushing group was significantly higher than that in the 30 min-flushing group and the 2 h-flushing group (P<0.05), and in the 2 h-flushing group was also higher than that in the 30 min-flushing group (P<0.05). There was no significant difference in the blood urea nitrogen clearance rate among the three groups (P=0.570), but the serum creatinine clearance rate was significantly different among the three groups (P=0.020). Compared with the 30 min-flushing group, the 2 h-flushing group had a higher serum creatinine clearance rate, and there was statistical significance (P<0.05). Twenty-five patients had hypotension during treatment. The frequency of 30 min-flushing caused a higher risk of coagulation during cardiopulmonary bypass (hazard ratio=2.502, P=0.001). Conclusion For CVVHDF without anticoagulation, longer extracorporeal circuit lifespan and longer effective treatment time can be achieved without using normal saline flush.
Objective To investigate the effectiveness and safety of low molecular weight heparin combined with aspirin for perioperative prophylactic anticoagulation in patients with lower extremity fracture after splenectomy. MethodsThe clinical data of 50 patients with splenic rupture combined with lower extremity fracture between January 2009 and June 2022 were retrospectively analyzed. All patients were given enoxaparin sodium at 48 hours after splenectomy, and stopped at 24 hours before fracture surgery. After fracture surgery, the patients were divided into aspirin group (group A, 15 cases), low molecular weight heparin group (group B, 16 cases), and low molecular weight heparin combined with aspirin group (group C, 19 cases) according to different anticoagulation regimens. The treatment course was 28 days. There was no significant difference in gender, age, body mass index, cause of injury, fracture site, time from injury to operation, complications, and other general data between groups (P>0.05). The occurrence of venous thromboembolism (VTE) was observed; hemoglobin (Hb), platelet (PLT), D-D dimer, and fibrinogen degradation product (FDP) were recorded before operation and at 1, 3, and 7 days after operation, and the effect of anticoagulation regimen on coagulation function was observed. The incidences of wound complications and bleeding related complications were recorded, and the total perioperative blood loss, hidden blood loss, and overt blood loss were calculated. Results The incidences of VTE in groups A, B, and C were 13.33% (2/15), 12.50% (2/16), and 5.26% (1/19), respectively, and there was no significant difference between groups (χ2=0.770, P=0.680). There was no portal vein thrombosis and no VTE-related death in the 3 groups. There was no significant difference in the levels of Hb, PLT, D-D dimer, and FDP between groups before and after operation (P>0.05); and there was no significant difference in total perioperative blood loss, hidden blood loss, and overt blood loss between groups (P>0.05). No local skin necrosis was found in all patients. In group A, 1 case occurred redness and swelling of incision; in group B, 1 case had incision discharge, redness, and swelling, and 1 case had fat liquefaction; in group C, 1 case had repeated incision exudation accompanied by local tissue redness and swelling, and 1 case had local hematoma. The incidences of adverse incision in groups A, B, and C were 6.66% (1/15), 12.50% (2/16), and 11.76% (2/19), respectively, with no significant difference (χ2=0.302, P=0.860). There were 4 cases of bleeding related complications, including 1 case of incision ecchymosis in groups A and B respectively, with the incidence of 6.66% and 6.25%, respectively; there was 1 case of incision hematoma and 1 case of bleeding in group C, with the incidence of 11.76%; showing no significant difference in the incidence of bleeding related complications between groups (χ2=0.268, P=0.875). Conclusion Perioperative combined use of low molecular weight heparin and aspirin for prevention of anticoagulation in patients with splenic rupture and lower extremity fracture can effectively prevent the occurrence of VTE without increasing the incidence of complications, which is an effective and safe treatment method. However, whether the incidence of VTE can be reduced needs to be further studied by expanding the sample size.
Objective To explore the application of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) for patients with sepsis and hyperlactacidemia, and to provide a basis for the clinical application of RCA in such patients. Methods Sepsis patients who underwent RCA-CRRT at West China Hospital of Sichuan University between May 2021 and May 2023 were retrospectively included. Patients were divided into a normal lactate group (≤2.0 mmol/L) and a hyperlactacidemia group (>2.0 mmol/L) based on their initial lactate levels before CRRT, and subgroup analysis was performed on patients with moderate hyperlactacidemia (2 mmol/L<lactate level<4 mmol/L) and severe hyperlactacidemia (≥4.0 mmol/L). Propensity score matching (PSM) was used, and baseline characteristics and outcome measures of different groups of patients were compared. Results A total of 441 patients were included, with 228 in the normal lactate group and 213 in the hyperlactacidemia group. Before PSM, there were statistically significant differences in the proportion of liver failure, proportion of chronic kidney disease, mean arterial pressure, bicarbonate, total bilirubin, creatinine, activated partial thromboplastin time, international standardized ratio, procalcitonin, and interleukin-6 between the normal lactate group and the hyperlactacidemia group (P<0.05). After PSM, there were 162 patients in both the normal lactate group and the hyperlactacidemia group. There was no statistically significant difference in baseline characteristics between the two groups of patients (P>0.05). The incidence of citric acid accumulation in the normal lactate group and the hyperlactacidemia group was 13.0% and 25.9%, respectively (P<0.05). There was no statistically significant difference in the incidence of metabolic acidosis, metabolic alkalosis, hypernatremia, filter coagulation events, or in-hospital mortality between the two groups (P>0.05). Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan between the normal lactate group and the hyperlactacidemia group (P>0.05). Among 213 patients with hyperlactacidemia, 186 had moderate hyperlactacidemia and 27 had severe hyperlactacidemia. Before PSM, there were statistically significant differences in the proportion of male, proportion of diabetes, albumin level, international standardized ratio, and interleukin-6 between moderate and severe hyperlactacidemia groups (P<0.05). After PSM, there were 22 patients in both the moderate and severe hyperlactacidemia groups. There was no statistically significant difference in baseline characteristics between the two groups of patients (P>0.05). The incidence of citric acid accumulation was 18.2% and 50.0% in the moderate and severe hyperlactacidemia groups, respectively (P<0.05). There was no statistically significant difference in the incidence of metabolic acidosis, metabolic alkalosis, hypernatremia, filter coagulation events, or in-hospital mortality between the two groups (P>0.05). Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan between the moderate and severe hyperlactacidemia groups (P>0.05). Conclusion When RCA is used for CRRT anticoagulation in patients with sepsis and hyperlactacidemia, the incidence of citric acid accumulation is high (especially in patients with severe hyperlactacidemia), and should be closely monitored.
Objective To investigate the role of clinical pharmacists in warfarin therapy. Methods A total of 134 patients underwent prosthetic heart valve replacement and had warfarin for life from March 2013 to October 2013 in Fujian Medical University Union Hospital. All patients were equally divided into two groups (an intervention and a non-intervention group) crosswise by sequence. There were 67 patients in each group. The anticoagulant effects of the two groups were compared. Results There was no statistical difference in the patients' demographic information between the two groups. However, the time for the patients to reach the target international normalized ratio(INR) values for the first time (7.1±3.3 dvs. 10.5±5.0 d,P=0.000) and time of INR in the therapy range (46.3%±18.8%vs.19.0%±16.2%,P=0.000) during their hospitalization, proportion of time of under anticoagulation (47.5%±19.5%vs. 71.2%±22.9%,P=0.000), proportion of time of anticoagulation overdose (5.3%±8.2%vs. 9.9%±16.7%,P=0.002) were significantly different. While there was no statistical difference in postoperative hospitalization time between the two groups (19.9±6.6 dvs. 18.1±7.0 d,P=0.137). There were 4 patients (6.0%) with minor hemorrhage and no severe complication was found in the intervention group. There were seven patients (10.4%) with mild hemorrhage, two patients with stroke, one patient with mild pulmonary embolism, and severe complication rate of 4.5% in the non-intervention group. Conclusion With clinical pharmacists involved in the whole anticoagulation therapy progress of patients after mechanical heart valve replacement, the time to achieve the therapeutic window for the first time is effectively shorten, and the time of the INR value controlled in therapeutic range is highly improved during hospitalization time. Moreover, the patients' risk of thrombosis and bleeding is eventually reduced.
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.