磺达肝癸钠与低分子量肝素治疗创伤性感染继发高凝状态的比较

Comparison of fondaparinux sodium and low molecular weight heparin in the treatment of hypercoagulability secondary to traumatic infection.

作者信息

Li Baiqiang, Wang Kang, Zhao Xin, Lin Chao, Sun Haichen

机构信息

Department of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China.

出版信息

Chin J Traumatol. 2015;18(3):147-9.

PMID:26643240

Abstract

PURPOSE

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

METHODS

Thirty-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.

RESULTS

The 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).

CONCLUSION

Fondaparinux 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.

摘要

目的

比较磺达肝癸钠与低分子量肝素对创伤感染伴高凝状态患者的疗效及副作用。

方法

选取2012年2月至2013年2月在我院重症监护中心确诊为创伤后感染伴高凝状态的36例患者，随机分为2组。F组（18例）患者接受磺达肝癸钠治疗，2.5mg，每日1次，共11天。L组（18例）患者接受低分子量肝素治疗，4100U，每12小时1次，共11天。分析两组抗凝治疗后深静脉血栓形成、出血事件及多器官功能障碍综合征（MODS）的发生率和死亡率。采用凝血分析仪检测纤维蛋白原、D - 二聚体水平及抗凝血酶III活性。

结果

两组深静脉血栓形成发生率、MODS发生率及死亡率差异无统计学意义。F组出血事件发生率低于L组（p < 0.05）。抗凝治疗后抗凝血酶III呈上升趋势，其中F组在第5天和第11天高于L组（p < 0.05）。纤维蛋白原水平逐渐升高，两组间差异无统计学意义（p > 0.05）。抗凝治疗5天后D - 二聚体显著降低（p < 0.01），第5天和第7天两组间差异有统计学意义（p < 0.05）。第11天差异无统计学意义（p > 0.05）。