Holm H A, Abildgaard U, Kalvenes S
Thromb Haemost. 1985 Apr 22;53(2):278-81.
Bleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.
280例接受持续肝素输注治疗深静脉血栓形成（DVT）的患者中，有30例（11%）出现出血并发症。22例（8%）为轻度出血，8例（3%）为严重出血并发症（1例胸腔内出血[致死]、2例胃肠道出血和5例腹膜后出血）。通过四种检测方法（发色底物[CS]检测、活化部分凝血活酶时间[APTT]、枸橼酸盐血浆凝血酶时间[CiTT]和复钙血浆凝血酶时间[CaTT]）测定每日采集血样中的肝素活性。轻度出血患者与无出血患者之间，任何检测方法的肝素活性中位数差异均无统计学意义。在严重出血患者中，CS检测（p = 0.011）和CaTT检测（p = 0.030）的差异具有统计学意义。所有四种检测方法均显示，腹膜后出血患者的肝素活性中位数显著升高：CS检测（p = 0.002）、CaTT检测（p = 0.003）、APTT检测（p = 0.010）、CiTT检测（p = 0.029）。肝素治疗四天后差异最为明显，但与无出血患者有相当程度的重叠。
