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1.
BMC Pregnancy Childbirth ; 23(1): 335, 2023 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-37165315

RESUMO

BACKGROUND: Recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) during in vitro fertilization (IVF) treatment are still tough problems without effective treatments; thus, they are important research topics. There is controversy on whether low molecular weight heparin (LMWH) improves pregnancy outcomes in women with unexplained RPL and RIF. Moreover, currently, there is a paucity of reports on the role of LMWH in the entire population undergoing frozen-thawed embryo transfer (FET) cycles. This study aimed to estimate the effects of LMWH on pregnancy outcomes in women undergoing FET cycles. METHODS: There were 1881 female patients included in the study. Of the 1881 patients, 107 underwent preimplantation genetic diagnosis cycles, which were analyzed individually. The patients were divided into two groups: the LMWH group received injections of 4100 IU/d LMWH from the day of transfer until 14 ± 2 days posttransplant, the control group was the comparison group (without LMWH use). The baseline characteristics and reproductive outcomes of the patients were reviewed. RESULTS: Of the 1774 women with normal FET cycles, no significant differences were found in the number of embryos implanted (1.31 ± 0.02 vs. 1.28 ± 0.02), embryo implantation rate, biochemical pregnancy rate, clinical pregnancy rate, live birth rate, late abortion rate, and ectopic pregnancy rate between the two groups. The LMWH group had a higher early abortion (17.8% [76/427] vs. 12.5% [55/439], p = 0.030). In the sub-group analysis, among the patients who underwent more than four transfers, the LMWH group had a lower late abortion rate (1.7% [1/60] vs. 13.2% [7/53], p = 0.043). Similarly, of the 107 women who underwent preimplantation genetic diagnosis cycles, the reproductive outcomes were comparable between the two groups. CONCLUSION: In the general population and PGD patients, LMWH did not improve pregnancy outcomes. Therefore, the routine use of LMWH is not recommended for early treatment.


Assuntos
Aborto Habitual , Heparina de Baixo Peso Molecular , Gravidez , Humanos , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Estudos Retrospectivos , Transferência Embrionária , Implantação do Embrião , Taxa de Gravidez , Fertilização In Vitro
2.
Clin Appl Thromb Hemost ; 29: 10760296231173965, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37170559

RESUMO

The risk of heparin shortage opens up the possibility of diversifying the sources of heparin by introducing products of other animal/organ origins. In addition to bovine heparin, already used in the past in the United States and Europe, ovine heparin can become another alternative to the widely used pig source. It is therefore appropriate to compare the anticoagulant activity of pig heparin with that of products of different animal origin and to verify whether blended heparin obtained from different sources can give rise to anticoagulant effects comparable to those of heparin of a single origin.


Assuntos
Anticoagulantes , Heparina , Animais , Ovinos , Bovinos , Suínos , Heparina/farmacologia , Heparina/uso terapêutico , Anticoagulantes/farmacologia , Anticoagulantes/uso terapêutico , Europa (Continente) , Heparina de Baixo Peso Molecular
3.
Methods Mol Biol ; 2663: 163-173, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37204709

RESUMO

The prothrombin time (PT) and the activated partial thromboplastin time (aPTT) are two basic tests for routine purposes, which are widely used in the clinical screening of coagulopathies. PT and aPTT are useful tests for detecting both symptomatic (hemorrhagic) and asymptomatic defects, but they are unsuitable for studying hypercoagulable states. However, these tests are available for studying the dynamic process of clot formation by means of the detection of the clot waveform analysis (CWA), which has been introduced several years ago. CWA can provide useful information on both hypocoagulable and hypercoagulable states. Nowadays it is possible to detect the whole clot formation both in the PT and aPTT tubes starting from the initial step of fibrin polymerization by means of specific and dedicated algorithm implemented in a coagulometer. In particular, CWA provides information on the velocity (first derivative), acceleration (second derivative), and density (delta) of clot formation. CWA has been applied to several pathologic conditions such as coagulation factor deficiency (including congenital hemophilia from factor VIII, IX, or XI deficiency), acquired hemophilia, disseminated intravascular coagulation (DIC), sepsis, replacement therapy management, chronic spontaneous urticarial, and liver cirrhosis, in patients with high venous thromboembolic risk before LMWH prophylaxis, and in patients with different hemorrhagic patterns along with an electron microscopy evaluation of the clot density. We report here materials and methods used for detecting the additional clotting parameters available in both PT and aPTT.


Assuntos
Hemofilia A , Trombofilia , Trombose , Humanos , Heparina de Baixo Peso Molecular , Testes de Coagulação Sanguínea/métodos , Tempo de Protrombina , Tempo de Tromboplastina Parcial , Trombose/diagnóstico
4.
Methods Mol Biol ; 2663: 343-353, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37204722

RESUMO

Heparin remains a critical therapy in hospitalized patients requiring anticoagulation. Unfractionated heparin (UFH) mediates its therapeutic effect by binding to antithrombin (AT) and inhibiting thrombin and FXa, as well as other serine proteases. Because of its complex pharmacokinetics, monitoring UFH therapy is required, which is usually achieved with either the activated partial thromboplastin time (APTT) or the anti-factor Xa (anti-Xa) assay. Low molecular weight heparin (LMWH) is fast replacing UFH, as it has a more predictable response, negating the need for routine monitoring in most cases. When required, the anti-Xa assay is used for monitoring of LMWH. The APTT has many notable limitations when used for heparin therapeutic monitoring, including biologic, preanalytical, and analytical issues. With its increasing availability, the anti-Xa assay is appealing as it is less affected by patient factors (e.g., acute-phase reactants, lupus anticoagulants, consumptive coagulopathies), known to interfere with the APTT. The anti-Xa assay has shown additional benefits, such as faster time to achieve therapeutic levels, more consistent therapeutic levels, less dose adjustments, and, overall, less tests performed during therapy. However, poor interlaboratory agreement has been observed among anti-Xa reagents, highlighting that further work needs to be done to standardize this assay for use in patient heparin monitoring.


Assuntos
Heparina de Baixo Peso Molecular , Heparina , Humanos , Heparina/uso terapêutico , Heparina de Baixo Peso Molecular/farmacologia , Inibidores do Fator Xa/farmacologia , Inibidores do Fator Xa/uso terapêutico , Anticoagulantes , Testes de Coagulação Sanguínea , Tempo de Tromboplastina Parcial , Monitoramento de Medicamentos
5.
Rev Lat Am Enfermagem ; 31: e3923, 2023.
Artigo em Espanhol, Inglês, Português | MEDLINE | ID: mdl-37194813

RESUMO

to examine the effect of the medium intensity coughing technique during subcutaneous low molecular weight heparin injection on pain severity and individual satisfaction in general surgery patients. the prospective, quasi-experimental study included 100 patients who had been prescribed a subcutaneous low molecular weight heparin injection once in 24 hours. Each patient received two injections by the same researcher, one using the standard injection technique with medium intensity coughing technique and the other only the standard injection technique. there was a statistically significant difference between patients' mean scores on pain severity and satisfaction levels after injections administered by the two techniques (p= 0.000). Also, it was found that gender affected pain severity relating to the injection but did not affect the level of individual satisfaction. the medium intensity coughing technique was found to reduce pain severity and increase patient satisfaction in general surgery patients receiving subcutaneous low molecular weight heparin injections. Trial registration: NCT05681338.


examinar el efecto de la técnica de tos de mediana intensidad durante la inyección subcutánea de heparina de bajo peso molecular sobre la severidad del dolor y la satisfacción individual en pacientes de cirugía general. estudio prospectivo, cuasi experimental, que incluyó a 100 pacientes a los que se les prescribió una inyección subcutánea de heparina de bajo peso molecular una vez cada 24 horas. Cada paciente recibió dos inyecciones por el mismo investigador utilizando técnica de inyección estándar con técnica de tos de intensidad media y solo técnica de inyección estándar. hubo una diferencia estadísticamente significativa entre las puntuaciones medias de los pacientes sobre la intensidad del dolor y los niveles de satisfacción después de las inyecciones administradas por las dos técnicas (p= 0,000). Además, se encontró que el género afectó la severidad del dolor relacionado con la inyección, pero no afectó el nivel de satisfacción individual. se encontró que la técnica de tos de intensidad media reduce la severidad del dolor y aumenta la satisfacción del paciente de cirugía general que reciben inyecciones subcutáneas de heparina de bajo peso molecular. Registro del ensayo: NCT05681338.


examinar o efeito da técnica de tosse de média intensidade durante injeção subcutânea de heparina de baixo peso molecular na intensidade da dor e satisfação individual em pacientes submetidos à cirurgia geral. estudo prospetivo, quasi experimental que incluiu 100 pacientes que haviam recebido uma injeção subcutânea de heparina de baixo peso molecular em 24 horas. Cada paciente recebeu duas injeções pelo mesmo pesquisador usando a técnica de injeção padrão com técnica de tosse de média intensidade e apenas técnica de injeção padrão. houve diferença estatisticamente significativa entre as pontuações médias dos pacientes quanto à gravidade da dor e níveis de satisfação após as injeções administradas pelas duas técnicas (p = 0,000). Além disso, verificou-se que o sexo do paciente afetou a intensidade da dor relacionada à injeção, mas não afetou o nível de satisfação individual. a técnica de tosse de média intensidade reduz a intensidade da dor e aumenta a satisfação de pacientes submetidos à cirurgia geral recebendo injeções subcutâneas de heparina de baixo peso molecular. Registro do ensaio clínico: NCT05681338.


Assuntos
Contusões , Heparina , Humanos , Anticoagulantes , Heparina de Baixo Peso Molecular , Medição da Dor , Estudos Prospectivos , Fatores de Tempo
6.
Thromb Res ; 226: 117-126, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37146438

RESUMO

INTRODUCTION: Patients with brain cancer are at a high risk of developing venous thromboembolism (VTE) and are underrepresented in clinical trials. This study compared the risk of recurrent VTE (rVTE), major bleeding (MB), and clinically relevant non-major bleeding (CRNMB) among VTE cancer patients initiating apixaban, low molecular weight heparin (LMWH), or warfarin stratified by patients with brain vs other cancer types. MATERIALS AND METHODS: Active cancer patients initiating apixaban, LMWH, or warfarin within 30 days after VTE diagnosis were identified from 4 US commercial and the Medicare databases. Inverse probability of treatment weights (IPTW) was used to balance patient characteristics. Cox proportional hazards models were used to evaluate the interaction between brain cancer status and treatment on outcomes (rVTE, MB, and CRNMB), with a p-value <0.1 indicating a significant interaction. RESULTS: Of 30,586 patients with active cancer (5 % had brain cancer), apixaban (vs. LMWH and warfarin) was associated with lower risk of rVTE, MB, and CRNMB. Generally, no significant interactions (P > 0.1) were found between brain cancer status and anticoagulant treatment across outcomes. The exception was MB for apixaban [vs LMWH (p-value for interaction = 0.091)] with a higher reduction among those with brain cancer (HR = 0.32) than those with (HR = 0.72) other cancer. CONCLUSIONS: Among VTE patients with all types of cancer, apixaban (vs LMWH and warfarin) was associated with a lower risk of rVTE, MB, and CRNMB. In general, anticoagulant treatment effects were not significantly different between VTE patients with brain cancer and those with other cancer.


Assuntos
Neoplasias Encefálicas , Neoplasias , Tromboembolia Venosa , Humanos , Idoso , Estados Unidos , Anticoagulantes/efeitos adversos , Varfarina/efeitos adversos , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico , Heparina de Baixo Peso Molecular/efeitos adversos , Medicare , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Hemorragia/induzido quimicamente , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/tratamento farmacológico
7.
Clin Appl Thromb Hemost ; 29: 10760296231164355, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37131319

RESUMO

A high rate of thromboembolism and a high risk of death have been reported regarding hospitalized patients with coronavirus disease 2019 (COVID-19). Recently, we noticed that clinicians in some comparative studies used direct oral anticoagulants (DOACs) to prevent thromboembolism in patients with COVID-19. However, it is uncertain whether DOACs are better than recommended heparin for hospitalized patients with COVID-19. Therefore, a direct comparison of the prophylactic effects and safety between DOACs and heparin is needed. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from 2019 to December 1, 2022. Randomized controlled trials or retrospective studies comparing the efficacy or safety of DOACs with that of heparin in preventing thromboembolism for hospitalized patients with COVID-19 were included. We assessed endpoints and publication bias using Stata 14.0. Five studies comprising 1360 hospitalized COVID-19 patients with mild to moderate cases were identified in the databases. Comparing the embolism incidence, we found that DOACs had a better effect than heparin, mainly low-molecular-weight heparin (LMWH), in preventing thromboembolism (risk ratio [RR] = 0.63, 95% confidence interval [CI] [0.43-0.91], P = 0.014). Considering safety, DOACs resulted in less bleeding than heparin during hospitalization (RR = 0.52, 95% CI [0.11-2.44], P = 0.411). Similar mortality was discovered in the 2 groups (RR = 0.94, 95% CI [0.59-1.51], P = 0.797). In noncritically hospitalized patients with COVID-19, DOACs are superior to heparin, even LMWH, in preventing thromboembolism. Compared with heparin, DOACs have a lower trend of bleeding and yield a similar mortality rate. Therefore, DOACs may be a better alternative for patients with mild to moderate COVID-19.


Assuntos
COVID-19 , Neoplasias , Tromboembolia Venosa , Humanos , Heparina/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Anticoagulantes/efeitos adversos , Estudos Retrospectivos , Tromboembolia Venosa/etiologia , COVID-19/complicações , Hemorragia/induzido quimicamente , Neoplasias/complicações
8.
G Ital Cardiol (Rome) ; 24(6): 424-431, 2023 Jun.
Artigo em Italiano | MEDLINE | ID: mdl-37227201

RESUMO

Heparin-induced thrombocytopenia (HIT) is a potentially fatal, immune-mediated adverse drug reaction to heparin (both unfractionated and low molecular weight heparin) which is caused by the formation of IgG antibodies against an epitope composed by platelet-derived PF4 and heparin. Binding of IgG to PF4/heparin neoantigen induces platelet activation which may cause venous or arterial thrombosis, associated with thrombocytopenia. HIT diagnosis is based on both pre-test clinical probability evaluation and the detection of platelet activating antibodies. Laboratory diagnosis is based on immunologic and functional assays. When HIT is diagnosed any type of heparin should be stopped immediately and non-heparin alternative anticoagulant must be started in order to halt the pro-thrombotic process. Argatroban and danaparoid are currently the only drugs approved for HIT treatment. Bivalirudin and fondaparinux are also used for the treatment of this rare but severe condition.


Assuntos
Trombocitopenia , Trombose , Humanos , Trombocitopenia/induzido quimicamente , Heparina/efeitos adversos , Anticoagulantes/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Imunoglobulina G/efeitos adversos , Trombose/tratamento farmacológico
9.
Clin Appl Thromb Hemost ; 29: 10760296231178300, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37231620

RESUMO

The aim of this study was to determine which type of prophylaxis was effective for postoperative symptomatic venous thromboembolism (VTE) in patients with gynecological malignancies. A total of 1756 consecutive patients undergoing laparotomy as first-line treatment were included. In Period 1 (2004-2009), low-molecular weight heparin (LMWH) was not available for postoperative VTE prophylaxis, but available in after Period 2 (2009-2013). In Period 3 (2013-2020), patients with pretreatment VTE could switch from LMWH to direct oral anticoagulant (DOAC) as of 2015. Preoperative VTE was screened by measuring D-dimer, followed by venous ultrasound imaging, and computed tomography and/or perfusion lung scintigraphy. Postoperative symptomatic VTE occurred with an incidence of 2.8% by the measures without prophylactic LMWH administration in Period 1. The incidence of postoperative symptomatic VTE was 0.6% in Period 2 and 0.3% in Period 3, being significantly reduced compared with Period 1 (P < .01 and < .0001). The incidences were not significantly different between Periods 2 and 3, but no patient switching to DOAC in Period 3 (n = 79) developed symptomatic VTE. Our preoperative VTE screening and postoperative selective LMWH administration were significantly preventive against postoperative symptomatic VTE.


Assuntos
Neoplasias dos Genitais Femininos , Tromboembolia Venosa , Feminino , Humanos , Heparina de Baixo Peso Molecular , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/epidemiologia , Neoplasias dos Genitais Femininos/cirurgia , Neoplasias dos Genitais Femininos/induzido quimicamente , Neoplasias dos Genitais Femininos/complicações , Anticoagulantes
10.
Am J Nurs ; 123(6): 63, 2023 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-37233144

RESUMO

According to this study: Thromboprophylaxis with aspirin was noninferior to low-molecular-weight heparin for preventing fatal events in patients with orthopedic trauma.The incidence of deep vein thrombosis, pulmonary embolism, and death at 90 days was low in both groups.


Assuntos
Tromboembolia Venosa , Trombose Venosa , Humanos , Heparina de Baixo Peso Molecular/uso terapêutico , Aspirina/efeitos adversos , Anticoagulantes/efeitos adversos , Trombose Venosa/tratamento farmacológico , Trombose Venosa/prevenção & controle , Tromboembolia Venosa/prevenção & controle
11.
Arterioscler Thromb Vasc Biol ; 43(6): 824-831, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37139840

RESUMO

Patients with cancer are at higher risk of developing venous thromboembolism (VTE) compared with the general population. This elevated risk is due to several risk factors and multiple, overlapping thrombotic and hemostatic pathophysiological pathways that are specific to this patient population. Hence, the management of cancer-associated VTE can be challenging for clinicians. Patients with cancer-associated VTE are at higher risk of both recurrent events despite anticoagulation and bleeding complications due to the anticoagulant regimens. Direct oral anticoagulants have recently been shown to be effective, safe, and more convenient than parenteral low-molecular-weight heparin for the management of cancer-associated VTE. Despite these recent advances in anticoagulant therapy, many unmet needs remain in these patients (increased risk of bleeding with specific cancer types, drug-drug interactions, liver dysfunction). Factor XI inhibitors are currently being assessed for the management of cancer-associated VTE and may help clinicians address these important knowledge gaps.


Assuntos
Neoplasias , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Incidência , Anticoagulantes/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia
12.
Clin Appl Thromb Hemost ; 29: 10760296231174001, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37186766

RESUMO

In patients with liver failure complicated by acute kidney injury, renal replacement therapy (RRT) is often required to improve the internal environment. The use of anticoagulants for RRT in patients with liver failure remains controversial. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for studies. The methodological quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies. A meta-analysis was performed using R software (version 3.5.1) and Review Manager (version 5.3.5). During RRT, 348 patients from 9 studies received regional citrate anticoagulation (RCA), and 127 patients from 5 studies received heparin anticoagulation (including heparin and LMWH). Among patients who received RCA, the incidence of citrate accumulation, metabolic acidosis, and metabolic alkalosis were 5.3% (95% confidence interval [CI]: 0%-25.3%), 26.4% (95% CI: 0-76.9), and 1.8% (95% CI: 0-6.8), respectively. The potassium, phosphorus, total bilirubin (TBIL), and creatinine levels were lower, whereas the serum pH, bicarbonate, base excess levels, and total calcium/ionized calcium ratio were higher after treatment than before treatment. Among patients who received heparin anticoagulation, the TBIL levels were lower, whereas the activated partial thromboplastin clotting time and D-dimer levels were higher after treatment than before treatment. The mortality rates in the RCA and heparin anticoagulation groups were 58.9% (95% CI: 39.2-77.3) and 47.4% (95% CI: 31.1-63.7), respectively. No statistical difference in mortality was observed between the 2 groups. For patients with liver failure, the administration of RCA or heparin for anticoagulation during RRT under strict monitoring may be safe and effective.


Assuntos
Heparina , Falência Hepática , Humanos , Heparina/uso terapêutico , Ácido Cítrico/farmacologia , Ácido Cítrico/uso terapêutico , Heparina de Baixo Peso Molecular , Cálcio , Anticoagulantes/uso terapêutico , Citratos/efeitos adversos , Terapia de Substituição Renal , Falência Hepática/induzido quimicamente , Falência Hepática/tratamento farmacológico
19.
J Thromb Thrombolysis ; 55(4): 617-625, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37029256

RESUMO

Venous thromboembolism (VTE) is a common complication in hospitalized patients. Pharmacologic prophylaxis is used in order to reduce the risk of VTE events. The main purpose of this study is to compare the prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients admitted to the intensive care unit (ICU) who received unfractionated heparin (UFH) versus enoxaparin as VTE prophylaxis. Mortality was evaluated as a secondary outcome. This was a Propensity Score Adjusted Analysis. Patients admitted to neurology, surgical, or medical ICUs and screened with venous doppler ultrasonography or computed tomography angiography for detection of VTE were included in the analysis. We identified 2228 patients in the cohort, 1836 (82.4%) patients received UFH and 392 (17.6%) patients received enoxaparin. Propensity score matching yielded a well-balanced cohort of 950 (74% UFH, 26% enoxaparin) patients. After matching, there was no difference in prevalence of DVT (RR 1.05; 95% CI 0.67-1.64, p = 0.85) and PE (RR 0.76; 95% CI, 0.44-1.30, p = 0.31). No significant differences in location and severity of DVT and PE between the two groups were detected. Hospital and intensive care unit stay was similar between the two groups. Unfractionated heparin was associated with a higher rate of mortality, (HR 2.04; 95% CI, 1.13-3.70; p = 0.019). The use of UFH as VTE prophylaxis in ICU patients was associated with a similar prevalence of DVT and PE compared with enoxaparin, and the site and degree of occlusion were similar. However, a higher mortality rate was seen in the UFH group.


Assuntos
Embolia Pulmonar , Tromboembolia Venosa , Humanos , Heparina/efeitos adversos , Enoxaparina/efeitos adversos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Pontuação de Propensão , Anticoagulantes/efeitos adversos , Embolia Pulmonar/tratamento farmacológico , Unidades de Terapia Intensiva , Heparina de Baixo Peso Molecular/uso terapêutico
20.
Discov Med ; 35(175): 104-115, 2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-37105921

RESUMO

BACKGROUND: At present, there is no comprehensive evaluation of the efficacy and safety of low molecular weight heparin (LMWH) for the treatment of thrombophilia during pregnancy in clinical practice. This study aimed to systematically evaluate the efficacy of LMWH in the treatment of patients and its effects on coagulation function, thereby providing a reference for the clinical treatment and prognosis evaluation of thrombophilia during pregnancy. METHODS: Database PubMed, Web of Science and Embase as well as China National Knowledge Infrastructure and Wanfang Database were applied for the search of data. A comparative study on the efficacy of LMWH in the treatment of gestational thrombophilia was enrolled. Stata 16.0 software (Stata, College Station, TX, USA) was utilized to conduct the meta-analysis. RESULTS: A total of 487 relevant articles were retrieved and 14 studies were finally included. Patients in the LMWH combined with the low-dose aspirin group had a significantly higher live birth rate than those in the aspirin or LMWH treat group (OR (odds ratio) = 4.54, 95% CI (confidence interval): 2.76, 7.45). The adverse effects rate was lower in the LMWH combined with the low-dose aspirin group than in the aspirin or LMWH treatment group (OR = 0.40, 95% CI: 0.29, 0.56). After treatment, patients in the LMWH combined with the low-dose aspirin group had significantly lower D-dimer (SMD (standardized mean differences) = -1.50, 95% CI: -2.19, 0.80) and platelet count (PLT; SMD = -0.13, 95% CI: -0.35, 0.09) than those in the aspirin or LMWH treatment group. However, activated partial thromboplastin time (APTT; SMD = 0.16, 95% CI: -0.10, 0.42), thrombin time (TT; SMD = 0.60, 95% CI: -0.14, 1.34), plasma prothrombin time (PT; SMD = 0.42, 95% CI: -0.71, 1.56), and fibrin values (FIB; SMD = -0.92, 95% CI: -2.12, 0.28) were significantly higher in the LMWH combined with low-dose aspirin group than those in the aspirin or LMWH treatment group. CONCLUSIONS: LMWH heparin combined with low-dose aspirin can effectively correct coagulation function in pregnant women, improve prothrombotic state and increase the live birth rate, which has high clinical value.


Assuntos
Trombofilia , Trombose , Humanos , Feminino , Gravidez , Heparina de Baixo Peso Molecular/uso terapêutico , Aspirina/uso terapêutico , Anticoagulantes/uso terapêutico , Trombofilia/induzido quimicamente , Trombofilia/tratamento farmacológico , Trombose/tratamento farmacológico , Trombose/induzido quimicamente
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