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Objective To analyze the predictive efficacy of serum growth differentiation factor 15 (GDF-15) in combination with the bleeding score on bleeding after percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). Methods Totally 225 CAD patients were divided into the bleeding group (31 patients) and non-bleeding group (194 patients) according to whether they bled after PCI treatment, and the serum GDF-15 levels and bleeding scores (HAS-BLED bleeding score and CRUSADE bleeding score) of the two groups were compared. Multi-factor Logistic regression analysis was used to analyze the influencing factors and risk factors for bleeding after PCI treatment in CAD patients. Receiver operating characteristic (ROC) curves were plotted to examine the predictive efficacy of serum GDF-15, HAS-BLED bleeding score, and CRUSADE bleeding score alone and in combination on bleeding after PCI treatment in CAD patients. Results Significant differences were found in the proportion of women, serum GDF-15 levels, HASBBLED bleeding score, and CRUSADE bleeding score between the bleeding and non-bleeding groups (all P<0. 05). Multifactorial Logistic regression analysis showed that serum GDF-15 level [OR (95%CI) =13. 408 (3. 130 to 57. 442), P= 0. 000], HAS-BLED bleeding score [OR (95%CI) =2. 394 (1. 313 to 4. 364), P=0. 004], and CRUSADE bleeding score [OR (95%CI) =1. 065 (1. 010 to 1. 123), P=0. 019)] were associated with bleeding events. When the critical value of serum GDF-15 was 2 467. 61 pg/mL, its predictive sensitivity for bleeding after PCI treatment in CAD patients was 51. 6%, specificity was 86. 1%, and area under ROC was 0. 720 (95%CI: 0. 623 to 0. 817, P<0. 05); when the critical value of HAS-BLED bleeding score was 2, its predictive sensitivity for bleeding after PCI treatment in patients was 74. 2%, specificity was 68. 8%, and area under ROC was 0. 730, (95%CI: 0. 635 to 0. 825, P<0. 05); when the critical value of CRUSADE bleeding score was 30, its predictive sensitivity for bleeding events was 77. 4%, specificity was 55. 2%, and area under ROC was 0. 689 (95%CI: 0. 596 to 0. 781, P<0. 05); the predictive sensitivity of serum GDF-15 combined with HAS-BLED bleeding score for bleeding after PCI treatment in CAD patients was 74. 2%, specificity was 78. 9%, and area under ROC was 0. 794 (95%CI: 0. 711 to 0. 876); serum GDF-15 combined with CRUSADE bleeding score had a predictive sensitivity of 87. 1%, specificity of 61. 3%, and area under ROC of 0. 788, 95%CI of 0. 711 to 0. 865 for bleeding after PCI treatment in patients with CAD; significant difference was found in the bleeding between the GDF-15 and GDF-15 combined with HAS-BLED bleeding score (P<0. 05). Conclusion Serum GDF-15, HAS-BLED bleeding score, and CRUSADE bleeding score were all effective predictors of bleeding risk after PCI in patients with CAD. The combined predictive efficacy of the two indicators was higher than that of the single indicator. [ABSTRACT FROM AUTHOR]

To explore the risk factors of hemorrhage induced by argatroban in patients with progressive cerebral infarction and to establish a risk prediction model. Methods Totally 216 inpatients treated with argatroban due to progressive cerebral infarction were divided into the bleeding group and non-bleeding group according to whether hemor⁃ rhage occurred or not. Univariate analysis was used to identify risk factors for bleeding，and then we established a risk pre⁃ diction model of bleeding by multivariate Logistic regression analysis. Results Among 216 patients，bleeding occurred in 39 cases（18. 06%）after treatment，including massive bleeding（10. 3%）and minor bleeding（89. 7%）. The results of multivariate Logistic regression analysis demonstrated that BMI，whether the anticoagulants were used within 48 h，wheth⁃ er cerebrovascular intervention therapy was received，and the admission blood glucose were independent influence factors for bleeding after argatroban treatment. Further，the combined predictor Y was obtained（Y=-0. 206-2. 042XBMI（1）- 2. 459XBMI（2）-1. 677XBMI（3） + 2. 775X whether anticoagulants were used-2. 673X whether cerebrovascular intervention therapy was received + 0. 102X admission glucose），and the area under the receiver operating characteristic（ROC）curve（AUC）was 0. 738. Conclusions The progressive cere⁃ bral infarction patients with low BMI，high blood glucose at admission，combined use of anticoagulants，and no cerebral vascular intervention have a higher bleeding probability after applying argatroban. The model constructed in this study has a good predictive ability，which can effectively identify the patients at high risk of bleeding induced by argatroban treat⁃ ment from patients with progressive cerebral infarction [ABSTRACT FROM AUTHOR]

Objective To observe the application effect of " full management mode " in anticoagulantion therapy for patients after cardiac valve replacement. Methods Totally 208 patients after cardiac valve replacement were selected as the observation group，and then the " full management mode " covering "outpatient clinic + community" was adopted in the anticoagulation management by multidisciplinary collaboration "one-stop" anticoagulation clinic combined with informa‑ tion follow-up platform. In addition，208 patients after cardiac valve replacement，followed up in the general outpatient de‑ partment，were selected as the control group. During the follow-up period，modified Morisky score was applied to evalu‑ ate medication compliance of warfarin in the two groups，while the results and detection times of prothrombin time and in‑ ternational normalized ratio（INR）were compared. Time in therapeutic range（FTTR）was used to evaluate the anticoag‑ ulation therapy in the two groups and the anticoagulation related complications were observed. Results Morisky scores of patients in the observation group and control group were 6. 75（1. 50）and 5. 50（2. 00）points，INR test numbers were 9. 00（12. 75）and 5. 00（10. 00），INR test results were 1. 96（0. 65）and 1. 91（0. 76），and FTTR were 49. 64% and 41. 05%，respectively，with statistically significant differences between these two groups（all P< 0. 05）. There were 19 cases of anticoagulation related complications in the observation group and 27 cases in the control group. Conclusion "Full management mode "，which can improve INR detection frequency and warfarin medication compliance of patients af‑ ter cardiac valve replacements，has good effect on anticoagulation management and improves anticoagulation quality of pa‑ tients. [ABSTRACT FROM AUTHOR]

目的观察单节段腰椎后路椎间融合术 (PLIF)患者围术期静脉滴注联合局部灌洗氨甲环酸 (TXA)的止 血效果。方法接受单节段PLIF手术治疗的患者105例，根据TXA应用方式不同分为静脉组、静脉联合局部用药 组、对照组，每组35例。静脉联合局部组患者在切皮前30 min首次静脉滴注TXA，手术结束缝合切口前使用TXA+ 0. 9%氯化钠溶液进行创口灌洗，手术结束后6 h再次静脉滴注TXA。静脉组患者在缝合切口前使用0. 9%氯化钠 溶液进行创口灌洗，其余处理与静脉联合局部组相同。对照组患者在切皮前30 min和术后6 h静脉滴注等量0. 9% 氯化钠溶液，手术结束缝合切口前使用0. 9%氯化钠溶液进行创口灌洗。观察三组患者总失血量、显性失血量、隐 性失血量、术后血红蛋白 (Hb)、术后红细胞压积 (Hct)等围术期失血指标。术后1周进行双下肢血管彩超检查，观察 患者术后1周下肢静脉血栓发生情况。结果与对照组相比，静脉组总失血量、术后引流量均降低 (P 均<0. 05)，术 后Hb升高 (P 均<0. 05)；静脉联合局部组总失血量、隐性失血量、显性失血量、术后引流量均降低 (P 均<0. 05)，术后 Hb、术后Hct均升高 (P 均<0. 05)。与静脉组相比，静脉联合局部组术后引流量降低 (P<0. 05)，术后Hct升高 (P< 0. 05)。静脉联合局部组发生下肢静脉血栓1例，静脉组发生下肢静脉血栓1例，对照组发生下肢静脉血栓0例，三 组相比，P>0. 05。结论与单纯静脉应用和不应用TXA相比，在单节段PLIF术中静脉滴注联合局部灌洗TXA止血 效果更好，且不增加血栓发生风险。 [ABSTRACT FROM AUTHOR]

目的 对比观察髂内动脉预置球囊、双侧子宫动脉栓塞对凶险性前置胎盘(PPP)患者剖宫产术中出血的预防效果.方法 将54例PPP患者随机分为A、B组,各27例.A组先在髂内动脉预置球囊然后再行剖宫产术,术中用生理盐水充盈球囊阻断血流.B组先栓塞双侧子宫动脉然后行剖宫产术.采用容积法、称重法和血色素法综合计算两组患者术中出血量、产后24 h出血量.产后24 h出血量>500 mL为发生产后出血.记录两组子宫切除、新生儿窒息、产褥病发生情况.剖宫产术后随访2~6个月,随访患者术后并发症发生情况,包括发热、绝经、动脉血栓、疼痛、供血不足、下肢肿胀等.结果 A组患者术中出血量、术中输血量、24h出血量分别为(2187.50±300.50)、(1500.10±250.30)、(2380.40±110.30)mL,B组分别为(2320.30±320.10)、(1600.05±280.00)、(2410.40±100.66)mL,两组术中出血量、产后24 h出血量、术中输血量相比差异无统计学意义.A组发生产后出血3例(11.11%),B组发生产后出血5例(18.51%),两组产后出血发生率相比,P>0.05.两组子宫切除、新生儿窒息、产褥病发生率差异无统计学意义.A组4例(14.81%)发生术后并发症,包括发热1例、疼痛2例、供血不足1例;B组11例(40.74%)发生术后并发症,包括发热6例、疼痛3例、供血不足2例.两组术后并发症发生率相比,P<0.05.结论 髂内动脉预置球囊、双侧子宫动脉栓塞对PPP患者剖宫产术中出血的预防效果相当.与双侧子宫动脉栓塞相比,髂内动脉预置球囊术后并发症较少. [ABSTRACT FROM AUTHOR]

目的系统评价全膝关节置换术(TKA)和全髋关节置换术(THA)后应用FXa抑制剂(FXaI)与低分子肝素(LMWH)抗凝治疗导致出血的风险。方法计算机检索PubMed、Web of Science、Obvid、Elsevier、the Cochrane Library中关于TKA和THA后应用FXa I与LMWH抗凝治疗导致出血的随机对照研究(分别为FXa I组、LMWH组),检索时限2004年1月~2014年6月。采用Review Manager5.2软件对出血风险进行Meta分析。结果共纳入10篇研究,FXa I组12 311例,LMWH组12 486例。FXaI组与LMWH组大出血发生率分别为0.58%、0.58%;临床相关性非大出血发生率分别为3.08%、3.04%;小出血发生率分别为4.68%、5.06%;总出血发生率分别为7.87%、8.08%;两组比较P均>0.05。结论 TKA和THA后应用FXaI与LMWH抗凝治疗均可导致出血发生,但其出血风险比较并无明显统计学差异。 [ABSTRACT FROM AUTHOR]

目的探讨关节腔注人氨甲环酸与肾上腺素混合液对全膝关节置换术（TKA)后患者出血及凝血功能的影响。方法选择初次行单侧TKA患者64例，随机分为观察组和对照组，每组32例。两组常规进行TKA,术后留置引流管。观察组通过引流管向关节腔内注人含3.0g氨甲环酸、0.25mg肾上腺素的生理盐水50mL，对照组通过引流管向关节腔内注人含3.0g氨甲环酸的生理盐水50mL，两组均夹闭引流管2h。观察两组出血量（包括术中出血量、隐形出血量及总出血量）、术后引流量；两组术前及术后24h采用全自动生化分析仪检测血红蛋白(Hb)、红细胞压积（PCV)、凝血酶原时间（PT)、活化的部分凝血活酶时间（APTT)。结果两组术中出血量比较无统计学差异（P>0.05);观察组隐性出血量、总出血量及术后引流量均低于对照组（P<0.03或<0.0〗）。与术前比较，两组术后24hHb、PCV均降低，观察组术后24hPT升高（P均<0.05);对照组术后24hPT、APTT均较术前无明显变化(P均>0.05)。术后24h，观察组Hb、PCV均高于对照组（P均<0.01)，两组PT、APTT比较差异均无统计学意义(P均>0.05)。结论关节腔内局部注人氨甲环酸与肾上腺素混合液可减少TKA患者术后出血，且对其凝血功f旨影响较小。 [ABSTRACT FROM AUTHOR]