Effects of Natural Hirudin and Low Molecular Weight Heparin in Preventing Deep Venous Thrombosis in Aged Patients with Intertrochanteric Fracture

Improvement of Post-Surgery Constipation in Patients with Fractures by Lactobacillus rhamnosus JYLR-127: A Single-Blind Randomized Controlled Trial

The high prevalence of constipation after fracture surgery brings intolerable discomfort to patients on the one hand, and affects post-surgery nutrient absorption on the other hand, resulting in poor prognosis. Given the acknowledged probiotic properties of Lactobacillus rhamnosus, 100 fracture patients with post-surgery constipation were centrally enrolled and administered orally with L. rhamnosus JYLR-127 to assess the efficacy of probiotic-adjuvant therapy in alleviating post-fracture constipation symptoms. The results showed that L. rhamnosus JYLR-127 improved fecal properties, promoted gastrointestinal recovery, and relieved constipation symptoms, which were mainly achieved by elevating Firmicutes (p < 0.01) and descending Bacteroidetes (p < 0.001), hence remodeling the disrupted intestinal microecology. In addition, blood routine presented a decrease in C-reactive protein levels (p < 0.05) and an increase in platelet counts (p < 0.05) after probiotic supplementation, prompting the feasibility of L. rhamnosus JYLR-127 in anti-inflammation, anti-infection and hemorrhagic tendency prevention after fracture surgery. Our study to apply probiotics in ameliorating constipation after fracture surgery is expected to bless the bothered patients, and provide broader application scenarios for L. rhamnosus preparations.

Mechanical thromboprophylaxis for hip fractures in elderly patients: a prospective randomized controlled study

BACKGROUND

Hip fractures, most common in the geriatric age group, can develop proximal deep vein thrombosis (DVT). There is no consensus regarding the ideal method or duration of prophylaxis, particularly in a trauma patient. This study bridges this lacuna in data by making a random comparison between mechanical prophylaxis alone vis-a-vis combined with mechanical and Enoxaparin-based chemoprophylaxis.

MATERIALS AND METHODS

75 Elderly hip trauma patients from January 2019 to October 2020 at a single tertiary care center were randomly allocated into two groups using the sequentially numbered opaque sealed envelope method (SNOSE): one (n=44) receiving Enoxaparin and Mechanical prophylaxis and another (n=31) receiving Mechanical prophylaxis alone. All patients underwent CT (computed tomography) venography to screen for proximal DVT between days 5 to 10 of injury. The primary outcomes were the incidence of proximal DVT and pulmonary embolism (PE), and safety outcomes (wound complications and adverse systemic events) were recorded during the treatment.

RESULTS

No symptomatic or asymptomatic proximal DVT and death incidence was reported in either group. One case of pulmonary embolism was seen in the combined prophylaxis group. There was no significant difference between the groups regarding the above-mentioned parameters mentioned.

CONCLUSIONS

There is no significant difference in the incidence of proximal DVT between mechanical alone and combined chemical-mechanical prophylaxis in elderly patients sustaining hip trauma. The incidence of proximal DVT can be reduced by mechanical prophylaxis alone. It was efficacious and safer than combined mechanical and enoxaparin prophylaxis in preventing venous thromboembolism in elderly hip trauma patients.

Low-molecular-weight heparin reduces the formation of lower limb deep venous thrombosis in patients with hypertensive intracerebral hemorrhage

OBJECTIVE

To demonstrate that low-molecular-weight heparin (LMWH) can reduce the formation of lower limb deep venous thrombosis (DVT) and improve the quality of life (QOL) of patients with hypertensive intracerebral hemorrhage (HICH).

METHODS

Totally, 98 patients with HICH were selected according to different treatment and intervention schemes. Patients receiving routine intracranial pressure reduction and blood pressure regulation intervention were included in group A (n=46) and those receiving LMWH calcium on the basis of treatment in group A were included in group B (n=52). The total effective rate of patients was compared between the two groups, and the prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen degradation product (FDP), D-dimer, and inflammatory factor levels as well as complications and QOL scores before and after treatment were recorded and compared.

RESULTS

The FDP and D-dimer showed an increasing trend in both groups after treatment, with the increase being significantly lower in group B than in group A (P<0.001). Serum tumor necrosis factor-α and interleukin-1β levels increased significantly in the two groups after treatment, with the increase being significantly lower in group B than in group A (P<0.05). Complications of pulmonary embolism, DVT, intracranial hemorrhage, and gastrointestinal hemorrhage were better in group B than in group A (P<0.05). In terms of QOL, physical and mental health, material life, and social functioning were significantly higher in patients of group B than for those in group A (P<0.001).

CONCLUSIONS

The application of LMWH in patients with HICH can reduce the formation of lower limb DVT.

Factors Affecting the Formation and Treatment of Thrombosis by Natural and Synthetic Compounds

Venous thromboembolism (VTE) refers to deep vein thrombosis (DVT), whose consequence may be a pulmonary embolism (PE). Thrombosis is associated with significant morbidity and mortality and is the third most common cardiovascular disease after myocardial infarction and stroke. DVT is associated with the formation of a blood clot in a deep vein in the body. Thrombosis promotes slowed blood flow, hypoxia, cell activation, and the associated release of many active substances involved in blood clot formation. All thrombi which adhere to endothelium consist of fibrin, platelets, and trapped red and white blood cells. In this review, we summarise the impact of various factors affecting haemostatic disorders leading to blood clot formation. The paper discusses the causes of thrombosis, the mechanism of blood clot formation, and factors such as hypoxia, the involvement of endothelial cells (ECs), and the activation of platelets and neutrophils along with the effects of bacteria and reactive oxygen species (ROS). Mechanisms related to the action of anticoagulants affecting coagulation factors including antiplatelet drugs have also been discussed. However, many aspects related to the pathogenesis of thrombosis still need to be clarified. A review of the drugs used to treat and prevent thrombosis and natural anticoagulants that occur in the plant world and are traditionally used in Far Eastern medicine has also been carried out.

Preventive application of low molecular weight heparin ameliorates peripherally inserted central catheter-related venous thrombosis

OBJECTIVE

Peripherally inserted central catheter (PICC) is being increasingly used in critical care settings. However, PICC is associated with various complications, particularly venous thrombosis. Our aim was to observe the effects of preventive application of low molecular weight heparin on venous thrombosis in a PICC model.

METHODS

All rabbits were randomly divided into four groups: a control group, and low/medium/high concentration of low molecular weight heparin groups. All rabbits were injected prophylactically with normal saline or low molecular weight heparin once a day for 7 days. A PICC model was constructed. The pathologic changes of ear vein, anterior vena cava, and venous thrombosis were investigated using hematoxylin and eosin (H&E). Biochemical testing was performed including prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT). Serum D-dimer (D2D) and fibrinogen (FG) levels were detected using Enzyme-linked immunosorbent assay (ELISA).

RESULTS

X-ray results showed that the PICC model was successfully constructed. H&E results showed that preventive application of low molecular weight heparin significantly ameliorated the pathologic damage to ear vein and anterior vena cava in the PICC model. Furthermore, we found that preventive application of low molecular weight heparin inhibited venous thrombosis in the model by H&E stain. Moreover, it significantly reduced serum FG and D2D levels in PICC model. Biochemical testing results showed that PT, APTT, and TT were significantly elevated in the PICC model.

CONCLUSION

Our findings revealed that preventive application of low molecular weight heparin significantly ameliorates venous thrombosis in a PICC model.

Interaction of the synthetic antithrombotic peptide P10 with thrombin: a spectroscopy study

Thrombin is a critical serine protease in the coagulation system and is widely used as a target protein for antithrombotics. Spectroscopic analysis is a simple and effective method that is used to study the interaction between small molecules and proteins. In this study, the interactions of a potential antithrombotic peptide AGFAGDDAPR (P10) with thrombin were investigated by fluorescence spectroscopy, UV-vis spectroscopy, circular dichroism, Fourier-transform infrared spectroscopy and Raman spectroscopy, respectively. The results showed that the peptide P10 bonded to thrombin via hydrogen bonding and van der Waals forces, resulting in fluorescence quenching. And, the secondary structure of thrombin changed, the β-sheet decreased, and the random coil increased. The peptide P10 bonded to proline and lysine, and changed the space structure of thrombin, resulting in inhibition of thrombin activity. The results contributed to exploration of the mechanism of this potential antithrombotic drug interaction with thrombin in order to provide a preliminary understanding of the pharmacodynamic properties of P10.

Supramolecular Aptamers on Graphene Oxide for Efficient Inhibition of Thrombin Activity

Graphene oxide (GO), a two-dimensional material with a high aspect ratio and polar functional groups, can physically adsorb single-strand DNA through different types of interactions, such as hydrogen bonding and π-π stacking, making it an attractive nanocarrier for nucleic acids. In this work, we demonstrate a strategy to target exosites I and II of thrombin simultaneously by using programmed hybrid-aptamers for enhanced anticoagulation efficiency and stability. The targeting ligand is denoted as Supra-TBA_15/29 (supramolecular TBA_15/29), containing TBA₁₅ (a 15-base nucleotide, targeting exosite I of thrombin) and TBA₂₉ (a 29-base nucleotide, targeting exosite II of thrombin), and it is designed to allow consecutive hybridization of TBA₁₅ and TBA₂₉ to form a network of TBAs (i.e., supra-TBA_15/29). The programmed hybrid-aptamers (Supra-TBA_15/29) were self-assembled on GO to further boost anticoagulation activity by inhibiting thrombin activity, and thus suppress the thrombin-induced fibrin formation from fibrinogen. The Supra-TBA_15/29-GO composite was formed mainly through multivalent interaction between poly(adenine) from Supra-TBA_15/29 and GO. We controlled the assembly of Supra-TBA_15/29 on GO by regulating the preparation temperature and the concentration ratio of Supra-TBA_15/29 to GO to optimize the distance between TBA₁₅ and TBA₂₉ units, aptamer density, and aptamer orientation on the GO surfaces. The dose-dependent thrombin clotting time (TCT) delay caused by Supra-TBA_15/29-GO was >10 times longer than that of common anticoagulant drugs including heparin, argatroban, hirudin, and warfarin. Supra-TBA_15/29-GO exhibits high biocompatibility, which has been proved by in vitro cytotoxicity and hemolysis assays. In addition, the thromboelastography of whole-blood coagulation and rat-tail bleeding assays indicate the anticoagulation ability of Supra-TBA_15/29-GO is superior to the most widely used anticoagulant (heparin). Our highly biocompatible Supra-TBA_15/29-GO with strong multivalent interaction with thrombin [dissociation constant (K _d) = 1.9 × 10^-11 M] shows great potential as an effective direct thrombin inhibitor for the treatment of hemostatic disorders.

Comprehensive functional exercises with patient education for the prevention of venous thrombosis after major gynecologic surgery: A randomized controlled study

OBJECTIVE

To explore the functional exercises of deep breathing and lower limb motions for the prevention of venous thrombosis in patients undergoing major surgery for gynecologic malignancy.

METHODS

All eligible patients admitted to the gynecologic oncology unit were randomized into the study and control groups. A comprehensive set of functional exercises was provided to the study group under the instruction and supervision of medical staff. All patients received pre- and postoperative educational material, followed by questionnaires about the patient's perception and satisfaction of the material, and all indicated prophylactic medications were administered.

RESULTS

In total, 132 patients were randomized, and 62 and 53 patients in the study and control groups, respectively, were included in the final analysis. Venous thrombosis, identified by symptoms and/or postoperative ultrasound, was found in 9 (17.0%) and 2 (3.2%) patients in the control and study groups, respectively, which was significantly different (p = 0.012), and most of these instances (9/11, 81.8%) were intramuscular vein thrombosis. The incidence of venous thromboembolism (VTE) was not significantly different (1 [1.9%] versus 1 [1.6%]) between the two groups. In the regression model, functional exercise was the only factor associated with venous thrombosis (odds ratio 0.170, 95% confidence interval 0.035-0.815, p = 0.032) adjusted with diagnosis and surgical parameters. The detailed educational material had improved the perception and satisfaction of patients about the prevention of VTE.

CONCLUSION

In a phase 3, single-center randomized controlled study, a comprehensive set of functional exercises combining deep breathing and lower limb motions would significantly decrease the risk of venous thrombosis in patients undergoing major surgery for gynecologic malignancy, especially the risk of intravascular thrombosis.