The most common adverse reactions of heparin
Excessive use of heparin can easily lead to spontaneous bleeding. Once it happens, stop heparin and inject protamine with positive charge. Every 1mg protamine can neutralize 100U heparin. Platelet deficiency can occur in some patients within 2 ~ 14 days after heparin application, which is related to platelet aggregation caused by heparin.
Heparin is not easy to cross the placental barrier, but it can lead to premature delivery and fetal death in pregnant women.
Continuous application of heparin for 3 ~ 6 months can cause osteoporosis and spontaneous fracture. Heparin can also cause allergic reactions, such as rash and drug fever. Patients with hepatic and renal insufficiency, hemorrhagic constitution, peptic ulcer, severe hypertension and pregnant women are prohibited.
Clinical application of heparin
1, heparin is the first choice drug that needs to achieve anticoagulant effect quickly, and can be used for surgical prevention of thrombosis and anticoagulant therapy for pregnant women. For patients with acute myocardial infarction, heparin can be used to prevent venous thromboembolism and arterial embolism in patients with large area of anterior wall transmural myocardial infarction.
2. Another important clinical application of heparin is to keep blood circulation smooth during heart surgery and renal dialysis.
3. It can be used to treat disseminated intravascular coagulation (DIC) caused by various reasons, as well as glomerulonephritis, nephrotic syndrome and rheumatoid arthritis.
Heparin treats various diseases.
angina pectoris
To observe the risk of myocardial infarction (MI) and death in patients with unstable angina pectoris treated with aspirin plus heparin and aspirin alone, patients were randomly divided into aspirin plus heparin group and aspirin alone group. The study reported the incidence of myocardial infarction and death. Compared with aspirin alone, the total relative risk (RR) of myocardial infarction or death in patients with unstable angina pectoris is 0.67[95% confidence limit (CI), 0.44 ~ 1.02]. Compared with patients who received aspirin alone, the total RR of secondary end points of aspirin plus heparin treatment was: recurrent ischemic pain after random treatment was 0.68(95%CI, 0.40 ~ 1. 17), MI or death was 0.82(95%CI, 0.56 ~ 12 weeks. Vascular recanalization was 65438 0.03 (95% CI, 0.74 ~ 65438 0.43); The bleeding rate was 1.99(95%CI was 0.52 ~ 7.65). No significant statistical heterogeneity was found in all experimental results. Conclusion: Compared with aspirin alone, the risk of myocardial infarction or death in patients with unstable angina pectoris is reduced by 33%. There is sufficient evidence that most patients with unstable angina pectoris should be treated with aspirin and heparin at the same time.
Lens epithelial cells
Inhibition of the proliferation or migration of lens epithelial cells is the main complication of extracapsular cataract extraction. Heparin can inhibit the proliferation or migration of lens epithelial cells. The proliferation, migration and fibrosis of lens epithelial cells play an important role in the occurrence of after cataract. At present, the prevention of posterior capsule opacification is mainly to completely remove lens epithelial cells and cortex during operation and implant biconvex or kyphosis posterior chamber intraocular lens. Its treatment mainly depends on laser posterior capsulotomy. It is found that dispersing enzyme (a neutral protease), ethylenediamine tetraacetic acid (EDTA), heparin and antimetabolites such as 5- fluorouracil, daunorubicin, colchicine and mitomycin have inhibitory effects on the migration and/or proliferation of lens epithelial cells. The proliferation or inhibition of lens epithelial cells by various cytokines is also significant.
Dural sinus thrombosis
In recent years, some progress has been made in the treatment of dural sinus thrombosis with heparin and tissue plasminogen activator (tPA) abroad. Tissue plasminogen activator is safer than urokinase, and the combination with small molecular heparin is better than heparin alone.
Ulcerative colitis
There are many researches on the pathogenesis of ulcerative colitis (UC), such as immune abnormality, infection and oxygen free radical damage. In addition, the study found that there were significant differences in prethrombotic state indexes in patients with ulcerative colitis, such as WF, anticardiolipin antibody, prothrombin fragment 1+2, thrombin antithrombin complex, D- dimer, tissue factor pathway inhibitor, platelet globulin and so on. Compared with the healthy control group, it is reported that heparin has successfully treated refractory UC, suggesting that microthrombosis may be one of the important pathogenesis of UC.
Acute cerebral infarction
In order to observe the clinical efficacy of low molecular weight heparin in the treatment of acute cerebral infarction and its influence on hemodynamic parameters, 30 patients with acute cerebral infarction were treated with low molecular weight heparin (LMWH) (observation group) and compared with 30 patients with acute cerebral infarction (controlling blood pressure, using calcium antagonists, scavenging free radicals, using brain metabolic activators, etc.). Results: The total effective rate of the observation group was 90%, which was significantly higher than that of the control group (63.3%(P < 0.05). Compared with the neurological deficit score before and after treatment, the number of points reduction in the observation group was significantly higher than that in the control group (P
serious burn
Severe burn complicated with systemic multiple organ dysfunction has a high mortality rate. Wound healing often leaves scars and contractures, complicated with different degrees of deformity or dysfunction. Glucosamine (GAG) has been used to treat burns in many clinical and animal experiments, and its mechanisms of anticoagulation, anti-infection and promoting vascular regeneration have been preliminarily revealed. These mechanisms are beneficial to tissue repair and epithelial re-formation. Glycosaminoglycans include heparin, dermatan sulfate, keratin sulfate, chondroitin sulfate 4, 6 and hyaluronic acid. Heparin contains a lot of sulfate groups and is the most acidic GAG. It is mainly administered by parenteral route, topical application and inhalation, and can also be made into capsules for oral administration, or used in conjunction with artificial skin, or used as raw materials for artificial skin. Heparin has the functions of analgesia, anticoagulation, inhibiting inflammatory reaction, promoting blood vessel regeneration, restoring local blood supply, and affecting collagen synthesis and degradation. After the wound healed, the skin was smooth, and scars and scar contracture were reduced. Heparin can also protect intestinal barrier function and reduce bacterial translocation; Protect lung tissue and improve lung function; Protect and improve renal function; Improve immunity and prevent infection. Local application of heparin is an effective means to treat burns.
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