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01 May 2013, Volume 33 Issue 5 Previous Issue    Next Issue

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Prevention of emergency medical disputes. YU Xue-zhong. 2013, 33(5): 333-335.  Abstract ( )   PDF (876KB) ( )   Abstract：With the development of society and improvement of peoples living standard,the self-protection awareness of patients is continuously increasing.Meanwhile，patients and their families are requesting more and more from emergency medical activities.As a result，medical disputes occur frequently.In this paper，we analyze the current status and causes of emergency medical disputes，and discuss how to control and reduce the incidence of emergency medical disputes.

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The recommendation on The Antithrombotic Therapy and Prevention of Thrombosis，9th ed:American College of Chest Physicians. ZHAI Zhen-guo*，WANG Chen. 2013, 33(5): 336-338.  Abstract ( )   PDF (884KB) ( )   Abstract：The Antithrombotic Therapy and Prevention of Thrombosis，9th ed:American College of Chest Physicians (ACCP)Evidence-Based Clinical Practice Guidelines was produced in February 2012.This guideline has made a number of changes in process，resulting in differences in the approach to making recommendations and their content，which enriches and updates clinical prophylaxis and treatment of thromboembolic diseases，which was considered one of the most authoritative and comprehensive guideline in thromboembolic area.Clinicians should use the guideline carefully and objectively the objective.The rigorous application of the science of guideline development will ultimately best serve our patients.

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Emphasis on coagulation problems and laboratory indicators in post-operative patients. GUAN Zhen-peng. 2013, 33(5): 339-343.  Abstract ( )   PDF (909KB) ( )   Abstract：The mortality rate in venous thromboembolism (VTE) is much higher than that in infections and tumors.Along with promulgating of Antithrombotic Therapy and Prevention of Thrombosis，9th ed: American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines in January 2012，the safety of anticoagulant therapy after major orthopedic surgery has been paid attention gradually.There are three main changes: Firstly，it has added some new oral anticoagulants，such as Apixaban，Pradaxa，Rivaroxaban and Aspirin (Being specially emphasised that Aspirin has no effect on DVT prevention in previous 8 editions) (Level 1B).Secondly，the ACCP recommends that low molecular weight heparin (LMWH) is a prior choice for safety of anticoagulant (Level 2B).Finally，the ACCP specially emphasis that the first injection time of LMWH should be later than 12 hours aftermajor orthopedic surgery，and combined with other prevention measures，which could improve the preventive effect of VTE and the safety of anticoagulant therapy at the same time.In addition，surgeons should pay close attention to postoperative bleeding and other problems caused by anticoagulant therapy.Meanwhile，surgeons should deeply understand and grasp laboratory index of these risks of bleeding and its importance，so as to ensure patients safety in perioperative period.

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Cancer and venous thromboembolism. XU Xiao-mao，WANG Chen. 2013, 33(5): 344-347.  Abstract ( )   PDF (897KB) ( )   Abstract：Venous thromboembolism (VTE) represents one of the most important causes of morbidity and mortality in cancer patients.Hypercoagulability，stasis and vessel wall injury，which are the mechanisms of VTE，are associated with cancer or chemotherapy.There are several factors that might increase the risk of VTE，including those related to patients themselves，cancer or treatments.But most of oncologists have underestimated the prevalence of VTE and its negative impact on their patients.Measurements should be taken to enhance the perceptions about magnitude of VTE risk in patients with malignancy and to improve prophylaxis and treatment of VTE in cancer patients.

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The new progress of the antithrombotic treatment of the pulmonary thromboembolism. LI Sheng-qing. 2013, 33(5): 348-351.  Abstract ( )   PDF (898KB) ( )   Abstract：The pulmonary thromboembolism is divided into acute pulmonary embolism and chronic thromboembolic pulmonary hypertension (CTEPH).Antithrombotic treatment of acute pulmonary embolism is divided into the initial treatment and long-term treatment.Initial treatment includes parenteral anticoagulation，systemic thrombolysis，catheter thrombectomy，surgical thrombectomy and vena cava filter implantation.Long-term treatment needs comprehensive consideration in patients with predisposing factors for VTE and bleeding risk factors.It is divided into (1)treatment of a shorter period；(2)treatment with anticoagulation for 3 months；(3)treatment of a longer time-limited period (eg，6 or 12 months)；(4)extended therapy.In selected patients with CTEPH，such as those with central disease under the care of an experienced thromboendarterectomy team，we suggest pulmonary thromboendarterectomy (PEA).In those patients not suitable for the PEA surgery，it is recommended that the use of the pulmonary targeting antihypertensive drugs and long-term anticoagulation.

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Pathological obstetric hemorrhage and embolism and their balance problems. LI Li，YU Li-li. 2013, 33(5): 352-354.  Abstract ( )   PDF (883KB) ( )   Abstract：Obstetric hemorrhage and embolism are two common complications that severely threaten the parturients life.Attentions should be paid to pathological obstetric bleeding and thrombotic complications as well as their balance problems regarding pregnancy.The puerperal women are a special group，so prenatal coagulation tests is very necessary.For obstetric hemorrhage and venous thromboembolism，great emphasis，early identification and active treatment are very important.

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Management strategy on anticoagulant therapy of venous thrombembolism. ZHU Yan-yan，ZHAI Zhen-guo. 2013, 33(5): 355-358.  Abstract ( )   PDF (897KB) ( )   Abstract：The management of anticoagulant therapy and health education for patients with venous thrombembolism (VTE) should be emphasized.The aim of high-quality management of anticoagulant therapy is to guarantee anticoagulants which have limited indications as safe and effective as possible.There are not sufficient evidences from randomized tests to support the clinical problems regarding management of most anticoagulants (parenteral and oral anticoagulants).Recommended proposals with adequate evidence include：(1) VTE patients are treated with vitamin K antagonist (VKA)，with a therapeutic INR range of 2.0 to 3.0；and (2) it is not recommended to adjust VKA dosage routinely by pharmacogenetic test.Other proposals which are in a lower recommending grade include：load dose，initial overlapping treatment，inspection frequency，supplementation of vitamin K，patients self-management，adjustment of dosage by weight and renal function，dosage decision support，avoiding interaction between drugs，prevention and treatment of bleeding，and so on.

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Diagnosis of deep vein thrombosis. GUO Li-long，LI Yong-jun. 2013, 33(5): 359-362.  Abstract ( )   PDF (894KB) ( )   Abstract：Deep vein thrombosis (DVT) without treatment will probably cause serious complications which have been concerned by more and more medical staff.Correct and quick diagnosis is the basis of treatment.This article illustrates how to diagnose DVT by summarizing related articles and domestic as well as international and national guidelines.Consensus has been reached by experts that clinical pretest probability together with D-dimmer level and ultrasound sonography are the main recommended strategies to diagnose DVT.

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Complications and their management in thrombolytic treatment of pulmonary thromboembolism. YANG Yuan-hua. 2013, 33(5): 363-365.  Abstract ( )   PDF (881KB) ( )   Abstract：The main complication of thrombolysis for pulmonary thromboembolism (PTE) is bleeding.Fever and rash are relatively rare.Increasing aging，pre-existing diseases such as intracranial disease，arterial or vene-puncture and large thrombolytic dosage are causes of bleeding.To reduce the incidence of bleeding，the indication and contraindication of thrombolysis must be controlled，the risk-effect of thrombolysis should be evaluated，and some prevention methods should be utilized.Different therapies should be used based on site and amount of bleeding if that has been developed.

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Common problems in diagnosis and treatment of heparin-induced thrombocytopenia. ZHAO Yong-qiang. 2013, 33(5): 366-368.  Abstract ( )   PDF (941KB) ( )   Abstract：The common clinical manifestations of heparin-induced thrombocytopenia (HIT) include mild or moderate thrombocytopenia and venous or arterial thromboembolism.Thromboembolism is the most fatal outcome of HIT.Since timely diagnosis and treatment of HIT may reduce the risk of adverse outcomes，it is very important to raise awareness of HIT in the clinicians and improve the diagnostic methods in our country.

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Update and explanation of suggestions on anticoagulant therapy of atrial fibrillation and valvular heart disease in the 2012-edition guideline from The American College of Chest Physicians. SUN Yi-hong. 2013, 33(5): 369-371.  Abstract ( )   PDF (887KB) ( )   Abstract：The ninth edition of ACCP (The American College of Chest Physicians) guideline emphasizes the antithrombotic therapy based on CHADS2 stratification in patients with atrial fibrillation (AF).For patients with nonrheumatic AF (NVAF)，including those with paroxysmal AF，who are at intermediate to high risk of stroke (e.g.，CHADS 2 score ≥1)，we recommend oral anticoagulation，which include warfarin and a new oral anticoagulant (darbigatran).Antiplatelet treatment is not universally recommended for NVAF.The guideline also states how to choose the antithrombotic strategies in patients with acute coronary syndrome (ACS) or stent and in those undergo cardioversion.For patients with rheumatic vavular disease and prosthetic valve implantation，dose-adjusted wafarin is strongly recommended.The guideline suggests stopping VKA (vitamin K antagonist) therapy until the patient is stabilized without neurologic complications for infective endocarditis of a prosthetic valve.In patients with thrombosed prosthetic valve，fibrinolysis is recommended for right-sided valves and left-sided valves with thrombus area 0.8 cm2 (Grade 2C).For patients with left-sided prosthetic valve thrombosis and thrombus area 0.8 cm2，we recommend early surgery.