Application of reteplase combined with warfarin and low molecular weight heparin in high-risk acute pulmonary embolism patients
Objective To explore the application effect of reteplase combined with warfarin and low molecular weight heparin in the treatment of high-risk acute pulmonary embolism(PE)patients,in order to provide a reference for treating acute PE patients.Methods A retrospective analysis was conducted on the clinical data of 101 high-risk acute PE patients admitted to Suining Municipal Hospital of TCM from August 2020 to May 2023.The patients were assigned to the control group(48 ca-ses)and the observation group(53 cases)according to the treatment regimen.The control group was treated with warfarin combined with low molecular weight heparin,while the observation group was treated with reteplase in addition to the regi-men used in the control group.The clinical efficacy,coagulation function indicators,vascular endothelial function indica-tors,inflammatory factor levels,and adverse reactions during treatment were compared between the two groups.Results The overall response rate in the observation group was significantly higher than that in the control group[88.68％(47/53)vs.68.75％(33/48);x2=6.075,P=0.014].Before treatment,no significant differences were noted in activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),and fibrinogen(FiB)levels between the two groups(P＞0.05).After treatment,APTT,PT,and TT were increased in both groups,and the observation group had longer values than the control group;FiB levels were decreased,with the observation group showing lower levels than the control group,all with significant differences(P＜0.05).Before treatment,no significant differences were found in serum endothelin-1(ET-1),thromboxane B2(TXB2),soluble intercellular adhesion molecule-1(sICAM-1),and nitric oxide(NO)levels between the two groups(P＞0.05).After treatment,serum levels of ET-1,TXB2,and sICAM-1 showed reductions in both groups,with the observation group having lower levels than the control group;serum NO levels indicated an in-crease,with the observation group having higher levels than the control group,all with significant differences(P＜0.05).Before treatment,no significant differences were observed in serum interleukin-10(IL-10)and C-reactive protein(CRP)lev-els between the two groups(P＞0.05).After treatment,serum IL-10 and CRP levels indicated a decline in both groups,with the observation group showing lower levels than the control group,with significant differences(P＜0.05).The inci-dence of adverse reactions was 12.50％in the control group and 7.52％in the observation group,with no significant differ-ence(x2=0.249,P=0.618).Conclusion Reteplase in combination with warfarin and low molecular weight heparin is ef-fective in the treatment of high-risk acute PE.It not only significantly improves coagulation function and vascular endothelial function but also inhibits the increase in inflammatory factor levels,thereby alleviating the inflammatory response.It is worth applying in clinical practice.
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