Objective To compare the result of different anticoagulation methods after mechanical heart valve replacement in order to optimize the early-stage anticoagulation therapy. Methods Eighty-six patients with mechanical valve replacement were divided into four groups according to different anticoagulation methods, warfarin group 1 ： warfarin was given from the 1st day after operation; warfarin group 2： warfarin was given from the 2nd day after operation; dipyridamole group： dipyridamole was given for two days from the 1st day after operation, and usage of warfarin from the 2nd day after operation ; fraxiparine group ： fraxiparine was given for two days from the 1st day after operation, and warfarin was given from the 2nd day after operation. Complication and post-operative death were observed. The value of porthrombin time （PT）, international normal ratio （INR）, and blood clotting factor Ⅱ , Ⅶ etc. were monitored respectively at the day before operation, the day of operation and the 3rd, 5th day after operation. Results All the results of 4 groups have met the anticoagulation requirement on the 5th day after operation （INR 1.5-2. 0）, and no hemorrhage, embolism and death occurred. In warfarin group 1, level of blood clotting factor Ⅱ , Ⅶ decreased, and level of PT, INR rose continuously, level of INR was 2.13±1.14 at the 5th day after operation, 1NR of 7 cases more than 2.0 in warfarin group 1 which was significant statistically compare with the other 3 groups（P〈0. 01）. Conclusions To adopt warfarin with the maintainable dose from the 2nd day after mechanical valve replacement could simplify anticoagulation method, with no increased risk of post-operative complications, such as hemorrhage and embolism. There is no need for additional anticoagulation methods.
Objective To investigate the prethrombotic state and effect of anticoagulation therapy in patients with chronic obstructive pulmonary disease(COPD) and ventilator-associated pneumonia (VAP)．Methods Forty-six COPD patients were divided into VAP group(25 cases)and non-VAP group (21 cases)．The VAP group were randomly subdivided into two groups：group A(conventional therapy group，n=13)，group B(conventional therapy+anticoagulation therapy group，n=12)．The D-dimer (DD)，fibfinogen(FIB)，pulmonary artery pressure(PAP)and the time of weaning were compared between these groups．Results In the COPD patients，the levels of DD，FIB and PAP were significantly increased in VAP group compared with non-VAP group[(0．50±0．26)mg／L，(3．67 ±0．88) L，(31．71 ± 5．66)mm Hg vs(0．23±0．12)mg／L，(1．56±0．45) L，(15．28 ±2．84)mm Hg，respectively，all Plt; 0．05]．In the COPD patients with VAP，the levels of DD，the content of FIB，PAP and mortality were significantly lower in group B with shorter time of weaning compared with group A[(0．22±0．16)mg／L， (1．56±1．17)g／L，(16．00±2．48)him Hg，8．33％ and(4．00±1．41)d vs(O／41±0．09)mg／L，(3．66± 1．03) L，(28．00±0．85)mm Hg，15．4％ and(10．76±3．35)d，respectively，all Plt;0．05]． Conclusions Prethrombotic state exists in COPD patients with VAP．Aggressive anticoagulation on base of routine therapy，by ameliorating microcireulation，call shorten the time of weaning and reduce the mortalit in these patient