[The effect of low molecular heparin on the prognosis of severe pneumonia in elderly patients].
OBJECTIVE
To investigate the effect of low molecular heparin on degree of severity and prognosis of severe pneumonia in elderly patients.


METHODS
A prospective randomized control study was conducted. During October 2009 to July 2013, 63 patients over 65 years old and suffering from severe pneumonia were enrolled. Patients were grouped into control or treatment group randomly. The control group (n=36) received routine treatment, while low molecular heparin 4 kU once a day was added in treatment group (n=39) for 7 days. Acute physiology and chronic health evaluationII(APACHEII) score, coagulation function indexes, blood gas analysis, arterial lactic acid at 1, 3, 7 days after treatment, and length of mechanical ventilation, days of stay in ICU, and 7-day mortality were compared between both groups.


RESULTS
The basic data and APACHEII score had no difference between two groups (all P>0.05). Bleeding events occurred on day 1, 3, 7 in 1, 1, 2 patients in control group, respectively, and 0, 1, 3 cases in treatment group. There was no difference in APACHEII score on day 1 and day 3 between control group and treatment group (1 day: 19.33 ± 5.90 vs. 20.31 ± 4.97, t=0.775, P=0.441; 3 days: 18.69 ± 4.88 vs. 17.41 ± 3.83, t=1.272, P=0.207). APACHEII score on day 7 in treatment group was significantly lower than that in control group (13.92 ± 3.61 vs. 16.20 ± 4.23, t=2.480, P=0.016). There was no significant difference in coagulation function indexes during observation period between two groups (all P>0.05). The blood gas analysis showed that only arterial partial pressure of oxygen (PaO2) 7 days after treatment in treatment group was significantly higher than that in control group (110.52 ± 28.57 mm Hg vs. 95.47 ± 24.17 mm Hg, t=-2.354, P=0.022). There was no significant difference in 7-day mortality between two groups. The mechanical ventilation time in treatment group was slightly shorter than that in control group (147.45 ± 111.45 hours vs. 192.20 ± 115.57 hours, t=1.704, P=0.093). The length of stay in ICU in treatment group was significantly shorter than that in control group (13.77 ± 5.77 days vs. 17.22 ± 6.21 days, t=2.497, P=0.015).


CONCLUSIONS
In elderly patients suffering from severe pneumonia, low molecular heparin may reduce APACHEII score, shorten mechanical ventilation time and length of ICU stay, and the prognosis may be improved.
Department of Critical Care Medicine, Chengdu Fifth People's Hospital, Chengdu 611130, Sichuan, China. Corresponding author: Wang Ping, Email: wp_710714@hotmail.com.
Ping
P
Wang
Xi
X
Wang
Li-juan
LJ
Zhang
Fang
F
Yang
Guo-xiang
GX
Wang
Xue-lian
XL
Li
Xian
X
Huang
D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy*; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial
D006495:Heparin, Low-Molecular-Weight