肝素和低分子肝素:第七届抗血栓和溶栓治疗ACCP会议。

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赫希J，拉施克R

肝素和低分子肝素:第七届抗血栓和溶栓治疗ACCP会议。

Chest, 2004 Sep;126(3 Suppl):188S-203S。

PubMed ID

15383472 (PubMed视图

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摘要

这篇关于未分离肝素(UFH)和低分子肝素(LMWH)的文章是第七届美国胸科医师学会抗血栓和溶栓治疗会议的一部分:循证指南。UFH是一种糖胺聚糖的异质混合物，通过五糖与抗凝血酶结合，催化凝血酶和其他凝血因子的失活。UFH还结合内皮细胞、血小板因子4和血小板，导致相当不可预测的药代动力学和药效学特性。活化部分凝血活酶时间(aPTT)试剂的可变性需要对aPTT治疗范围进行位点特异性验证，以便正确监测UFH治疗。在许多比较UFH和低分子肝素的临床试验中，缺乏验证一直是一个疏忽。在有明显肝素耐药的患者中，抗Xa因子监测可能优于aPTT测量。低分子肝素缺乏UFH的非特异性结合亲和力，因此，低分子肝素制剂具有更可预测的药代动力学和药效学特性。LMWHs已经取代了UFH的大多数临床适应症，原因如下:(1)这些特性允许LMWHs皮下给药，每天一次，无需实验室监测;(2)来自临床试验的证据表明，低分子肝素与UFH一样有效，而且更安全。关于低分子肝素使用的几个临床问题仍未得到解答。 These relate to the need for monitoring with an anti-factor Xa assay in patients with severe obesity or renal insufficiency. The therapeutic range for anti-factor Xa activity depends on the dosing interval. Anti-factor Xa monitoring is prudent when administering weight-based doses of LMWH to patients who weigh > 150 kg. It has been determined that UFH infusion is preferable to LMWH injection in patients with creatinine clearance of < 25 mL/min, until further data on therapeutic dosing of LMWHs in renal failure have been published. However, when administered in low doses prophylactically, LMWH is safe for therapy in patients with renal failure. Protamine may help to reverse bleeding related to LWMH, although anti-factor Xa activity is not fully normalized by protamine. The synthetic pentasaccharide fondaparinux is a promising new antithrombotic agent for the prevention and treatment of venous thromboembolism.

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