肝素和低分子量肝素:第七ACCP会议抗凝和溶栓治疗。

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Hirsh J, Raschke R

肝素和低分子量肝素:第七ACCP会议抗凝和溶栓治疗。

胸部。2004年9月,126(3):188 - 203年代。

PubMed ID

15383472 (在PubMed

]

文摘

这篇关于未分离肝素(能)和beplayapp低分子量肝素(LMWH)是第七的一部分的美国胸科医师学会会议上抗栓和溶栓治疗:以证据为基础的指导方针。超高频的异构混合物葡糖氨基葡聚糖结合通过pentasaccharide抗凝血酶催化的凝血酶失活和其他凝血因子。也能结合内皮细胞、血小板因子4和血小板,导致,而不可预知的药动学和药效学性质。变化局部血栓形成质激活时间(aPTT)试剂需要特定站点验证的aPTT治疗范围以适当的监控能治疗。缺乏验证一直是一个在许多临床试验比较超高频LMWH监督。患者明显肝素抵抗,anti-factor Xa监测可能优于aPTT测量。LMWH缺乏超高频的非特异性结合亲和力,和,因此,LMWH的准备工作有更多的可预测的药动学和药效学性质。lmwh已经取代了超高频对于大多数临床适应症有以下原因:(1)这些属性允许lmwh管理皮下注射,每天一次没有实验室监测;(2)临床试验的证据,LMWH至少是比素能有效和更安全。几个使用lmwh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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