Schulman S
Department of Haematology and Infectious Disease, Karolinska Hospital, Stockholm, Sweden.
Haemostasis. 1998;28 Suppl 3:17-21. doi: 10.1159/000022401.
Warfarin remains the standard drug for secondary prophylaxis following venous thromboembolism, however this treatment is not ideal. In patients for whom monitoring is problematic or who have a high risk of bleeding complications, other possible solutions have been explored. Unfractionated heparin has been used to a limited extent in these situations and requires dose adjustment in order to achieve an acceptable efficacy. Low-molecular-weight heparin (LMWH) is a valuable alternative to warfarin for these patients and for thromboprophylaxis during pregnancy. In several subgroups of patients with venous thromboembolism the use of a LMWH instead of warfarin could offer specific advantages. The combination of warfarin and LMWH is warranted in patients for whom it is predicted that warfarin treatment alone may fail. The optimal dose of LMWH in long-term prophylaxis has not been evaluated in a properly designed study and the optimal duration of prophylaxis with LMWH is thought to be similar to that for warfarin.
华法林仍然是静脉血栓栓塞症二级预防的标准药物，然而这种治疗并不理想。对于监测存在问题或有出血并发症高风险的患者，人们已经探索了其他可能的解决方案。普通肝素在这些情况下的使用有限，并且需要调整剂量以达到可接受的疗效。低分子量肝素（LMWH）对于这些患者以及孕期血栓预防而言，是华法林的一种有价值的替代药物。在静脉血栓栓塞症患者的几个亚组中，使用低分子量肝素而非华法林可能具有特定优势。对于预计单独使用华法林治疗可能失败的患者，华法林与低分子量肝素联合使用是必要的。在一项设计合理的研究中尚未评估低分子量肝素长期预防的最佳剂量，并且认为低分子量肝素预防的最佳持续时间与华法林相似。
