Choussat R, Montalescot G
Service de cardiologie du Pr. Thomas, Hôpital Pitié-Salpêtrière, Paris.
Rev Mal Respir. 1999 Nov;16(5 Pt 2):985-95.
The limitations of conventional treatment using nonfractionated heparin have stimulated research in new anticoagulants which act at different levels of the coagulation pathways. New natural or synthetic compounds have been developed to improve current treatments. Included among these compounds are indirect thrombin inhibitors such as dermatan sulfate, heparanoids and low-molecular weight heparin. Low-molecular weight heparins are particularly interesting for venous thromboembolism and acute coronary syndromes. Several studies have demonstrated their efficacy in unstable angina and myocardial infarction without Q wave. In comparison with nonfractionated heparin, administration of enoxaparin offers a supplementary benefit. Indirect thrombin inhibitors such as hirudin and its derivatives are also being evaluated and have shown a certain efficacy in the prevention of postoperative deep vein thrombosis although no superior effect compared with nonfractionated heparin has been demonstrated in thrombotic coronary disease. Finally, indirect anti-Xa agents and physiological coagulation inhibitors are also being assessed.
使用普通肝素的传统治疗方法的局限性推动了对作用于凝血途径不同水平的新型抗凝剂的研究。已经开发出新型天然或合成化合物以改进现有治疗方法。这些化合物包括间接凝血酶抑制剂，如硫酸皮肤素、类肝素和低分子量肝素。低分子量肝素对静脉血栓栓塞症和急性冠状动脉综合征特别有意义。多项研究已证明其在不稳定型心绞痛和非Q波心肌梗死中的疗效。与普通肝素相比，使用依诺肝素具有额外的益处。诸如水蛭素及其衍生物等间接凝血酶抑制剂也正在接受评估，并且在预防术后深静脉血栓形成方面已显示出一定疗效，尽管在血栓性冠状动脉疾病中尚未证明其比普通肝素具有更优越的效果。最后，间接抗Xa因子药物和生理性凝血抑制剂也正在接受评估。
