Ageno W, Turpie A G
University of Insubria, Varese, Italy.
Semin Vasc Surg. 2000 Sep;13(3):189-93.
Unfractionated heparin is the traditional treatment of choice for patients presenting with submassive pulmonary embolism. However, newer low-molecular-weight heparins have been developed and tested in several clinical trials in the last 2 decades because of the many limitations of unfractionated heparin. The pharmacologic properties of the low-molecular-weight heparins allow them to be administered subcutaneously in fixed, weight-adjusted doses without need for laboratory monitoring. Different studies have recently proved their efficacy in the treatment of patients with deep vein thrombosis. Because there is good evidence that deep vein thrombosis and pulmonary embolism are 2 expressions of a single disease, the use of low-molecular-weight heparins has been extended to patients presenting with clinically stable pulmonary embolism. In particular, the results of 2 important clinical trials, the Columbus and the Thésée, have conclusively proved that the low-molecular-weight heparins are as safe and effective as unfractionated heparin. In some centers, approximately 80% of patients with deep vein thrombosis are treated at home. This suggests that carefully selected patients with clinically stable pulmonary embolism can receive home treatment with low-molecular-weight heparins.
普通肝素是亚大面积肺栓塞患者的传统首选治疗药物。然而，由于普通肝素存在诸多局限性，在过去20年里，新型低分子肝素已被研发并在多项临床试验中进行了测试。低分子肝素的药理特性使其能够以固定的、根据体重调整的剂量皮下给药，无需实验室监测。最近不同的研究证实了其在治疗深静脉血栓形成患者中的有效性。由于有充分证据表明深静脉血栓形成和肺栓塞是单一疾病的两种表现形式，低分子肝素的应用已扩展至临床症状稳定的肺栓塞患者。特别是两项重要临床试验——哥伦布试验和忒修斯试验的结果，确凿地证明了低分子肝素与普通肝素一样安全有效。在一些中心，约80%的深静脉血栓形成患者在家中接受治疗。这表明，经过精心挑选的临床症状稳定的肺栓塞患者可以在家中接受低分子肝素治疗。
