Agnelli G, Rossi R, Santamaria M G
Department of Internal Medicine, Institute of Internal and Vascular Medicine, University of Perugia, Italy.
Semin Hematol. 2000 Jul;37(3 Suppl 5):23-6. doi: 10.1016/s0037-1963(00)90097-0.
Low-molecular-weight heparins (LMWHs) are suitable for self-administration at home, because they have a predictable anticoagulant effect following subcutaneous injection and do not require laboratory monitoring. Clinical trials evaluating the safety and efficacy of LMWHs in the outpatient setting for the prevention of deep vein thrombosis (DVT) after orthopedic surgery and for the treatment of established DVT are reviewed. Extended LMWH prophylaxis reduces the incidence of venographically detected DVT by approximately 50%. Medical practice relies heavily on clinical diagnosis of DVT, for which both sensitivity and specificity are poor. It is uncertain how the results of research trials on DVT prevention based on venography relate to ordinary practice. In the treatment of established DVT, there was no significant difference between outpatient management with LMWH and inpatient treatment with unfractionated heparin (UFH). However, outpatient management offered a considerable reduction in resource usage, with associated cost savings.
低分子量肝素（LMWHs）适合在家自行给药，因为皮下注射后它们具有可预测的抗凝作用，且无需实验室监测。本文综述了评估低分子量肝素在门诊环境中预防骨科手术后深静脉血栓形成（DVT）以及治疗已确诊DVT的安全性和有效性的临床试验。延长低分子量肝素预防可使静脉造影检测到的DVT发生率降低约50%。医学实践严重依赖于DVT的临床诊断，而其敏感性和特异性都很差。基于静脉造影的DVT预防研究试验结果与常规实践之间的关系尚不确定。在治疗已确诊的DVT方面，低分子量肝素门诊治疗与普通肝素（UFH）住院治疗之间没有显著差异。然而，门诊治疗可大幅减少资源使用，并节省相关成本。
