Ottani F, Ferrini D, Di Pasquale G, Galvani M
Divisione di Cardiologia, Ospedale di Bentivoglio (BO).
Ital Heart J Suppl. 2001 Sep;2(9):958-71.
Thrombosis is responsible for the acute manifestations of coronary artery disease. Intravenous heparin has been shown to be effective in reducing the risk of death or myocardial infarction in patients with acute coronary syndromes. Compared to standard heparin, low-molecular weight heparins (LMWHs) have improved pharmacological and pharmacokinetic properties. A number of LMWHs, such as nadroparin, dalteparin and enoxaparin, have been evaluated in patients with acute coronary syndromes. FRISC (Fragmin during Instability in Coronary Artery Disease) and FRIC (Fragmin in Unstable Coronary Artery Disease), evaluated dalteparin and found the LMWH to be more effective than aspirin alone (FRISC) and as effective as heparin in a direct comparison (FRIC). In a small trial, nadroparin was shown to significantly reduce the risk of ischemic outcomes compared with a combination of aspirin and heparin, but this effect was no longer significant in the large FRAX.I.S. trial (FRAXiparine in Ischaemic Syndrome). Enoxaparin resulted in a statistically significant reduction in the combined outcome of death, myocardial infarction and recurrent angina or of urgent revascularization when compared with heparin in the ESSENCE (Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events) and TIMI 11B trials. Meta-analyzing of the data of these two trials revealed that even the combination of death and myocardial infarction was significantly reduced by the use of enoxaparin. There is accumulating evidence that LMWHs are safe and effective alternatives to standard heparin for the treatment of acute coronary syndromes and that they offer practical and therapeutic advantages.
血栓形成是冠状动脉疾病急性表现的原因。静脉注射肝素已被证明可有效降低急性冠状动脉综合征患者的死亡或心肌梗死风险。与标准肝素相比，低分子量肝素（LMWHs）具有更好的药理学和药代动力学特性。多种低分子量肝素，如那屈肝素、达肝素和依诺肝素，已在急性冠状动脉综合征患者中进行了评估。FRISC（冠状动脉疾病不稳定期使用达肝素）和FRIC（不稳定冠状动脉疾病使用达肝素）研究评估了达肝素，发现低分子量肝素比单独使用阿司匹林更有效（FRISC），并且在直接比较中与肝素效果相当（FRIC）。在一项小型试验中，与阿司匹林和肝素联合使用相比，那屈肝素显示可显著降低缺血性结局的风险，但在大型FRAX.I.S.试验（缺血综合征使用速避凝）中这种效果不再显著。与肝素相比，在ESSENCE（皮下注射依诺肝素在非Q波冠状动脉事件中的疗效和安全性）和TIMI 11B试验中，依诺肝素使死亡、心肌梗死和复发性心绞痛或紧急血运重建的联合结局有统计学意义地降低。对这两项试验的数据进行荟萃分析显示，使用依诺肝素甚至使死亡和心肌梗死的联合发生率也显著降低。越来越多的证据表明，低分子量肝素是治疗急性冠状动脉综合征的安全有效的标准肝素替代药物，并且它们具有实际和治疗优势。
