Hiebert Linda M
Department of Veterinary Biomedical Sciences, University of Saskatchewan, Western College of Veternary Medicine, Saskatoon, Canada.
Clin Lab. 2002;48(3-4):111-6.
The antithrombotic drug heparin is administered parenterally and believed not effective orally. Oral heparin would be most suitable for long term administration, often required for the prevention of thrombosis. Following parenteral administration, heparin is taken up by endothelial cells. Our laboratory has shown that heparin is similarly taken up by endothelium following oral administration, despite low plasma heparin concentrations. In a twenty-four hour period, endothelial heparin concentrations are greatest within 15 minutes of oral dosing although plasma levels never exceed one percent of dose. Endothelial uptake accounts for a considerable amount of absorption if the total body endothelium is considered. In support of oral heparin absorption, we demonstrated a dose-dependent decrease in thrombosis incidence in a rat jugular vein model following single oral doses of unfractionated heparins (bovine and porcine) or low molecular weight heparins (reviparin, logiparin and ardeparin). Low molecular weight heparins were effective at lower doses than unfractionated heparins where a fifty percent reduction in thrombosis was observed with 0.025 mg/kg reviparin, 0.1 mg/kg logiparin, versus 7.5 mg/kg bovine unfractionated heparin. These studies support the work of others demonstrating measurable systemic changes following oral heparin administration and suggest that heparin may be effective when administered by the oral route. It also indicates that the presence of heparin in plasma likely reflects a much greater amount associated with endothelium.
抗血栓药物肝素通过胃肠外途径给药,一般认为口服无效。口服肝素对于长期给药最为合适,这在预防血栓形成时常常是必需的。胃肠外给药后,肝素被内皮细胞摄取。我们实验室已表明,尽管血浆肝素浓度较低,但口服给药后肝素同样会被内皮摄取。在24小时内,口服给药后15分钟内内皮细胞中的肝素浓度最高,尽管血浆水平从未超过给药剂量的1%。如果考虑全身内皮细胞,内皮摄取占吸收的相当一部分。为支持口服肝素的吸收,我们在大鼠颈静脉模型中证明,单次口服未分级肝素(牛和猪)或低分子量肝素(瑞伐肝素、洛吉肝素和阿地肝素)后,血栓形成发生率呈剂量依赖性降低。低分子量肝素在比未分级肝素更低的剂量下有效,例如0.025mg/kg瑞伐肝素、0.1mg/kg洛吉肝素可使血栓形成减少50%,而未分级牛肝素则需7.5mg/kg。这些研究支持了其他人的工作,即口服肝素后有可测量的全身变化,表明肝素口服给药可能有效。这也表明血浆中肝素的存在可能反映了与内皮相关的大量肝素。