Rodrigues H Luz, Brandão E Serra, Lima B Silva
Instituto de Farmacologia e Terapêutica, Faculdade de Medicina, Lisboa.
Rev Port Cardiol. 2002 Feb;21(2):183-99.
Venous thromboembolism is the third most common cardiovascular disease. Its treatment is based in unfractionated heparin (UFH), but the advance of low molecular weight heparins, with clinical efficacy at least similar to UFH and better safety profile, have changed the therapeutic consensus. The highly relevant physiopathologic information has contributed to understand the paradoxical thrombotic mechanisms associated with heparin induced thrombocytopenia. New drugs, such as danaparoid sodium, lepirudin and argatroban, are an alternative to anticoagulation by heparin when this adverse reaction occurs. Another relevant progress was the determination of optimal duration of oral anticoagulation in order to prevent thromboembolic recurrences. In the meantime, other pharmacological approaches (thrombolytics and antiplatelet agents) have been assessed in several trials of limited value outcomes. Prophylactic measures like graduated compression stockings/intermittent external pneumatic compression and inferior vena cava filters have shown efficacy in primary and secondary prevention in patients with different risks of thromboembolic recurrence.
静脉血栓栓塞是第三常见的心血管疾病。其治疗基于普通肝素（UFH），但低分子量肝素的发展，其临床疗效至少与UFH相似且安全性更好，改变了治疗共识。高度相关的病理生理信息有助于理解与肝素诱导的血小板减少症相关的矛盾血栓形成机制。当发生这种不良反应时，新型药物，如达那肝素钠、比伐卢定和阿加曲班，是替代肝素抗凝的选择。另一个相关进展是确定口服抗凝的最佳持续时间以预防血栓栓塞复发。与此同时，其他药理学方法（溶栓剂和抗血小板药物）已在一些价值有限的试验中进行了评估。诸如分级压力袜/间歇性外部气动压迫和下腔静脉滤器等预防措施已在具有不同血栓栓塞复发风险的患者的一级和二级预防中显示出疗效。
