Graf J, Janssens U
Medical Clinic I, University Hospital Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
Curr Pharm Des. 2004;10(4):375-86. doi: 10.2174/1381612043453342.
A growing body of evidence suggests that low molecular weight heparin (LMWH) is at least as effective as unfractionated heparin (UFH) in the medical management of acute coronary syndromes (ACS) including acute myocardial infarction. Several studies support an early invasive as compared to a conservative (non-invasive) approach utilizing percutaneous coronary intervention (PCI) in these patients. During coronary angiography and PCI systemic anticoagulation usually administering UFH should prevent thrombus formation at the catheter equipment and at the site of vessel injury. The widespread use of UFH as the anticoagulant of choice is explained by low costs, easy reversibility and accepted anticoagulant properties. However, the clinical support for the use of UFH in PCI is largely based on retrospective and observational data only. Compared to UFH, LMWH have distinct pharmacological advantages, including ease of administration and usually no need for monitoring. A major drawback of LMWH is the predominant renal clearance which may lead to unpredictable levels of anticoagulation in patients with impaired renal function. Since LMWH constitute an extremely heterogeneous group of drugs each LMWH should be recognized as an individual pharmaceutical compound. Consequently, pharmacodynamic and pharmacokinetic properties of one LMWH must not be extrapolated for other LMWH. A growing body of evidence supports the use of LMWH in ACS, with or without GPIIb/IIIa receptor antagonists, thrombolysis, or PCI. Although in patients undergoing PCI, LMWH have yet not been shown to be superior to UFH they can safely be administered.
越来越多的证据表明，在包括急性心肌梗死在内的急性冠状动脉综合征（ACS）的药物治疗中，低分子量肝素（LMWH）至少与普通肝素（UFH）一样有效。多项研究支持在这些患者中采用早期侵入性治疗方法，而非使用经皮冠状动脉介入治疗（PCI）的保守（非侵入性）方法。在冠状动脉造影和PCI期间，通常使用UFH进行全身抗凝，以防止在导管设备和血管损伤部位形成血栓。UFH作为首选抗凝剂被广泛使用，原因在于其成本低、易于逆转且具有公认的抗凝特性。然而，UFH在PCI中应用的临床支持很大程度上仅基于回顾性和观察性数据。与UFH相比，LMWH具有明显的药理学优势，包括易于给药且通常无需监测。LMWH的一个主要缺点是主要通过肾脏清除，这可能导致肾功能受损患者的抗凝水平不可预测。由于LMWH是一类极其异质的药物，每种LMWH都应被视为一种单独的药物化合物。因此，一种LMWH的药效学和药代动力学特性不能外推至其他LMWH。越来越多的证据支持在ACS中使用LMWH，无论是否使用糖蛋白IIb/IIIa受体拮抗剂、溶栓治疗或PCI。尽管在接受PCI的患者中，尚未证明LMWH优于UFH，但它们可以安全给药。
