Bechtold H, Janssen D
Department of Internal Medicine, Regional Hospital of Crailsheim, Germany.
Eur J Med Res. 2004 Apr 30;9(4):186-98.
Low-molecular-weight heparins (LMWH) were investigated in different cardiac diseases requiring anticoagulation. In case of short term usage advantages over intravenous unfractionated heparin (UFH) are of relevance, such as simple subcutaneous application, possibility for outpatient treatment and predictable effect on anticoagulation enabling abstention of laboratory monitoring in most cases. Thromboprophylaxis in acute medically ill patients and therapy of non-ST-elevation acute coronary syndromes (NSTE-ACS) are important indications, in which significant advantages for special LMWH as compared to Placebo or UFH were shown. A significant effect versus Placebo was demonstrated for the LMWH Dalteparin in prolonged anticoagulation until revascularisation procedure in NSTE-ACS. Promising results from trials were also published concerning use of LMWH Dalteparin and Enoxaparin in TEE-guided cardioversion. Findings from cohort trials are available for temporary or long term switch from oral anticoagulation to LMWH. Due to limited data, determination of individual benefit-to-risk ratio is of special importance to select suitable anticoagulation regimen in this case. Further investigations as a basis of general recommendations on standard dosing regimen are outstanding for use of each LMWH in percutaneous coronary interventions, as combination with Glycoprotein IIb/IIIa-inhibitors, in acute myocardial infarction and in artificial heart valves. In cardiology, most studies were performed with Dalteparin and Enoxaparin, suggesting these to be used in established cardiac indications as well as in further investigations.
低分子量肝素（LMWH）已在不同需要抗凝治疗的心脏疾病中进行了研究。在短期使用时，与静脉注射普通肝素（UFH）相比，其优势显著，例如皮下注射简便、可门诊治疗以及抗凝效果可预测，多数情况下无需实验室监测。对急性内科疾病患者进行血栓预防以及治疗非ST段抬高型急性冠状动脉综合征（NSTE - ACS）是重要的适应证，在这些方面，特定的LMWH与安慰剂或UFH相比显示出显著优势。在NSTE - ACS中，LMWH达肝素在延长抗凝直至血运重建手术期间，与安慰剂相比有显著效果。关于在经食管超声心动图（TEE）引导下心脏复律中使用LMWH达肝素和依诺肝素的试验也公布了有前景的结果。队列试验的结果可用于从口服抗凝药临时或长期转换为LMWH。由于数据有限，在此情况下确定个体的获益风险比对于选择合适的抗凝方案尤为重要。对于每种LMWH在经皮冠状动脉介入治疗、与糖蛋白IIb/IIIa抑制剂联合使用、急性心肌梗死以及人工心脏瓣膜中的应用，作为标准给药方案通用建议基础的进一步研究仍未完成。在心脏病学领域，大多数研究是使用达肝素和依诺肝素进行的，这表明它们可用于既定的心脏适应证以及进一步的研究中。
