Loeliger E A
Afdeling Hematologie, Academisch Ziekenhuis, Leiden, The Netherlands.
Ann Hematol. 1992 Feb;64(2):60-5. doi: 10.1007/BF01715346.
Careful scrutiny of relevant thrombosis prevention studies in the light of recent knowledge on the responsiveness to the anticoagulant defect of the various prothrombin time assays used in these studies casts serious doubts on the adequacy of the so-called moderate-intensity warfarin regimens, currently recommended by British and North American experts, in the majority of clinical situations. As long as there is strict laboratory monitoring, more intensive anticoagulation provides satisfactory prevention of thromboembolic events. The Federation of Dutch Thrombosis Centers recommends a target of 3.0 International Normalized Ratio (INR) for the primary and secondary prevention of venous thrombosis and thromboembolism, 3.5 INR in case of recurrence under the former regimen and for patients at risk for a cardiogenic embolism from any source (including tissue heart valve replacement) and those with atherothrombotic disease, and 4.0 INR for patients with a mechanical heart valve prosthesis. The risk of hemorrhage at such levels of anticoagulation remains acceptable.
鉴于近期对这些研究中所使用的各种凝血酶原时间测定对抗凝缺陷反应性的认识，对相关血栓形成预防研究进行仔细审查后发现，英国和北美专家目前推荐的所谓中等强度华法林治疗方案在大多数临床情况下的充分性存在严重疑问。只要有严格的实验室监测，更强化的抗凝治疗就能提供令人满意的血栓栓塞事件预防效果。荷兰血栓形成中心联合会建议，对于静脉血栓形成和血栓栓塞的一级和二级预防，国际标准化比值（INR）目标为3.0；如果在前述治疗方案下复发，以及对于任何来源（包括组织心脏瓣膜置换）有心脏源性栓塞风险的患者和患有动脉粥样硬化血栓形成疾病的患者，INR目标为3.5；对于植入机械心脏瓣膜假体的患者，INR目标为4.0。在这种抗凝水平下出血风险仍可接受。
