Schoenenberger R A, Ménat L, Weiss P, Marbet G A, Ritz R
Departement of Internal Medicine, University Hospital (Kantonsspital), Basel, Switzerland.
Eur Heart J. 1992 Mar;13(3):411-4. doi: 10.1093/oxfordjournals.eurheartj.a060182.
A previously described nitroglycerin-induced heparin resistance could not be verified by in-vitro experiments or in a randomized, double-blind, crossover trial in healthy volunteers. A clinically relevant attenuation of the anticoagulant effect of a heparin bolus (40 U.kg-1) by a concomitant infusion of nitroglycerin (100 micrograms.min-1) was absent. Activated partial thromboplastin time was not significantly different under nitroglycerin infusion as compared to placebo after heparin injection. Concentrations and activities of antithrombin III and heparin cofactor II remained unchanged during nitroglycerin infusion. An interaction of these two frequently combined drugs in patients with active thromboembolic disease or after a prolonged concomitant intravenous administration cannot be ruled out. Since this is of clinical importance, further studies must clarify a possible nitroglycerin-induced heparin resistance.
先前描述的硝酸甘油诱导的肝素抵抗无法通过体外实验或在健康志愿者中进行的随机、双盲、交叉试验得到证实。在健康志愿者中，同时输注硝酸甘油（100微克/分钟）并未导致肝素推注（40单位/千克）的抗凝作用出现具有临床意义的减弱。注射肝素后，输注硝酸甘油时活化部分凝血活酶时间与输注安慰剂时相比无显著差异。在输注硝酸甘油期间，抗凝血酶III和肝素辅因子II的浓度及活性保持不变。在患有活动性血栓栓塞性疾病的患者中，或在长时间联合静脉给药后，不能排除这两种常联合使用的药物之间存在相互作用。鉴于此具有临床重要性，进一步的研究必须阐明是否存在可能的硝酸甘油诱导的肝素抵抗。
