Spyropoulos Alex C
Clinical Thrombosis Center, Lovelace Sandia Health Systems, 5400 Gibson Blvd SE, Albuquerque, NM 87108, USA.
Chest. 2005 Aug;128(2):958-69. doi: 10.1378/chest.128.2.958.
Venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in hospitalized patients with acute medical illness. The high prevalence of VTE in this patient population, its clinically silent nature, and associated morbidity and mortality indicate that prophylactic therapy is appropriate in those determined to be at increased risk. Unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) have been shown to reduce the incidence of VTE and are the primary therapies used for prophylaxis in these patients. Although both UFH and LMWH have received grade 1A recommendations for the prevention of VTE in at-risk medical patients in the 2004 American College of Chest Physicians consensus conference statements, LMWH has advantages over UFH in its once-daily dosing scheme, reduced incidence of major and minor bleeding events, and reduced incidence of heparin-induced thrombocytopenia. Fondaparinux is a novel antithrombotic agent characterized by specificity for factor Xa and a lack of platelet interaction. A recent clinical trial in hospitalized patients with acute medical illness found that fondaparinux significantly reduced the incidence of both VTE and fatal pulmonary embolism compared with placebo, without increased major bleeding. Despite the availability of effective thromboprophylactic therapies, VTE prophylaxis continues to be underutilized in hospitalized medical patients.
静脉血栓栓塞症（VTE）仍然是急性内科疾病住院患者发病和死亡的重要原因。该患者群体中VTE的高患病率、其临床无症状的性质以及相关的发病率和死亡率表明，对于那些被确定为风险增加的患者，预防性治疗是合适的。普通肝素（UFH）和低分子肝素（LMWH）已被证明可降低VTE的发生率，是这些患者预防治疗的主要药物。尽管在2004年美国胸科医师学会共识会议声明中，UFH和LMWH均获得了预防高危内科患者VTE的1A级推荐，但LMWH在每日一次给药方案、减少严重和轻微出血事件的发生率以及减少肝素诱导的血小板减少症的发生率方面优于UFH。磺达肝癸钠是一种新型抗血栓药物，其特点是对Xa因子具有特异性且缺乏与血小板的相互作用。最近一项针对急性内科疾病住院患者的临床试验发现，与安慰剂相比，磺达肝癸钠显著降低了VTE和致命性肺栓塞的发生率，且未增加严重出血。尽管有有效的血栓预防治疗方法，但住院内科患者的VTE预防仍未得到充分利用。
