Pollack Charles V, Goldberg A David
Department of Emergency Medicine, Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, Pennsylvania 19107, USA.
J Emerg Med. 2008 May;34(4):417-28. doi: 10.1016/j.jemermed.2007.08.058. Epub 2008 Jan 28.
Antithrombic therapy is recommended to prevent ischemic complications in patients with high-risk non-ST-segment elevation acute coronary syndromes, including patients with unstable angina/non-ST-segment elevation myocardial infarction and patients with ST-segment elevation myocardial infarction undergoing fibrinolysis with fibrin-specific agents. Ischemic benefit from these agents must be balanced against an increased risk of bleeding, which may itself carry adverse long-term consequences. Recent trials suggest that the low-molecular-weight heparin enoxaparin may be superior to unfractionated heparin for preventing ischemic complications, although it also may be associated with an increase in bleeding risk. In two other contemporary trials, the Factor Xa inhibitor fondaparinux improved mortality and morbidity in patients with unstable angina/non-ST-segment elevation myocardial infarction and in patients with ST-segment elevation myocardial infarction undergoing fibrinolytic reperfusion, without increasing bleeding risk. These data underscore the promise of new antithrombotic agents to improve outcomes in acute coronary syndrome (ACS) patients being medically managed.
对于高危非ST段抬高型急性冠脉综合征患者，包括不稳定型心绞痛/非ST段抬高型心肌梗死患者以及接受纤维蛋白特异性药物溶栓治疗的ST段抬高型心肌梗死患者，推荐使用抗栓治疗以预防缺血性并发症。这些药物带来的缺血获益必须与出血风险增加相权衡，而出血本身可能会带来不良的长期后果。近期试验表明，低分子量肝素依诺肝素在预防缺血性并发症方面可能优于普通肝素，尽管它也可能与出血风险增加有关。在另外两项当代试验中，Xa因子抑制剂磺达肝癸钠改善了不稳定型心绞痛/非ST段抬高型心肌梗死患者以及接受纤维蛋白溶解再灌注治疗的ST段抬高型心肌梗死患者的死亡率和发病率，且未增加出血风险。这些数据强调了新型抗栓药物有望改善接受药物治疗的急性冠脉综合征（ACS）患者的预后。
