Fraser Ian S, Porte Robert J, Kouides Peter A, Lukes Andrea S
Department of Obstetrics and Gynaecology, University of Sydney, Sydney, NSW, Australia.
Drug Saf. 2008;31(4):275-82. doi: 10.2165/00002018-200831040-00001.
The first part of this benefit-risk review examined the efficacy and adverse effect profiles of systemic haemostatic agents commonly used in major surgery. The second part of this review examines the efficacy and adverse effect profiles of systemic haemostatic agents commonly used in the treatment of excessive or heavy menstrual bleeding, and provides individual benefit-risk profiles that may assist clinicians in selecting appropriate pharmacological therapy in this setting. Historically, surgery has played a dominant role in treatment; however, pharmacological therapy is increasingly popular, especially in women who wish to retain their fertility. When selecting the appropriate treatment, patient preference should be considered, as well as the benefits and risks associated with each agent. Recommended pharmacological therapies that are effective and generally well tolerated include the levonorgestrel-releasing intrauterine system and the oral agents tranexamic acid, NSAIDs (e.g. mefenamic acid) and combined estrogen/progestogen oral contraceptives. In patients with an underlying bleeding disorder (e.g. von Willebrand disease), an additional option is intranasal desmopressin.
本获益-风险评估的第一部分考察了大手术中常用的全身性止血剂的疗效和不良反应情况。本评估的第二部分考察了治疗月经过多或严重月经出血时常用的全身性止血剂的疗效和不良反应情况，并提供了个体化的获益-风险概况，这可能有助于临床医生在这种情况下选择合适的药物治疗。从历史上看，手术在治疗中一直占据主导地位；然而，药物治疗越来越受欢迎，尤其是在希望保留生育能力的女性中。选择合适的治疗方法时，应考虑患者的偏好以及每种药物的获益和风险。推荐的有效且通常耐受性良好的药物治疗包括左炔诺孕酮宫内节育系统以及口服药物氨甲环酸、非甾体抗炎药（如甲芬那酸）和复方雌激素/孕激素口服避孕药。对于患有潜在出血性疾病（如血管性血友病）的患者，另一种选择是鼻内去氨加压素。
