Ruchin Peter E, Labinaz Marino
Cardiac Catheterization Laboratory, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7.
Curr Cardiol Rep. 2008 Jul;10(4):312-8. doi: 10.1007/s11886-008-0050-0.
Acute coronary syndromes (ACS) are among the most common presentations to emergency departments in North America. An important therapeutic decision facing the clinician is whether antithrombotic therapy is justified and which type confers the lowest risk:benefit ratio. Using low molecular weight heparin (LMWH) has resulted in improved cardiovascular outcomes over unfractionated heparin in the noninvasively treated; however, its use as the antithrombotic agent in the invasive management of ACS has not always been superior. There have also been concerns about bleeding risk with LMWH, especially in the elderly and those with impaired renal function. The longer half-life of LMWH and the complexity of reversing its effect, in the context of multiple antiplatelet and fibrinolytic drugs, have also spurred debate. Finally, there is concern over unwanted thrombotic events with these agents in the cardiac catheterization laboratory.
急性冠状动脉综合征（ACS）是北美急诊科最常见的病症之一。临床医生面临的一个重要治疗决策是抗血栓治疗是否合理，以及哪种类型的抗血栓治疗具有最低的风险效益比。在非侵入性治疗中，使用低分子量肝素（LMWH）相比于普通肝素已改善了心血管结局；然而，其在ACS侵入性治疗中作为抗血栓药物的应用并不总是更具优势。人们也一直担心LMWH的出血风险，尤其是在老年人和肾功能受损者中。在多种抗血小板和纤维蛋白溶解药物的背景下，LMWH较长的半衰期及其作用逆转的复杂性也引发了争论。最后，人们担心这些药物在心脏导管实验室中会引发不良血栓事件。
