Crowther M A, Warkentin T E
Division of Hematology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
J Thromb Haemost. 2009 Jul;7 Suppl 1:107-10. doi: 10.1111/j.1538-7836.2009.03429.x.
Heparin, low molecular weight heparin (LMWH) and coumarins are familiar to most clinicians, inexpensive, highly effective when correctly used and widely available. However, coumarin has a delayed onset of action, interacts with many medications, has a narrow therapeutic window, and can cause thrombosis in some settings (e.g. hereditary protein C deficiency, heparin induced thrombocytopenia, warfarin loading). Additionally, warfarin and heparin require monitoring of their therapeutic effect. These real and perceived limitations have led to the development of 'novel' anticoagulants. However, these new agents have one general limitation--a lack of a widely available antidote. We focus on the management of bleeding in anticoagulated patients, with particular regard to novel anticoagulants.
肝素、低分子量肝素（LMWH）和香豆素类药物为大多数临床医生所熟知，价格低廉，正确使用时疗效显著且广泛可得。然而，香豆素类药物起效延迟，与多种药物相互作用，治疗窗狭窄，并且在某些情况下（如遗传性蛋白C缺乏、肝素诱导的血小板减少症、华法林负荷）可导致血栓形成。此外，华法林和肝素需要监测其治疗效果。这些实际存在的以及人们所察觉到的局限性促使了“新型”抗凝剂的研发。然而，这些新型药物有一个普遍的局限性——缺乏一种广泛可得的解毒剂。我们重点关注抗凝患者出血的处理，尤其涉及新型抗凝剂。
