Levi M M, Eerenberg E, Löwenberg E, Kamphuisen P W
Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Neth J Med. 2010 Feb;68(2):68-76.
The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. In case of serious or even life-threatening bleeding in a patient who uses anticoagulant agents or when patient on anticoagulants needs to undergo an urgent invasive procedure, anticoagulant treatment can be reversed by various specific strategies. Heparin and heparin derivatives can be counteracted by protamine sulphate, whereas the anticoagulant effect of vitamin K antagonists may be neutralised by administration of vitamin K or prothrombin complex concentrates. The antihaemostatic effect of aspirin and other antiplatelet strategies can be corrected by the administration of platelet concentrate and/or desmopressin, if needed. Recently, a new generation of anticoagulants with a greater specificity towards activated coagulation factors has been introduced and most of these agents are currently being evaluated in clinical studies, showing promising results. The new-generation anticoagulants include specific inhibitors of factor IIa or factor Xa (including pentasaccharides) and antiplatelet agents belonging to the class of thienopyridine derivatives. A limitation of the new class of anti-IIa and anti-Xa agents may be the lack of an appropriate strategy to reverse the effect if a bleeding event occurs, although in some cases the administration of recombinant factor VIIa may be an option.
抗栓治疗最重要的不良反应是出血。使用抗凝剂的患者发生严重甚至危及生命的出血时，或正在接受抗凝治疗的患者需要进行紧急侵入性操作时，可通过各种特定策略逆转抗凝治疗。硫酸鱼精蛋白可中和肝素及肝素衍生物，而维生素K拮抗剂的抗凝作用可通过给予维生素K或凝血酶原复合物浓缩剂来中和。必要时，可通过输注血小板浓缩液和/或去氨加压素纠正阿司匹林及其他抗血小板策略的止血作用。最近，已引入了新一代对活化凝血因子具有更高特异性的抗凝剂，目前大多数此类药物正在临床研究中进行评估，结果令人鼓舞。新一代抗凝剂包括凝血因子IIa或Xa的特异性抑制剂（包括戊糖）以及噻吩并吡啶衍生物类抗血小板药物。新一代抗IIa和抗Xa药物的一个局限性可能是，如果发生出血事件，缺乏适当的逆转作用策略，尽管在某些情况下给予重组凝血因子VIIa可能是一种选择。
