Dipartimento di Scienze Mediche Internistiche, University of Cagliari, Cagliari, Italy.
Intern Emerg Med. 2012 Feb;7(1):21-5. doi: 10.1007/s11739-011-0543-5. Epub 2011 Mar 5.
In this review, we present some different and special conditions that are generally being treated with anticoagulants such as cerebral vein thrombosis (CVT), mesenteric vein thrombosis (MVT), Budd-Chiari syndrome (BCS), and Pulmonary Hypertension (PH) despite the lack of controlled clinical trials. While either low molecular weight heparins (LMWHs) or unfractioned heparin (UFH) are used in the acute phase of the first three conditions, the potential chronic use of warfarin in PH is controversial. What is not completely known in the management of CVT, MTV, and BCS is whether (a) LMWHs are similar to UFH in terms of efficacy and safety, and (b) a fibrinolytic drug could be employed in the acute phase. The timing at which warfarin should be started, and the duration of its employment are two additional crucial points that deserve to be examined. In the course of PH, the role of warfarin is controversial, but it could be employed after a careful balance of the hemorrhagic and thromboembolic risk. In conclusion, we tried to simplify the approach to this sometimes problematic task considering the available literature with the aim of providing some practical skills to be used by physicians in their daily clinical practice. Since it is improbable that in the future controlled clinical trials will be designed to find the optimal anti-thrombotic management of these conditions, we believe that a physician should be aware of the lack of solid data in the field but at the same time should always exert clinical judgment when considering an aggressive anticoagulant approach. The duration of oral anticoagulant treatment is left to the clinical judgment of the balance between the hemorrhagic and thrombotic risks in any single patient.
在这篇综述中，我们介绍了一些不同的特殊情况，尽管缺乏对照临床试验，但这些情况通常会使用抗凝剂进行治疗，如脑静脉血栓形成（CVT）、肠系膜静脉血栓形成（MVT）、布加综合征（BCS）和肺动脉高压（PH）。在这三种疾病的急性期，低分子肝素（LMWHs）或未分级肝素（UFH）都可用于治疗，而华法林在 PH 的潜在慢性使用则存在争议。在 CVT、MVT 和 BCS 的管理中，尚未完全明确以下两个问题：（a）LMWHs 在疗效和安全性方面是否与 UFH 相似；（b）在急性期是否可以使用纤维蛋白溶解药物。何时开始使用华法林以及其使用时间长短是另外两个值得研究的关键问题。在 PH 中，华法林的作用存在争议，但在仔细权衡出血和血栓栓塞风险后，仍可使用。总之，我们试图参考现有文献，简化处理这一有时存在问题的任务，为医生在日常临床实践中提供一些实用技能。由于未来不太可能设计对照临床试验来确定这些疾病的最佳抗血栓治疗方法，因此我们认为，医生应该意识到该领域缺乏确凿的数据，但同时在考虑积极抗凝治疗方法时，应始终运用临床判断。抗凝治疗的持续时间取决于每个患者出血和血栓形成风险的临床判断。
