静脉血栓栓塞症预防和治疗中肠外抗凝剂的差异。
Differentiation of parenteral anticoagulants in the prevention and treatment of venous thromboembolism.
机构信息
Departments of Pathology, Loyola University Medical Center, Maywood, Illinois, USA.
出版信息
Thromb J. 2011 Mar 28;9(1):5. doi: 10.1186/1477-9560-9-5.
BACKGROUND
The prevention of venous thromboembolism has been identified as a leading priority in hospital safety. Recommended parenteral anticoagulant agents with different indications for the prevention and treatment of venous thromboembolism include unfractionated heparin, low-molecular-weight heparins and fondaparinux. Prescribing decisions in venous thromboembolism management may seem complex due to the large range of clinical indications and patient types, and the range of anticoagulants available.
METHODS
MEDLINE and EMBASE databases were searched to identify relevant original articles.
RESULTS
Low-molecular-weight heparins have nearly replaced unfractionated heparin as the gold standard antithrombotic agent. Low-molecular-weight heparins currently available in the US are enoxaparin, dalteparin, and tinzaparin. Each low-molecular-weight heparin is a distinct pharmacological entity with different licensed indications and available clinical evidence. Enoxaparin is the only low-molecular-weight heparin that is licensed for both venous thromboembolism prophylaxis and treatment. Enoxaparin also has the largest body of clinical evidence supporting its use across the spectrum of venous thromboembolism management and has been used as the reference standard comparator anticoagulant in trials of new anticoagulants. As well as novel oral anticoagulant agents, biosimilar and/or generic low-molecular-weight heparins are now commercially available. Despite similar anticoagulant properties, studies report differences between the branded and biosimilar and/or generic agents and further clinical studies are required to support the use of biosimilar low-molecular-weight heparins. The newer parenteral anticoagulant, fondaparinux, is now also licensed for venous thromboembolism prophylaxis in surgical patients and the treatment of acute deep-vein thrombosis; clinical experience with this anticoagulant is expanding.
CONCLUSIONS
Parenteral anticoagulants should be prescribed in accordance with recommended dose regimens for each clinical indication, based on the available clinical evidence for each agent to assure optimal safety and efficacy.
背景
预防静脉血栓栓塞症已被确定为医院安全的首要任务。具有不同适应证的推荐的肠外抗凝药物包括普通肝素、低分子肝素和磺达肝癸钠。由于静脉血栓栓塞症管理中的临床适应证和患者类型范围广泛，以及可用的抗凝剂种类繁多，因此处方决策可能看起来很复杂。
方法
检索 MEDLINE 和 EMBASE 数据库以确定相关的原始文章。
结果
低分子肝素已几乎取代普通肝素成为抗血栓形成的金标准药物。目前在美国上市的低分子肝素有依诺肝素、达肝素和亭扎肝素。每种低分子肝素都是一种具有不同适应证和可用临床证据的独特药理学实体。依诺肝素是唯一一种既用于静脉血栓栓塞症预防又用于治疗的低分子肝素。依诺肝素拥有最大量的支持其在静脉血栓栓塞症管理范围内使用的临床证据，并且已被用于新型抗凝剂试验中的参照标准比较抗凝剂。除了新型口服抗凝剂外，生物类似物和/或通用低分子肝素现在也已上市。尽管具有相似的抗凝特性，但研究报告表明，品牌药物与生物类似物和/或通用药物之间存在差异，需要进一步的临床研究来支持生物类似物低分子肝素的使用。新型肠外抗凝药物磺达肝癸钠现在也已获准用于手术患者的静脉血栓栓塞症预防和急性深静脉血栓形成的治疗；该抗凝剂的临床应用经验正在不断扩大。
结论
应根据每种药物的现有临床证据，按照每种适应证的推荐剂量方案，为患者开具肠外抗凝药物，以确保最佳的安全性和疗效。
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