Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
J Thromb Haemost. 2011 Sep;9(9):1705-12. doi: 10.1111/j.1538-7836.2011.04432.x.
The most important adverse effect of antithrombotic treatment is the occurrence of bleeding. In the case of severe bleeding in a patient who uses anticoagulant agents or when a patient on anticoagulants needs to undergo an urgent invasive procedure, it may be useful to reverse anticoagulant treatment. Conventional anticoagulants such as vitamin K antagonists may be neutralized by administration of vitamin K or prothrombin complex concentrates, whereas heparin and heparin derivatives can be counteracted by protamine sulphate. The anti-hemostatic 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 as well as new antiplatelet agents have been introduced and these drugs show promising results in clinical studies. A limitation of these new agents may be the lack of an appropriate strategy to reverse the effect if a bleeding event occurs, although experimental studies show hopeful results for some of these agents.
抗栓治疗最重要的不良反应是出血。在使用抗凝药物的患者发生严重出血的情况下，或者当需要接受紧急有创操作的抗凝患者时，可能需要逆转抗凝治疗。传统抗凝剂，如维生素 K 拮抗剂，可以通过给予维生素 K 或凝血酶原复合物浓缩物来中和，而肝素和肝素衍生物可以用硫酸鱼精蛋白中和。如果需要，阿司匹林和其他抗血小板策略的抗止血作用可以通过给予血小板浓缩物和/或去氨加压素来纠正。最近，新一代针对活化凝血因子的特异性更高的抗凝药物和新型抗血小板药物已经问世，这些药物在临床研究中显示出有前途的结果。这些新药物的一个局限性可能是，如果发生出血事件，缺乏适当的逆转效果的策略，尽管实验研究显示对于其中一些药物有希望的结果。
