Hirsh J, Ofosu F, Buchanan M
Semin Thromb Hemost. 1985 Jan;11(1):13-6. doi: 10.1055/s-2007-1004352.
There is now considerable evidence that the antithrombotic and the hemorrhagic effects of heparin can be dissociated by using low molecular weight heparins and by using heparin with low affinity to AT III. The findings with low-affinity heparin suggest that hemorrhage is contributed to by heparin properties that are independent of AT III binding and thus of their major anticoagulant effect. The current evidence supports the suggestion that the hemorrhagic effect of heparin is contributed to by a reversible platelet functional defect that is relatively less important than its AT III dependent anticoagulant effect for preventing experimental venous thrombosis. Whether these promising results in animals also apply to human thromboembolism disease will require careful evaluation by suitably designed clinical trials.
现在有大量证据表明，通过使用低分子量肝素以及使用与抗凝血酶III（AT III）亲和力低的肝素，可以使肝素的抗血栓形成作用和出血作用分离。低亲和力肝素的研究结果表明，出血是由肝素的特性导致的，这些特性独立于与AT III的结合，因此也独立于其主要的抗凝作用。目前的证据支持这样的观点，即肝素的出血作用是由一种可逆的血小板功能缺陷导致的，对于预防实验性静脉血栓形成而言，这种缺陷相对其依赖AT III的抗凝作用不太重要。这些在动物身上取得的有前景的结果是否也适用于人类血栓栓塞疾病，将需要通过精心设计的临床试验进行仔细评估。
