Meltzer Joseph, Guenzer Joseph R
Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
Department of Anesthesiology, University of Utah Medical School, 30 North 1900 East, Room 3C444, Salt Lake City, UT 84132-2501, USA.
Anesthesiol Clin. 2017 Jun;35(2):191-205. doi: 10.1016/j.anclin.2017.01.005. Epub 2017 Mar 30.
Bleeding complications are a common concern with the use of anticoagulant agents. In many situations, reversing of neutralizing their effects may be warranted. Prothrombin complex concentrate replaces coagulation factors lowered by warfarin, as does fresh frozen plasma, but in a more concentrated form. Protamine negates the effect of heparin and combines chemically with heparin molecules to form an inactive salt. It also partially reverses the effects of low-molecular-weight heparin. Recombinant activated factor VII is a nonspecific procoagulant that activates the extrinsic clotting pathway, resulting in thrombin generation, but does not directly neutralize the activity of any of the new oral anticoagulants.
出血并发症是使用抗凝剂时常见的问题。在许多情况下，可能需要逆转或中和其作用。凝血酶原复合物浓缩物可替代华法林降低的凝血因子，新鲜冷冻血浆也有此作用，但前者的形式更为浓缩。鱼精蛋白可消除肝素的作用，并与肝素分子发生化学反应形成无活性的盐。它还能部分逆转低分子量肝素的作用。重组活化因子VII是一种非特异性促凝血剂，可激活外源性凝血途径，导致凝血酶生成，但不能直接中和任何新型口服抗凝剂的活性。
