Cole C W, Bormanis J
Departments of Surgery, Ottawa Civic Hospital, Ontario, Canada.
J Vasc Surg. 1988 Jul;8(1):59-63. doi: 10.1067/mva.1988.avs0080059.
To rapidly start systemic anticoagulation there are few alternatives to heparin; those that may be used are often less effective and are impractical substitutes for various reasons. We report the cases of seven patients in whom anticoagulant therapy was begun with ancrod instead of heparin for one or more of the following reasons: (1) failure to achieve systemic anticoagulation in response to heparin (e.g., antithrombin III deficiency), (2) heparin-associated complications (e.g., thrombocytopenia, thrombosis, or both), and (3) combined anticoagulation and improved blood rheology considered to be potentially more beneficial than anticoagulation alone (e.g., massive thrombosis). In the cases reported, ancrod permitted systemic anticoagulation equal to that of heparin; this was achieved without bleeding complications. In contrast to streptokinase or urokinase, ancrod does not degrade preformed, fully cross-linked thrombin fibrin; consequently hemorrhagic complications are uncommon. Ancrod appears to be an appropriate alternative to heparin and may be preferable to it in certain circumstances.
为迅速启动全身抗凝治疗，除肝素外几乎没有其他选择；那些可能被使用的药物往往效果较差，且由于各种原因不切实际。我们报告了7例患者的病例，这些患者因以下一个或多个原因开始使用安克洛酶而非肝素进行抗凝治疗：（1）对肝素无反应而未能实现全身抗凝（如抗凝血酶III缺乏），（2）肝素相关并发症（如血小板减少、血栓形成或两者兼有），以及（3）联合抗凝和改善血液流变学被认为可能比单独抗凝更有益（如大面积血栓形成）。在所报告的病例中，安克洛酶可实现与肝素相当的全身抗凝；且未出现出血并发症。与链激酶或尿激酶不同，安克洛酶不会降解已形成的、完全交联的凝血酶纤维蛋白；因此出血并发症并不常见。安克洛酶似乎是肝素的合适替代品，在某些情况下可能更优于肝素。
