Watson-Williams E J
Clin Chest Med. 1986 Sep;7(3):469-80.
Antithrombotic therapy with heparin is effective in reducing the incidence of thromboembolic disease when given prophylactically to high-risk patients. Heparin followed by oral antithrombotic therapy is accepted practice for the management of established thromboembolism. Fibrinolytic therapy has been demonstrated to be effective in recanalization of vessels occluded by thrombus, but is contraindicated if the effect of peripheral embolization from the occlusion is likely to result in severe morbidity. The use of heparin and oral antithrombotic drugs is associated with an increased frequency of bleeding, and requires careful clinical and laboratory control, for which the best methods have not yet been determined. Low-molecular-weight preparations of heparin have been shown to have effectiveness when administered once or twice a day, but not to have less risk for hemorrhage than regular heparin. Fibrinolytic therapy is entering a new phase with the conclusion of clinical trials of the newer agents that are associated with a reduced risk of systemic anticoagulation.
对高危患者进行预防性肝素抗栓治疗可有效降低血栓栓塞性疾病的发生率。对于已确诊的血栓栓塞症，先使用肝素再进行口服抗栓治疗是公认的治疗方法。纤维蛋白溶解疗法已被证明对血栓阻塞血管的再通有效，但如果阻塞引起的外周栓塞可能导致严重发病，则该疗法为禁忌。使用肝素和口服抗栓药物会增加出血频率，需要仔细的临床和实验室监测，而目前尚未确定最佳监测方法。低分子量肝素制剂已显示出每日给药一到两次的有效性，但与普通肝素相比，出血风险并未降低。随着新型药物临床试验的完成，纤维蛋白溶解疗法正进入一个新阶段，这些新型药物与全身抗凝风险降低相关。
