Loeliger E A, Broekmans A W
Haemostasis. 1985;15(4):283-92. doi: 10.1159/000215161.
The relevant literature on the intensity of anticoagulation needed to prevent the development or growth of thrombi in patients at risk is reviewed. In case of elective surgery, prevention of venous thrombosis is easily attained with heparin or with coumarin alone, at levels of anticoagulation involving only a minor risk of bleeding complications. For posttraumatic prophylaxis, more intensive oral anticoagulation is required, similar to that for the management of active venous thrombosis, for which a combined heparin/coumarin regimen is proposed. A 90% reduction of the incidence of systemic emboli in patients with a high risk of developing intracardiac thrombosis requires high-intensity treatment with a target INR of 4. More intensive anticoagulation would be needed to obtain the same 90% protection in case of arterial (coronary) thrombosis. This is prohibited, however, by the rapidly increasing bleeding risk in cases with INR values greater than 5. With a target INR of 3.5 (sixty-Plus patients), the reinfarction rate will not be lowered by more than two thirds. Antiplatelet drugs given alone or in combination with anticoagulants have not been convincingly successful thus far in the prevention and treatment of thrombosis.
本文综述了关于处于血栓形成或发展风险的患者预防血栓所需抗凝强度的相关文献。对于择期手术，仅使用肝素或香豆素，在抗凝水平仅涉及轻微出血并发症风险的情况下，即可轻松预防静脉血栓形成。对于创伤后预防，需要更强化的口服抗凝治疗，类似于对活动性静脉血栓形成的治疗，为此建议采用肝素/香豆素联合方案。对于有发生心内血栓高风险的患者，将系统性栓塞发生率降低90%需要高强度治疗，目标国际标准化比值（INR）为4。对于动脉（冠状动脉）血栓形成，若要获得相同的90%保护率，则需要更强化的抗凝治疗。然而，当INR值大于5时，出血风险会迅速增加，这限制了这种治疗。对于目标INR为3.5的患者（60岁及以上），再梗死率降低幅度不会超过三分之二。单独使用抗血小板药物或与抗凝剂联合使用，在预防和治疗血栓形成方面迄今尚未取得令人信服的成功。
