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低剂量肝素治疗是否需要连续血液学监测?(作者译)

[Does low-dosage heparin treatment require serial haematological controls? (author's transl)].

作者信息

Bruhn H D, Albert J P, Sachs L, Timme H

出版信息

Dtsch Med Wochenschr. 1979 Sep 21;104(38):1336-9. doi: 10.1055/s-0028-1129094.

Abstract

Blanket serial controls are not necessary in low-dosage heparin treatment. It would, in any case, be difficult under normal clinical conditions and would run counter to the whole conception of low-dose heparin treatment. However, in problem cases with an increased thrombo-embolic risk, sensitive methods for monitoring the heparin effect are recommended. A study on 150 patients has indicated that the most sensitive method is the use of chromogenic substrates. Thrombin time, using low-concentration thrombin solution of 1.5 NIH units/ml, thrombelastogram and activated partial thromboplastin time are less sensitive. Antithrombin III levels should be determined in all cases of increased heparin tolerance. With reduced antithrombin III levels and higher body weight an increase of the standard dose from 5000 U.S.P. units heparin t. i. d. subcutaneously to 7500 U.S.P. units t. i. d. should be considered.

摘要

在低剂量肝素治疗中,无需进行常规系列监测。无论如何,在正常临床情况下这都很困难,并且会与低剂量肝素治疗的整体理念相悖。然而,对于血栓栓塞风险增加的疑难病例,建议采用敏感方法监测肝素效果。一项针对150名患者的研究表明,最敏感的方法是使用发色底物。使用1.5 NIH单位/毫升的低浓度凝血酶溶液测定的凝血酶时间、血栓弹力图和活化部分凝血活酶时间的敏感性较低。在所有肝素耐受性增加的病例中均应测定抗凝血酶III水平。当抗凝血酶III水平降低且体重增加时,应考虑将标准剂量从皮下注射5000美国药典单位肝素每日三次增至7500美国药典单位每日三次。

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