Tomaru T, Nakamura F, Fujimori Y, Omata M, Kawai S, Okada R, Murata Y, Uchida Y
Second Department of Internal Medicine, University of Tokyo, Japan.
J Am Coll Cardiol. 1995 Nov 1;26(5):1325-32. doi: 10.1016/0735-1097(95)00324-X.
This study was designed to evaluate the efficacy of local versus systemic treatment of thrombosis with various antithrombotic drugs.
Local use of low dose antithrombotic drugs has been proposed as being effective and safe.
Heparin (30 U/kg), an antithrombin agent (argatroban, 0.05 mg/kg body weight) or a defibrinogenating drug (batroxobin, 0.05 U/kg) was locally infused into one side of the canine iliac artery after injury by balloon inflation. The other side was injured as a control. The efficacy of systemic delivery of high dose (heparin [300 U/kg] and argatroban [0.5 mg/kg]) and low dose drugs was also assessed.
Sixty minutes after local treatment in 22 dogs, no thrombotic stenosis was observed by angiography in locally treated arteries (p < 0.005 vs. mean thrombotic stenosis of 27% in control segments for heparin, 25.3% in control segments for argatroban and 32% in control segments for batroxobin). Angioscopy demonstrated the same trend. In locally treated arteries, thrombus weight was significantly lower in the treated than control side. In the systemic high dose group (n = 10), angiographic thrombotic stenosis was < 5% after high dose drug delivery (p < 0.05 vs. control segments, 37.4% for heparin, 43% for argatroban). In another 10 dogs, low dose systemic delivery was not effective in inhibiting thrombus formation. Activated partial thromboplastin time and fibrinogen levels did not change with local treatment.
Compared with systemic administration of antithrombotic drugs, local treatment is a safer and more effective method of preventing thrombosis.
本研究旨在评估使用各种抗血栓药物进行局部治疗与全身治疗血栓形成的疗效。
已有人提出局部使用低剂量抗血栓药物是有效且安全的。
在通过球囊扩张造成犬髂动脉损伤后，将肝素（30 U/kg）、一种抗凝血酶药物（阿加曲班，0.05 mg/kg体重）或一种去纤维蛋白药物（巴曲酶，0.05 U/kg）局部注入一侧髂动脉。另一侧作为对照。还评估了高剂量（肝素[300 U/kg]和阿加曲班[0.5 mg/kg]）和低剂量药物全身给药的疗效。
22只犬局部治疗60分钟后，血管造影显示局部治疗的动脉未观察到血栓性狭窄（与肝素对照节段平均血栓性狭窄27%、阿加曲班对照节段25.3%、巴曲酶对照节段32%相比，p < 0.005）。血管内镜检查显示了相同趋势。在局部治疗的动脉中，治疗侧的血栓重量明显低于对照侧。在全身高剂量组（n = 10）中，高剂量药物给药后血管造影血栓性狭窄< 5%（与对照节段相比，p < 0.05，肝素对照节段为37.4%，阿加曲班对照节段为43%）。在另外10只犬中，低剂量全身给药在抑制血栓形成方面无效。局部治疗后活化部分凝血活酶时间和纤维蛋白原水平未发生变化。
与抗血栓药物的全身给药相比，局部治疗是预防血栓形成的一种更安全、更有效的方法。
