Fiessinger J N
Presse Med. 1994 Mar 19;23(11):509-10.
Anticoagulants are generally prescribed for the treatment of thrombosis occurring in deep veins. Recent progress in both heparin therapy and in antivitamin K agents require a new look at the therapeutic choice. Due to its immediate anticoagulant action heparin is essential as first intention therapy. Indeed, initial oral anticoagulants are less effective, both in terms of clinical extension and in radiological outcome, than an initial heparin/antivitamin K combination. Non-fractionated heparin administered with an automatic syringe after a priming bolus is the reference treatment for venous thrombosis since it has now been established that 2 subcutaneous injections of heparin are less effective than the intravenous route. Both the effect and safety of low molecular weight heparin have been shown to be comparable with that of non-fractionated heparin. When the dose is adapted to patient weight, 70% are within therapeutic limits after the first injection. Two daily injections of 100 IU per kg body weight can be recommended as initial treatment for deep vein thrombosis. Anticoagulation must be continued for several days but the risk of induced thrombocytopenia persists with low molecular weight heparin. Long-term use should be retained essentially for pregnant women with deep vein thrombosis due to the foetal risk of oral antivitamin K. Antivitamin K oral agents may be initiated early without hindering the anticoagulant effect of heparin. With oral agents, anticoagulant equilibrium is reached, on the average, after 6 days and is a function of vitamin K-dependent half-lives. Since antivitamin K agents affect the stability of prothrombin times during the day/night cycle, it has been recommended to favour long half-life molecules. Standardized prescription protocols can improve safety and anticoagulant equilibrium. To date, the recommended management of deep vein thrombosis includes combining low molecular weight heparin and long half-life antivitamin K. Further progress may be forthcoming with the development of new antithrombotic agents such as hirudine or sulfated heparanes.
抗凝剂通常用于治疗深静脉血栓形成。肝素疗法和抗维生素K药物的最新进展需要重新审视治疗选择。由于肝素具有即时抗凝作用，因此作为首选治疗方法至关重要。实际上，就临床扩展和放射学结果而言，初始口服抗凝剂不如初始肝素/抗维生素K联合用药有效。在给予首剂负荷量后用自动注射器注射普通肝素是静脉血栓形成的参考治疗方法，因为现已确定皮下注射2次肝素的效果不如静脉途径。低分子量肝素的疗效和安全性已被证明与普通肝素相当。当剂量根据患者体重调整时，首次注射后70%的患者处于治疗范围内。对于深静脉血栓形成的初始治疗，可推荐每日两次注射每公斤体重100 IU。抗凝必须持续数天，但低分子量肝素仍存在诱发血小板减少症的风险。由于口服抗维生素K对胎儿有风险，长期使用基本上应保留给患有深静脉血栓形成的孕妇。抗维生素K口服药物可早期开始使用，而不会妨碍肝素的抗凝作用。使用口服药物时，平均6天后达到抗凝平衡，这是维生素K依赖性半衰期的函数。由于抗维生素K药物会影响凝血酶原时间在昼夜周期中的稳定性，因此建议选择半衰期长的分子。标准化的处方方案可以提高安全性和抗凝平衡。迄今为止，推荐的深静脉血栓形成管理方法包括联合使用低分子量肝素和半衰期长的抗维生素K。随着新的抗血栓药物如hirudine或硫酸化肝素的开发，可能会取得进一步进展。
