Bounameaux H
Department of Medicine, University Hospital of Geneva, Switzerland.
Vasa. 1994;23(1):3-9.
Low molecular weight heparins (LMWH) are progressively replacing standard unfractionated heparin (UFH) for prophylaxis of venous thromboembolism, especially following surgery. LMWHs are also being used for treatment of established deep venous thrombosis. The main advantages of this new class of antithrombotic agents as compared with UFH are: 1) a new dosing concept (one single subcutaneous administration instead of two or three), based on improved bioavailability and prolonged half-life; 2) an improved efficacy: safety ratio both in the prophylactic and therapeutic settings. Despite these benefits, some unsolved issues remain to be addressed in specific clinical trials before LMWHs can definitively replace UFH in all previous indications of UFH. These issues include the use of LMWHs in patients with arterial thrombosis or myocardial infarction (e.g. in conjunction with thrombolytic treatment), and in patients with pulmonary embolism. In addition, the easy use of LMWHs opens the way towards outpatient therapy of proximal vein thrombosis but this modality needs to be fully assessed in well-designed clinical trials before definitive recommendations can be given.
低分子量肝素（LMWH）正逐渐取代标准普通肝素（UFH）用于预防静脉血栓栓塞，尤其是在手术后。LMWH也被用于治疗已确诊的深静脉血栓形成。与UFH相比，这类新型抗血栓药物的主要优点是：1）基于提高的生物利用度和延长的半衰期，有了新的给药概念（单次皮下给药而非两次或三次）；2）在预防和治疗方面，疗效：安全性比值有所提高。尽管有这些益处，但在LMWH能够在UFH以前的所有适应证中完全取代UFH之前，一些尚未解决的问题仍有待在特定的临床试验中加以解决。这些问题包括在动脉血栓形成或心肌梗死患者中使用LMWH（例如与溶栓治疗联合使用），以及在肺栓塞患者中使用。此外，LMWH使用方便，为近端静脉血栓形成的门诊治疗开辟了道路，但在能够给出明确建议之前，这种治疗方式需要在精心设计的临床试验中进行充分评估。
