Weitz J, Hirsh J
Department of Medicine, McMaster University.
J Lab Clin Med. 1993 Oct;122(4):364-73.
The limitations of standard heparin have prompted the development of a variety of newer antithrombotic agents. In fact, a LMWH preparation has recently been approved for clinical use in North America. Of these novel preparations, LMWH, the direct thrombin inhibitors, and inhibitors of GPIIb-IIIa have been used clinically and are in advanced stages of evaluation. Not only is LMWH effective in the prevention of venous thromboembolic disease in high-risk patients, but its more predictable dose response makes it an ideal candidate for the treatment of venous thrombosis. Further studies are needed to determine whether LMWH is superior to standard heparin as adjunctive therapy in patients undergoing coronary thrombolysis or angioplasty. Particularly promising in the setting of arterial thrombosis are hirudin, hirulog, and 7E3. With the encouraging results reported to date, it is likely that these agents will soon find their way into the treatment armamentarium of arterial thrombosis.
标准肝素的局限性促使了多种新型抗血栓药物的研发。事实上，一种低分子量肝素制剂最近已在北美获批用于临床。在这些新型制剂中，低分子量肝素、直接凝血酶抑制剂以及糖蛋白IIb-IIIa抑制剂已用于临床并处于评估的后期阶段。低分子量肝素不仅在预防高危患者的静脉血栓栓塞性疾病方面有效，而且其更可预测的剂量反应使其成为治疗静脉血栓形成的理想选择。需要进一步研究以确定在接受冠状动脉溶栓或血管成形术的患者中，低分子量肝素作为辅助治疗是否优于标准肝素。水蛭素、水蛭肽和7E3在动脉血栓形成的情况下尤其有前景。鉴于迄今报道的令人鼓舞的结果，这些药物很可能很快会进入动脉血栓形成的治疗手段中。
