Köhler H
Klin Wochenschr. 1977 Jan 15;55(2):49-56. doi: 10.1007/BF01469082.
In terminal renal insufficiency thrombosis occurs almost exclusively in the arteriovenous shunt. The management of this acute, life threatening thrombosis is hardly contested. On the other hand, few results are available concerning effective thrombosis prophylaxis. In addition to the effectiveness, the pharmacokinetics of a substance and also possible bleeding complications must be taken into account. The parenteral administration of heparin and its short half life restrict it to use in thehospital. Oral anticoagulants, because they are difficult to dose, should be avoided when possible. Dextrans (Rheomacrodex) and acetylsalicylic acid (Colfarit) appear to be best suited for thrombosis prophylaxis in renal insufficiency. Dextran has the disadvantage of volume overload, and acetylsalicylic acid that of stomach intolerance. Sulfinpyrazone (Anturano) also appears to be effective, although its pharmacokinetic behaviour in renal insufficiency is still not known. Dipyridamole (Persantin), whose effectiveness for this purpose has not yet been demonstrate, should be administered even more cautiously.
在终末期肾功能不全时，血栓形成几乎仅发生于动静脉分流处。对于这种急性的、危及生命的血栓形成的处理几乎没有争议。另一方面，关于有效的血栓形成预防，可用的结果很少。除了有效性外，还必须考虑一种物质的药代动力学以及可能的出血并发症。肝素的胃肠外给药及其短半衰期限制了它仅能在医院使用。口服抗凝剂由于难以确定剂量，应尽可能避免使用。右旋糖酐（低分子右旋糖酐）和乙酰水杨酸（阿司匹林）似乎最适合用于肾功能不全时的血栓形成预防。右旋糖酐有容量超负荷的缺点，而乙酰水杨酸有胃部不耐受的缺点。苯磺唑酮（安妥明）似乎也有效，尽管其在肾功能不全时的药代动力学行为仍不清楚。双嘧达莫（潘生丁）用于此目的的有效性尚未得到证实，使用时应更加谨慎。
