Hull R D, Pineo G F
Department of Medicine, University of Calgary, Alta., Canada.
Haemostasis. 1993 Mar;23 Suppl 1:2-9. doi: 10.1159/000216901.
Accumulating evidence indicates that certain low-molecular-weight (LMW) heparins administered subcutaneously may replace classic intravenous heparin therapy. LMW heparins do not require monitoring and may be safer and more effective than unfractionated heparin. The decreased mortality rate, evident in two randomized trials, which was particularly striking in patients with metastatic carcinoma, requires confirmation. The simplified care offered by LMW heparin therapy raises the possibility of transferring care from in-hospital to out of hospital in uncomplicated patients with deep-vein thrombosis [Salzman EW: Low-molecular weight heparin and other new antithrombotic drugs. N Engl J Med 1992;326: 1017-1019]. The advantages to the patient of avoiding in-hospital care and its associated hazards are obvious. Outpatient LMW heparin therapy will likely prove to be highly cost-effective. It is uncertain at present whether the findings associated with an individual LMW heparin preparation can be extrapolated to a different LMW heparin. For this reason the findings of clinical trials apply only to the particular LMW heparin evaluated and cannot be generalized to the LMW heparins at large.
越来越多的证据表明，某些皮下注射的低分子量（LMW）肝素可能会取代传统的静脉肝素治疗。低分子量肝素无需监测，可能比普通肝素更安全、更有效。两项随机试验中明显降低的死亡率，在转移性癌患者中尤为显著，这需要进一步证实。低分子量肝素治疗提供的简化护理增加了将深静脉血栓形成的非复杂性患者的护理从医院内转移到医院外的可能性[萨尔兹曼EW：低分子量肝素和其他新型抗血栓药物。《新英格兰医学杂志》1992年；326：1017 - 1019]。避免住院护理及其相关风险对患者的益处是显而易见的。门诊低分子量肝素治疗可能被证明具有很高的成本效益。目前尚不确定与一种低分子量肝素制剂相关的研究结果是否能外推至另一种低分子量肝素。因此，临床试验的结果仅适用于所评估的特定低分子量肝素，不能推广至所有低分子量肝素。
