Carter C J
Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada.
Postgrad Med. 1996 Jun;99(6):129-36.
The quest for an orally active anticoagulant to replace warfarin sodium (Coumadin, Panwarfin, Sofarin) in long-term use has been disappointing. Most advances in oral anticoagulant therapy have involved more judicious and efficacious use of warfarin or one of its analogues. The area of heparin substitutes has experienced some exciting discoveries, with most current interest centered on low-molecular-weight heparins. Their efficacy, safety, and perhaps most important, clinical utility as a once- or twice-daily unmonitored medication have given them a meaningful role in current anticoagulation therapy. Third-generation anticoagulants, such as the direct thrombin inhibitors, are being investigated but are not ready for general clinical use. The role of ancrod (Arvin) from snake venom in patients with heparin-induced thrombocytopenic thrombosis has been clearly established. A practical issue that remains under discussion is the most suitable interaction between fiscal and clinical applications of these medications.
寻求一种口服活性抗凝剂来长期替代华法林钠（香豆素、泛华法林、索法林）一直令人失望。口服抗凝治疗的大多数进展都涉及更合理、有效地使用华法林或其类似物之一。肝素替代品领域有一些令人兴奋的发现，目前大多数研究兴趣集中在低分子量肝素上。它们的疗效、安全性，以及可能最重要的是，作为每日一次或两次无需监测的药物的临床实用性，使其在当前抗凝治疗中发挥了重要作用。第三代抗凝剂，如直接凝血酶抑制剂，正在研究中，但尚未准备好用于一般临床。蛇毒中的安克洛酶（阿尔文）在肝素诱导的血小板减少性血栓形成患者中的作用已得到明确证实。这些药物在财务和临床应用之间最适当的相互作用仍是一个正在讨论的实际问题。
