Baglin T P
Department of Haematology, Addenbrooke's NHS Trust, Cambridge, UK.
Haemostasis. 1996;26 Suppl 2:10-5. doi: 10.1159/000217268.
Unfractionated heparin is the commonest treatment for established venous thromboembolism. While this treatment undoubtedly reduces mortality and morbidity there are problems associated with its use. It does not always prevent thrombus propagation or embolisation, the low bioavailability results in a frequent failure to achieve therapeutic heparin levels in vivo and the variable sensitivity of the partial thromboplastin time to the heparin effect may result in inappropriate heparin dosage. The low-molecular-weight heparins have high predictable bioavailability and can be administered as weight-calculated fixed-dose regimens for the treatment of established venous thromboembolism. While statistically significant clinical results are awaited, there is increasing evidence for the superior benefit-risk ratios for these agents compared to unfractionated heparin. In routine practice, the frequent failure to achieve a therapeutic intensity of anticoagulation is currently the main reason for adopting low-molecular-weight heparins for first-line treatment of venous thromboembolism. Cost analysis studies based on total health care costs may support the use of these drugs, because savings from the abolishment of laboratory monitoring, improved clinical outcome and shorter inpatient stay may prove treatment with low-molecular weight heparin to be more cost-effective than treatment with unfractionated heparin.
普通肝素是已确诊静脉血栓栓塞症最常用的治疗药物。虽然这种治疗方法无疑能降低死亡率和发病率，但使用过程中存在一些问题。它并不总能防止血栓扩展或栓塞，生物利用度低导致体内经常无法达到治疗性肝素水平，部分凝血活酶时间对肝素作用的敏感性差异可能导致肝素剂量不当。低分子量肝素具有高度可预测的生物利用度，可按体重计算的固定剂量方案给药，用于治疗已确诊的静脉血栓栓塞症。虽然统计学上显著的临床结果尚待观察，但越来越多的证据表明，与普通肝素相比，这些药物的效益风险比更优。在常规实践中，目前抗凝治疗强度经常无法达到是采用低分子量肝素作为静脉血栓栓塞症一线治疗药物的主要原因。基于总体医疗保健成本的成本分析研究可能支持使用这些药物，因为取消实验室监测、改善临床结果和缩短住院时间所节省的费用可能证明低分子量肝素治疗比普通肝素治疗更具成本效益。
