Volteas S K, Kalodiki E, Nicolaides A N
Academic Vascular Unit, St. Mary's Hospital Medical School, London, UK.
Int Angiol. 1996 Mar;15(1):67-74.
All major trials to-date provide strong evidence that, for the initial treatment of DVT, adjusted-dose LMWHs are at least as effective and safe as unfractionated heparin (UFH). When compared with UFH, LMWHs achieved better thrombus lysis and had less bleeding complications (21-91% risk reduction) and mortality (51% reduction). They also reduced the incidence of recurrent DVT and PE at 90 days follow-up while there was no need for monitoring. Despite these exciting findings however, long-term evaluation of mortality rate, recurrent venous thromboembolism, blood monitoring tests efficacy and thrombus propagation/reduction are open issues. Furthermore, venous haemodynamics have never been tested. There is an ongoing Canadian study today, aiming to determine LMWHs effectiveness in reducing death, recurrent venous thromboembolism and haemorrhagic complications; it is obvious however that further studies are needed. We must determine if a prolonged use of LMWHs (i.e. 90 days) is more effective in preventing the post-thrombotic sequelae, reducing also the incidence of haemorrhagic complications; we also need to know the nature of the haematological changes that develop and the relationship between these changes and the recurrence rate; and finally, we must identify effective blood tests to monitor this treatment.
迄今为止，所有主要试验均提供了强有力的证据，表明对于深静脉血栓形成（DVT）的初始治疗，调整剂量的低分子肝素（LMWH）至少与普通肝素（UFH）一样有效且安全。与UFH相比，LMWH实现了更好的血栓溶解，出血并发症（风险降低21%-91%）和死亡率（降低51%）更少。在90天随访时，它们还降低了复发性DVT和肺栓塞（PE）的发生率，同时无需监测。然而，尽管有这些令人兴奋的发现，但死亡率、复发性静脉血栓栓塞、血液监测测试疗效以及血栓扩展/缩小的长期评估仍是未解决的问题。此外，静脉血流动力学从未得到测试。目前加拿大正在进行一项研究，旨在确定LMWH在降低死亡、复发性静脉血栓栓塞和出血并发症方面的有效性；然而，显然还需要进一步的研究。我们必须确定延长使用LMWH（即90天）是否在预防血栓形成后后遗症、降低出血并发症发生率方面更有效；我们还需要了解所发生血液学变化的性质以及这些变化与复发率之间的关系；最后，我们必须确定有效的血液测试来监测这种治疗。
