Bounameaux H, Goldhaber S Z
Department of Internal Medicine, University of Geneva School of Medicine, Switzerland.
Blood Rev. 1995 Dec;9(4):213-9. doi: 10.1016/s0268-960x(95)90012-8.
Low-molecular-weight-heparin fractions are prepared from standard unfractionated heparin and are thus similar to unfractionated heparin in many aspects. The main advantages of this new class of antithrombotic agents as compared with unfractionated heparin are: (1) an improved bioavailability and a prolonged half-life, which alleviate cumbersome laboratory monitoring and may permit one single daily subcutaneous injection; (2) an improved efficacy-to-safety ratio, with less bleeding despite similar or improved efficacy. While low-molecular-weight heparin should replace unfractionated heparin for preventing postoperative thromboembolism, some unresolved issues remain to be addressed in specific trials before low-molecular-weight heparin can generally replace unfractionated heparin for all indications. These issues include the use of low-molecular-weight heparin in patients with arterial thrombosis, unstable angina, or myocardial infarction (usually in conjunction with thrombolytic treatment), and in patients with symptomatic pulmonary embolism, as well as formal cost-effectiveness analyses substantiating the advantages of the new agents. The potential of using low-molecular-weight-heparin outpatient treatment of established deep-vein thrombosis should be scrutinized from an economic and logistic point of view because two large-scale controlled trials have suggested both efficacy and safety.
低分子量肝素片段由标准的普通肝素制备而来，因此在许多方面与普通肝素相似。与普通肝素相比，这类新型抗血栓药物的主要优点是：（1）生物利用度提高，半衰期延长，这减轻了繁琐的实验室监测负担，并且可能允许每日单次皮下注射；（2）效价比提高，尽管疗效相似或有所提高，但出血更少。虽然低分子量肝素应取代普通肝素用于预防术后血栓栓塞，但在低分子量肝素能够普遍取代普通肝素用于所有适应症之前，一些尚未解决的问题仍有待在特定试验中加以解决。这些问题包括在动脉血栓形成、不稳定型心绞痛或心肌梗死患者（通常与溶栓治疗联合使用）以及有症状的肺栓塞患者中使用低分子量肝素，以及进行正式的成本效益分析以证实新型药物的优势。从经济和后勤角度审视使用低分子量肝素门诊治疗已确诊的深静脉血栓形成的可能性是有必要的，因为两项大规模对照试验均表明了其有效性和安全性。
