Kearon C
Hamilton Civic Hospitals Research Centre, Ontario, Canada.
Thromb Haemost. 1997 Jul;78(1):553-7.
Heparin and oral anticoagulants have been the mainstay of antithrombotic therapy for the prevention and treatment of venous thromboembolism for over 50 years. Randomized trials have established their efficacy and have been used to refine the optimal dose and duration of therapy for different indications. Low-dose, subcutaneous, standard heparin and low molecular weight heparin (LMWH) provide effective primary prophylaxis, higher doses being indicated for patients who are at highest risk. OA is an alternative in high risk patients, particularly if there are persistent risk factors. Heparin and OA can be started concomitantly when treating patients with acute VTE. At least 4 days of adjusted dose standard heparin, or fixed dose LMWH, should be administered, and heparin should not be stopped until therapeutic OA is established. Acute DVT can be treated as an outpatient with fixed dose LMWH. In general, OA, with an International Normalization Ratio of 2.0-3.0, should be continued for 3 to 6 months. The optimal duration of OA may differ between patients who have VTE associated with a transient or a continuing (including "idiopathic") risk factors; however, this remains to be defined. New antithrombotic agents, such as direct thrombin inhibitors, are in the preliminary stages of evaluation for the prevention and treatment of VTE.
五十多年来，肝素和口服抗凝剂一直是预防和治疗静脉血栓栓塞症抗栓治疗的主要手段。随机试验已证实了它们的疗效，并被用于确定不同适应证的最佳治疗剂量和疗程。低剂量皮下注射普通肝素和低分子肝素（LMWH）可提供有效的一级预防，高剂量适用于高危患者。对于高危患者，尤其是存在持续危险因素的患者，口服抗凝剂是一种替代选择。治疗急性静脉血栓栓塞症患者时，肝素和口服抗凝剂可同时开始使用。应给予至少4天的调整剂量普通肝素或固定剂量低分子肝素，在口服抗凝剂达到治疗水平之前，肝素不应停用。急性深静脉血栓形成可采用固定剂量低分子肝素进行门诊治疗。一般来说，国际标准化比值为2.0 - 3.0的口服抗凝剂应持续使用3至6个月。对于伴有短暂或持续（包括“特发性”）危险因素的静脉血栓栓塞症患者，口服抗凝剂的最佳疗程可能有所不同；然而，这一点仍有待明确。新型抗栓药物，如直接凝血酶抑制剂，正处于预防和治疗静脉血栓栓塞症的评估初期阶段。
