Spinler S A, Nawarskas J J
Philadelphia College of Pharmacy and Science, PA 19104, USA.
Ann Pharmacother. 1998 Jan;32(1):103-10. doi: 10.1345/aph.16483.
To review published literature regarding the use of low-molecular-weight heparins (LMWHs) for the acute coronary syndromes of unstable angina and acute myocardial infarction (MI).
A MEDLINE search (January 1986-August 1997) was performed to identify all pertinent articles. Selected references from these articles and abstracts of recent clinical trials were also included.
LMWHs have several distinct advantages over standard unfractionated heparin (UFH). These advantages include convenient once- or twice-daily standardized administration without the need for activated partial thromboplastin time monitoring. While the use of LMWHs as prophylaxis and treatment of venous thromboembolism is fairly well-established, the use of LMWHs for treating acute myocardial ischemia is evolving. Published studies and abstracts have shown LMWHs to be as effective as or more effective than UFH in preventing death, myocardial infarction, and recurrent ischemia in patients with unstable angina or acute MI. The comparative incidence of bleeding between LMWHs and UFH is controversial, with some studies reporting lower or similar rates of bleeding with LMWHs, while one study demonstrated a higher bleeding rate than with UFH. The cost-effectiveness of using LMWHs over UFH for acute coronary syndromes also remains to be established.
LMWHs appear to be as effective as, and potentially more effective than, UFH in preventing complications of acute coronary syndromes. However, further studies are needed to better define the comparative bleeding risks of LMWHs and UFH. This, plus the lack of published peer-reviewed trial results and pharmaco-economic analyses, preclude the recommendation of routinely using LMWHs for treating unstable angina and acute MI at this time.
回顾已发表的关于低分子量肝素（LMWHs）用于不稳定型心绞痛和急性心肌梗死（MI）等急性冠脉综合征的文献。
进行了一次MEDLINE检索（1986年1月至1997年8月）以确定所有相关文章。还纳入了这些文章的选定参考文献以及近期临床试验的摘要。
与标准普通肝素（UFH）相比，LMWHs有几个明显的优势。这些优势包括方便的每日一次或两次标准化给药，无需活化部分凝血活酶时间监测。虽然LMWHs用于预防和治疗静脉血栓栓塞已相当成熟，但LMWHs用于治疗急性心肌缺血仍在不断发展。已发表的研究和摘要表明，在预防不稳定型心绞痛或急性MI患者的死亡、心肌梗死和复发性缺血方面，LMWHs与UFH一样有效或更有效。LMWHs和UFH之间出血的相对发生率存在争议，一些研究报告LMWHs的出血率较低或相似，而一项研究显示其出血率高于UFH。使用LMWHs而非UFH治疗急性冠脉综合征的成本效益也有待确定。
在预防急性冠脉综合征的并发症方面，LMWHs似乎与UFH一样有效，甚至可能更有效。然而，需要进一步研究以更好地界定LMWHs和UFH相对的出血风险。此外，由于缺乏已发表的同行评审试验结果和药物经济学分析，目前尚不能推荐常规使用LMWHs治疗不稳定型心绞痛和急性MI。
