Voss R, Tillmanns H
Zentrum für Innere Medizin, Abt. Innere Medizin-Kardiologie/Angiologie.
Z Kardiol. 1997 Nov;86(11):911-9. doi: 10.1007/s003920050131.
In the last years, several studies addressed the role of the different antithrombotic therapeutics in unstable angina pectoris. Acetylsalicylic acid still is the standard treatment reducing the rate of death and myocardial infarction by 50% in the first six months. Ticlopidin has no clinical effect in the first six days and therefore is not suited for treatment in the acute phase. Unfractionated heparin has an additional favourable effect when added to aspirin. Low molecular weight-heparin is at least as effective as UF-heparin. Direct thrombin-inhibitors (hirudin, hirudin-analoga) seem to be comparable to UF-heparin. Plasminogen-activators should not be given in unstable angina, as they show a tendency to worsen the clinical outcome. GP IIb/IIIa-antagonists (antibodies, synthetic antagonists) significantly improve the clinical effects of aspirin. When combined with a reduced dose of heparin, their favourable effect remains unchanged, while bleeding complications are reduced to a minimum.
在过去几年中，多项研究探讨了不同抗血栓治疗药物在不稳定型心绞痛中的作用。乙酰水杨酸仍然是标准治疗方法，在前六个月可将死亡率和心肌梗死发生率降低50%。噻氯匹定在前六天没有临床效果，因此不适合用于急性期治疗。普通肝素与阿司匹林联合使用时具有额外的有益效果。低分子量肝素至少与普通肝素一样有效。直接凝血酶抑制剂（水蛭素、水蛭素类似物）似乎与普通肝素相当。在不稳定型心绞痛中不应使用纤溶酶原激活剂，因为它们有使临床结局恶化的趋势。糖蛋白IIb/IIIa拮抗剂（抗体、合成拮抗剂）可显著改善阿司匹林的临床效果。与减少剂量的肝素联合使用时，其有益效果不变，同时出血并发症降至最低。
