Hirsh J
Hamilton Civic Hospitals Research Center, Ontario, Canada.
Am Heart J. 1998 Jun;135(6 Pt 3 Su):S336-42. doi: 10.1053/hj.1998.v135.90303.
Unfractionated heparin (UFH) binds to several plasma, platelet, and endothelial proteins, producing a highly variable anticoagulant response. For this reason, frequent anticoagulation monitoring and dosage adjustment are necessary during UFH administration. In contrast, low-molecular-weight heparins (LMWHs) exhibit less protein binding and provide more predictable anticoagulation with reduced need for patient monitoring and dosage adjustment. Therefore, LMWHs are potentially useful for anticoagulation therapy on an outpatient basis. Several recent clinical trials have compared LMWHs (administered primarily on an outpatient basis) and UFH for the treatment of venous thromboembolism. These trials have indicated that LMWHs possess efficacy and safety characteristics similar to intravenous heparin but are easier to administer. LMWH preparations vary considerably in their methods of preparation and pharmacological properties, and the relative efficacies of these various LMWHs remain to be determined by direct comparisons in randomized clinical trials.
普通肝素（UFH）可与多种血浆、血小板及内皮蛋白结合，产生高度可变的抗凝反应。因此，在使用UFH期间，需要频繁进行抗凝监测和剂量调整。相比之下，低分子量肝素（LMWHs）与蛋白的结合较少，抗凝作用更可预测，减少了患者监测和剂量调整的需求。因此，LMWHs在门诊抗凝治疗中可能有用。最近的几项临床试验比较了LMWHs（主要在门诊给药）和UFH治疗静脉血栓栓塞的效果。这些试验表明，LMWHs具有与静脉注射肝素相似的疗效和安全性特征，但给药更简便。LMWH制剂的制备方法和药理特性差异很大，这些不同LMWHs的相对疗效仍有待通过随机临床试验中的直接比较来确定。
