Cohen M
MCP-Hahnemann School of Medicine and Allegheny University of the Health Sciences, Philadelphia, PA 19102-1192, USA.
Am Heart J. 1998 Jun;135(6 Pt 3 Su):S343-52. doi: 10.1053/hj.1998.v135.90302.
Thrombosis after the rupture of an atherosclerotic plaque often precipitates the acute coronary syndromes of unstable angina and myocardial infarction. The combination of aspirin and heparin has been shown to reduce the occurrence of both symptomatic and asymptomatic ("silent") ischemia, myocardial infarction, and death in patients with these syndromes. However, heparin and aspirin each have significant limitations as antithrombotic drugs. Additionally, coagulation abnormalities may persist for several months after an acute ischemic event, and long-term anticoagulation may be beneficial. Because of the need for frequent anticoagulation monitoring and dosage adjustment, the use of heparin is limited to short-term treatment during the acute in-hospital phase. Recently several novel antithrombotic treatments have been developed. The benefits of direct thrombin inhibitors, platelet fibrinogen receptor antagonists, and low-molecular-weight heparins in the treatment of acute coronary syndromes have been demonstrated in randomized clinical trials.
动脉粥样硬化斑块破裂后的血栓形成常引发不稳定型心绞痛和心肌梗死等急性冠状动脉综合征。阿司匹林和肝素联合使用已被证明可减少这些综合征患者出现有症状和无症状（“隐匿性”）缺血、心肌梗死及死亡的发生率。然而，肝素和阿司匹林作为抗血栓药物都有显著局限性。此外，急性缺血事件后凝血异常可能持续数月，长期抗凝可能有益。由于需要频繁进行抗凝监测和剂量调整，肝素的使用仅限于急性住院期的短期治疗。最近已研发出几种新型抗血栓治疗方法。直接凝血酶抑制剂、血小板纤维蛋白原受体拮抗剂和低分子量肝素在急性冠状动脉综合征治疗中的益处已在随机临床试验中得到证实。
