体重调整固定剂量普通肝素与低分子肝素治疗急性静脉血栓栓塞的比较被引量：1

Comparison of Fixed-Dose Weight-Adjusted Unfractionated Heparin and Low-Molecular-Weight Heparin for Acute Treatment of Venous Thromboembolism

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摘要背景：普通肝素用于治疗急性静脉血栓栓塞时，通常在监测血凝下静脉输注给药，患者需要住院治疗。然而，体重调整后皮下注射固定剂量普通肝素可能既适用于住院也适用于门诊静脉血栓栓塞患者的治疗。目的：确定皮下注射体重调整固定剂量普通肝素治疗静脉血栓栓塞是否与低分子肝素同样安全有效。设计、地点及患者：随机、开标、裁定者盲法、非劣效试验。708例急性静脉血栓栓塞患者来自加拿大和新西兰6所大学附属临床中心，年龄≥18岁。试验于1998年9月至2004年2月进行。在随机分组的患者中，11例从疗效分析中排除，8例从安全性分析中排除。干预：普通肝素皮下注射初始剂量为333U／kg，以后给予固定剂量250U／kg，每12小时1次（n=345）。低分子肝素（依诺肝素或达肝素）按100IU／kg剂量皮下注射，每12小时1次（n=352）。两种治疗均可院外进行，配合华法林治疗3个月。主要观测指标：随机分组后3个月内复发性静脉血栓栓塞事件及10天内严重出血情况。结果：普通肝素组有13例患者（3．8％）发生静脉血栓栓塞复发，而低分子肝素组有12例患者复发（3．4％；绝对差值，0．4％；95％可信区间，-2．6％～3．3％）。开始治疗后10天内普通肝素组有4例患者（1．1％）发生严重出血，而低分子肝素组有5例（1．4％；绝对差值，-0．3％；95％可信区间，-2．3％～1．7％）。院外治疗患者在普通肝素组占72％，低分子肝素组占68％。结论：对于急性静脉血栓栓塞患者而言，皮下注射固定剂量普通肝素与低分子肝素一样安全有效，适于门诊治疗。

作者 Clive Kearon Jeffrey S. Ginsberg Jim A. Julian James Douketis Susan Solymoss Paul Ockelford Sharon Jackson Alexander G. Turpie Betsy MacKinnon Jack Hirsh Michael Gent 王春玲（译）孙艺红（译）胡大一（校）

机构地区 McMaster University and the Henderson Research Centre McGill University McGill University and University of Auckland

出处《美国医学会杂志（中文版）》 2007年第5期259-264,共6页 The Journal of the American Medical Association(Chinese Edition)

关键词低分子肝素治疗静脉血栓栓塞普通肝素固定剂量急性体重安全性分析皮下注射

分类号 R541.405 [医药卫生—心血管疾病]

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1Bullet HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 suppl):401S-428S.
2O'Brien B, Levine M, Willan A, et al. Economic evaluation of outpatient treatment with low-molecular-weight heparin for proximal vein thrombosis. Arch Intern A4ed. 1999;159:2298-2304.
3Hommes DW, Bura A, Mazzolai L, Buller HR, ten Cate JW. Subcutaneous heparin compared with continuous intravenous heparin administration in the initial treatment of deep vein thrombosis. Ann Intern Med. 1992;116:279-284.
4Prandoni P, Carnovali M, Marchiori A. Subcutaneous adjusted-dose unfractionatecl heparin vs fixeddose low-molecular-weight heparin in the initial treatment of venous th romboembolism. Arch Intern Med. 2004;164:1077-1083.
5Bates SM, Weitz JI, Johnston M, Hirsh J, Ginsberg JS. Use of a fixed activated partial thromboplastin time ratio to establish a therapeutic range for unfractionated heparin. Arch Intern Med. 2001 ;161:385- 391.
6Kearon C, Johnston M, Moffat K, McGinnis J, Ginsberg JS. Effect of warfarin on activated partial thromboplastin time in patients receiving heparin. Arch Intern Med. 1998;158:1140-1143.
7Basu D, Gallus AS, Hirsh J, Cade J. A prospective study of the value of monitoring heparin treatment with the activated partial thromboplastin time. N Engl J Med. 1972;287:324-327.
8Hull RD, Raskob GE, Brant RF, Pineo GF, Valentine KA. Relation between the time to achieve the lower limit of the APTT therapeutic range and recurrent venous thromboembolism during heparin treatment for deep vein thrombosis. Arch Intern Med. 1997,157: 2562 -2568.
9Hull RD, Raskob G, Brant RF, Pineo GF, Valentine KA. The importance of initial heparin treatment on long-term dinical outcomes of antithrombotic therapy. Arch Interrl Med. 1997;157:2317-2321.
10Anand S, Ginsberg JS, Kearon C, Gent M. Hirsh J. The relation between the activated partial thromboplastin time response and recurrence in patients with venous thrombosis treated with continuous intravenous heparin. Arch Intern Med. 1996;156:1677- 1681.