儿童肺血栓栓塞症的抗凝治疗进展

Progress in Anticoagulant Therapy for Pulmonary Thromboembolism in Children

抗凝是肺血栓栓塞症(PTE)的基础治疗,治疗儿童PTE时要求用药途径方便、采血监测抗凝药物活性的需求低。因儿童药物临床试验的限制,除经典的肝素、低分子肝素和华法林外,部分新型抗凝药物在国内仍属于儿童超说明书用药,应用经验多来自成人,长期治疗的安全性和有效性仍有待完善。近年来,新型抗凝药物(磺达肝奎钠、直接凝血酶抑制剂以及直接口服抗凝药物)完成了儿童临床试验,其对应的抗凝药物逆转剂也得到开发应用,新型抗凝药物在儿童PTE中应用具有潜在优势。未来,使用更方便、固定剂量、抗凝效果可预测、无需常规监测、出血风险少的新型抗凝药物很可能取代传统儿童PTE抗凝药物。

Anticoagulant therapy is the basic treatment of pulmonary thromboembolism(PTE).Treatment of PTE of children needs more convenient drug administration and minimum requirement of blood taking for anticoagulant activity monitoring.Except the classic heparin,low molecular weight heparin and warfarin,some of the new anticoagulants are still off label for children in China,since the application experience is mostly from adults due to the limitation of clinical trials in children,and the safety and effectiveness data of long-term treatment still need to be improved.New anticoagulant drugs,such as fondaparinux,direct thrombin inhibitors and direct oral anticoagulants have recently completed clinical trials in children,which have potential advantages and are expected to be applied in children PTE.Their corresponding anticoagulant reversal agents have also been developed and applied.In the future,traditional anticoagulants for PTE in children will probably be replaced by new anticoagulants with more convenient operation,fixed dose,predictable anticoagulant effect,no need of routine monitoring and less bleeding risk.