Differentiation of parenteral anticoagulants in the prevention and treatment of venous thromboembolism.
Differentiation of parenteral anticoagulants in the prevention and treatment of venous thromboembolism.
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DOI：
10.1186/1477-9560-9-5
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发表时间：
2011-03-28
影响因子：
3.1
通讯作者：
Thethi I
中科院分区：
文献类型：
--
作者：
Fareed J;Adiguzel C;Thethi I
静脉血栓栓塞的预防已被确定为医院安全的首要任务。预防和治疗静脉血栓栓塞的不同适应症推荐的静脉外抗凝药物包括未分离肝素、低分子肝素和氟达肝素。由于临床适应症和患者类型以及可用抗凝剂的范围大，静脉血栓栓塞管理中的处方决定似乎很复杂。检索MEDLINE和EMBASE数据库以确定相关的原创文章。低分子肝素几乎取代了未分离肝素，成为抗血栓的金标准药物。目前在美国可获得的低分子量肝素有依诺肝素、达尔特肝素和丁扎肝素。每一种低分子量肝素都是一种独特的药理学实体，具有不同的许可适应症和现有的临床证据。依诺肝素是唯一一种被批准用于静脉血栓栓塞预防和治疗的低分子量肝素。依诺肝素也有大量的临床证据支持其在静脉血栓栓塞管理中的广泛应用，并已被用作新抗凝剂试验的参考标准比较剂抗凝剂。与新型口服抗凝剂一样，生物仿制药和/或通用低分子量肝素现在也可以在市场上买到。尽管抗凝性能相似，但研究报告了品牌药与生物仿制药和/或仿制药之间的差异，需要进一步的临床研究来支持低分子肝素生物仿制药的使用。较新的静脉外抗凝剂fondaparinux现在也被许可用于外科患者的静脉血栓栓塞预防和急性深静脉血栓的治疗；这种抗凝血剂的临床经验正在扩大。应根据每种药物的现有临床证据，根据每个临床适应症的推荐剂量方案处方静脉注射抗凝剂，以确保最佳的安全性和有效性。
The prevention of venous thromboembolism has been identified as a leading priority in hospital safety. Recommended parenteral anticoagulant agents with different indications for the prevention and treatment of venous thromboembolism include unfractionated heparin, low-molecular-weight heparins and fondaparinux. Prescribing decisions in venous thromboembolism management may seem complex due to the large range of clinical indications and patient types, and the range of anticoagulants available. MEDLINE and EMBASE databases were searched to identify relevant original articles. Low-molecular-weight heparins have nearly replaced unfractionated heparin as the gold standard antithrombotic agent. Low-molecular-weight heparins currently available in the US are enoxaparin, dalteparin, and tinzaparin. Each low-molecular-weight heparin is a distinct pharmacological entity with different licensed indications and available clinical evidence. Enoxaparin is the only low-molecular-weight heparin that is licensed for both venous thromboembolism prophylaxis and treatment. Enoxaparin also has the largest body of clinical evidence supporting its use across the spectrum of venous thromboembolism management and has been used as the reference standard comparator anticoagulant in trials of new anticoagulants. As well as novel oral anticoagulant agents, biosimilar and/or generic low-molecular-weight heparins are now commercially available. Despite similar anticoagulant properties, studies report differences between the branded and biosimilar and/or generic agents and further clinical studies are required to support the use of biosimilar low-molecular-weight heparins. The newer parenteral anticoagulant, fondaparinux, is now also licensed for venous thromboembolism prophylaxis in surgical patients and the treatment of acute deep-vein thrombosis; clinical experience with this anticoagulant is expanding. Parenteral anticoagulants should be prescribed in accordance with recommended dose regimens for each clinical indication, based on the available clinical evidence for each agent to assure optimal safety and efficacy.