新闻 凝血

2020沃芬凝血高峰论坛(2)

对于长期治疗的患者,应平衡疗效和出血风险


中国 - 2021/01/25

肝素(UFH)、低分子肝素(LMWH)和磺达肝癸钠等肝素类药物是临床常用的非口服抗凝药。与普通肝素相比,低分子肝素有很多优势,因此VTE相关指南均推荐低分子肝素作为一线预防及治疗用药。重庆医科大学附属第一医院呼吸科副主任 陈虹教授认为,肝素类药物在临床广泛应用,任何抗凝药物在治疗时均有两面性,抗凝不足易再发血栓、抗凝过量容易出血,因此抗凝药物监测临床应予以重视。

肝素和低分子肝素发挥抗凝活性的关键环节是通过AT灭活凝血因子Xa,我们通过测定抗Xa活性,根据指南建议可以很好地指导临床用药。首先,对于长期治疗的患者,应平衡疗效和出血风险。比如,普通肝素和低分子肝素应用后有可能出现肝素诱导的血小板减少症(HIT),此时需要常规监测血常规,如果发现血小板计数持续减少,则要进一步进行HIT抗体检测,以判断是否肝素类药物抗凝治疗引起的不良反应。此外,还需要重视低分子肝素对肾功能的影响和蓄积效应。通常低分子肝素通常不需要常规监测,但对于肾功能不全的患者,体重过轻或过重以及儿童等特殊患者,Anti-Xa的监测是必须的。一言以蔽之,肝素类药物监测,很有必要!

更多关于肝素类药物的临床应用及监测,请扫描以下二维码,收看陈虹教授的讲课视频。

陈教授视频

 

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