我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

抗凝药物在急性肺栓塞治疗中的应用进展

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2016年第3期
页码:
370-373
栏目:
综述
出版日期:
2016-01-05

文章信息/Info

Title:
Progress of anticoagulants in treatment of acute pulmonary embolism
作者:
何献春; 寇俊杰
（哈尔滨医科大学附属第二医院心内科，黑龙江 哈尔滨 150001）
Author(s):
HE Xian-chun;  KOU Jun-jie
(Department of Cardiology, Second Affiliated Hospital, Harbin Medical University, Harbin 150001, Heilongjiang, China)
关键词:
肠道外抗凝剂; 口服抗凝剂; 急性肺栓塞; 抗凝; 治疗
Keywords:
parenteral anticoagulants;  oral anticoagulants;  acute pulmonary embolism;  anticoagulation;  treatment
分类号:
R563.5
DOI:
-
文献标识码:
A
摘要:
抗凝是治疗急性肺栓塞(APE)的关键，一旦确诊APE，应立即开始抗凝治疗，除非存在明显的禁忌证。传统治疗APE方案包括初始胃肠外抗凝治疗（普通肝素或低分子肝素），随后长期口服维生素K拮抗剂(VKAs)。尽管传统治疗方案能有效减少静脉血栓栓塞（VTE）复发，但长期服用VKAs存在局限性，因此接受长期抗凝治疗的肺栓塞患者，目前需要一种无需实验室监测和剂量调整的口服抗凝剂，这就使新型口服抗凝剂应运而生。
Abstract:
Anticoagulation is the key to the treatment of acute pulmonary embolism (APE). Once the APE is diagnosed, anticoagulant therapy should begin immediately unless there is obvious contraindication. Traditional treatment includes initial parenteral anticoagulants (heparin or low-molecular weight heparin) along with vitamin K antagonists (VKAs). Although traditional treatment can effectively reduce the recurrence of venous thromboembolism (VTE), long-term use of vitamin K antagonists has some limitations. PE patients treated with a long-term anticoagulation therapy need some type of oral anticoagulants without laboratory monitoring and dose adjustment. This needs calls for some new oral anticoagulants (NOACs) for long-term anticoagulation therapy.

参考文献/References

[1]Heit JA.The epidemiology of venous thromboembolism in the community[J].Arterioscler Thromb Vasc Biol,2008,28(3):370-372.
[2]Huisman MV,Klok FA.Diagnostic management of acute deep vein thrombosis and pulmonary embolism[J].J Thromb Haemost,2013,11(3):412-422.
[3]den Exter PL,van der Hulle T,Klok FA,et al.Advances in the diagnosis and management of acute pulmonary embolism[J].Thromb Res,2014,133(Suppl 2):S10- S16.
[4]Hirsh J,Warkentin TE,Shaughnessy SG,et al.Heparin and low molecular weight heparin: Mechanisms of action, pharmacokinetics, dosing,monitoring,efficacy,and safety[J].Chest,2001,119(1 suppl):S64-S94.
[5]Basu D,Gallus AS,Hirsh J,et al.A prospective study of value of monitoring heparin treatment with the activated partial thromboplastin time[J].N Engl J Med,1972,287(7):324-327.
[6]Stein PD,Hull RD,Matta F,et al.Incidence of thrombocytopenia in hospitalized patients with venous thromboembolism[J].Am J Med, 2009,122(10):919-930.
[7]Meyer G,Marjanovic Z,Valcke J,et al.Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer:a randomized controlled study[J].Arch Intern Med,2002,162(15):1729-1735.
[8]Stein PD,Sostman HD,Hull RD,et al.Diagnosis of pulmonary embolism in the coronary care unit[J].Am J Cardiol,2009,103(6):881-886.
[9]Wang ZL.Acute pulmonary embolism:the clinical conundrum[J].Chin Med J,2012,125(2):352-366.
[10]Garcia DA,Baglin TP,Weitz JI,et al.Parenteral anticoagulants:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2 Suppl):e24S-e43S.
[11]De Caterina R,Husted S,Wallentin L,et al.Vitamin K antagonists in heart disease:Current status and perspectives(Section III).Position Paper of the ESC Working Group on Thrombosis-Task Force on Anticoagulants in Heart Disease[J].Thromb Haemost,2013,110(6):1087-1107.
[12]Blech S,Ebner T,Ludwig-Schwellinger E,et al.The metabolism and disposition of the oral direct thrombin inhibitor, dabigatran,in humans[J].Drug Metab Dispos,2008,36(2):386-399.
[13]Schulman S,Kearon C,Kakkar AK,et al.Dabigatran versus warfarin in the treatment of acute venous thromboembolism[J].N Engl J Med,2009,361(24):2342-2352.
[14]Schulman S,Kakkar AK,Goldhaber SZ,et al.Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis[J].Circulation,2014,129(7):764-772.
[15]Schulman S,Kearon C,Kakkar AK,et al.Extended use of dabigatran,warfarin,or placebo in venous thromboembolism[J].N Engl J Med,2013,368(8):709-718.
[16]Kubitza D,Becka M,Roth A,et al.Dose-escalation study of the pharmacokinetics and pharmacodynamics of rivaroxaban in healthy elderly subjects[J].Curr Med Res Opin,2008,24(10):2757-2765.
[17]Bauersachs R,Berkowitz SD,Brenner B,et al.Oral rivaroxaban for symptomatic venous thromboembolism[J].N Engl J Med,2010,363(26):2499-2510.
[18]Buller HR,Prins MH,Lensin AW,et al.Oral rivaroxaban for the treatment of symptomatic pulmonary embolism[J].N Engl J Med,2012,366(14):1287-1297.
[19]Raghavan N,Frost CE,Yu Z,et al.Apixaban metabolism and pharmacokinetics after oral administration to humans[J].Drug Metab Dispos,2009,37(1):74-81.
[20]Agnelli G,Buller HR,Cohen A,et al.Oral apixaban for the treatment of acute venous thromboembolism[J].N Engl J Med,2013,369(9):799-808.
[21]Eriksson BI,Quinlan DJ,Weitz JI.Comparative pharmacodynamics and pharmacokinetics of oral direct thrombin and factor xa inhibitors in development[J].Clin Pharmacokinet,2009,48(1):1-22.
[22]Sprynger M.Hokusai-VTE:edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism[J].Rev Med Liege,2013,68(10):548-551.
[23]Buller HR,Decousus H,Grosso MA,et al.Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism[J].N Engl J Med,2013,369(15):1406-1415.
[24]Konstantinides SV,Torbicki A,Agnelli G,et al.2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism:The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology(ESC)Endorsed by the European Respiratory Society(ERS)[J].Eur Heart J,2014,35(43):3033-3073.
[25]den Exter PL,van der Hulle T,Klok FA,et al.Advances in the diagnosis and management of acute pulmonary embolism[J].Thromb Res,2014,133(Suppl 2):S10-S16.
[26]Baber U,Mastoris I,Mehran R.Balancing ischaemia and bleeding risks with novel oral anticoagulants[J].Nat Rev Cardiol,2014,11(12):693-703.
[27]van der Hulle T,Kooiman J,den Exter PL,et al.Effectiveness and safety of novel oral anticoagulants as compared with vitamin K antagonists in the treatment of acute symptomatic venous thromboembolism: a systematic review and meta-analysis[J].J Thromb Haemost,2014,12(3):320-328.

备注/Memo

备注/Memo:
收稿日期：2014-12-30.
通讯作者：寇俊杰，教授，主要从事冠心病和心衰诊疗研究 Email：xiaohe19870406@163.com
作者简介：何献春，硕士生 Email：xiaohe_19870406@126.com
更新日期/Last Update: 2016-01-07