静脈性血栓塞栓症の初期治療について
Simon J McRae1, Jeffrey S Ginsberg
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada. smcrae@mcmaster.ca
Circulation
|September 2, 2004
まとめ
低分子量ヘパリン (LMWH) は,よりよい結果とより少ない合併症のために,初期静脈血栓塞栓症 (VTE) の治療のために,分断されていないヘパリン (UFH) よりもますます好まれています. LMWHは,外来治療の利点を提供し,ヘパリン誘発の血小板減少症と骨粗鬆症に関してより安全であるようです.
科学分野:
- 薬理学とセラピュティクス
- 血液学 ヘマトロジ
- 心血管医学 心血管医学
背景:
- 深静脈血栓症 (DVT) と肺栓塞 (PE) は,有害な結果を防ぐために効果的な初期抗凝固剤治療を必要とします.
- 静脈内未分化ヘパリン (UFH) が標準であったが,低分子量ヘパリン (LMWH) に取って代わられている.
研究 の 目的:
- 静脈血栓塞栓症 (VTE) の抗凝固剤治療の現在の状況を見直す.
- VTE治療におけるUFHとLMWHの有効性,安全性,および実用的な検討を比較する.
- 妊娠中のVTE管理における課題と,血栓溶解の役割に対処する.
主な方法:
- 文献レビューと現在の臨床実務ガイドラインの統合.
- UFHとLMWHの薬理学的特性と臨床試験データの比較分析.
- 妊婦や大量PEを患っている患者を含む特定の患者集団の議論.
主要な成果:
- LMWHは,UFHと比較して,改善された生体利用性と予測可能な応答を示し,外科医のVTE治療を容易にします.
- LMWHは,ヘパリン誘発性血栓縮症 (HIT) や骨粗鬆症などの深刻な合併症の発生率の低下と関連しています.
- 妊娠中のVTE治療は,胎児リスクと生理学的変化によって複雑化します; 大量のPEと近親DVTの全身性血栓解離は,患者の選択に関して論争の的であり続けています.
結論:
- LMWHは,UFHよりも好ましいプロファイルがあるため,VTEの好ましい初期抗凝固剤として浮上しています.
- 患者を慎重に選択することは,全身性血栓溶解のような介入において,特に妊娠に関連したVTEのような複雑な症例において極めて重要です.
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