低分子肝素治疗实验室监测现状血管病学进展20o7年第28卷第4期AdvCardiovascDis.July2oo7,Vo1.28.No.4[11⑵⑶[4]⑸⑹[参考文献]SombergJ,WeinbergerJ.Latestentthrombosis:problemornot[J]?AmJCar-diol,2007,99:1020—1023.JaffeR,StraussBH.Lateandverylatethrombosisofdrug一elutingstents[J].JAmCoilCardiol,2007,50:inpress.CutlipDE.BaimDS,HoKK.etal.Stentthrombosisintlleinodemera:apooledanalysisofmulticentercoronarystontclinicaltrials[J].Circulation,2001,103:1967—1971.MorenoR,FernandezC,HernandezR,eta1.Drug一elutingstentthrombosis:resultsfromapooledanalysisincluding1Orandomizedstudies[J].JAmCollCardiol,2005,45:954-959.IakovouI,SchmidtT,BonizzoniE,eta1.Incidence,predictors,andoutcomeofthrombosisaftersuccessfulimplantationofdrug一elutingstents[J].JAMA,2005,293:2126-2130.OngAT,HoyeA,AokiJ,etal.Thirty一dayincidenceandsix一monthclinical[7]⑻[10]9■517?outcomeofthromboticstentocchsionafterbare一rlletal,sirolimus,orpaclitaxelstentimplantation[J].JAmCoilCardiol,2005,45:947-953.CuflipDE,WindeckerS,MehranR,etal.Clinicalendpointsincorollarystenttli也:acaseforstandardizeddefinitions[J].Circulation,2007J15:2344—2351.LascherTF,SteffelJ,EberliFR,etal.Drug一elutingste〜tandcoronarythrom?bosisbiologicalmechanismsandclinicalimplications[J].Circulation.2007,27:105—1058.VirmaniR9GuagliumiG,FarbA5etal.Localizedhypersensitivityandlatecoronarythrombosissecondarytoasirolimus.-elutingstent:shouldwebecau一tious[J]?Circulation,2004,109:701-705.GrinesCL,BonowRO,CaseyDE,Bl比a1.Preventionofprematurediscontinua-tionofdualantiplatelettherapyinpatientswithcoronaryarterystents[J].JAmCoilCardiol,2007,49:734-739.收稿日期:2007-06-20(木文编辑:郭宪)低分子肝素治疗实验室监测现状史旭波胡大一综述(首都医科大学附属北京同仁医院心脏中心，北京100730)StatusQuoofLaboratoryMonitoringofLowolecularWeightHeparinTherapySHIXu—bo,HUDa—yi(CardiovascularCenter,TongrenHospitalAffiliated文章编号：1004-3934(2007)04-0517-04toCapitalUniversityoflMedicalSciences,Bering100730,China)中图分类号:R973.2文献标识码:A摘要:在急性冠脉综合征及静脉血栓栓塞等广泛领域低分子肝素正在逐步取代普通肝素成为主要主要抗凝药物.低分子肝素抗凝治疗是否需要以及如何进行监测，近几年已成为争论的焦点•普通的抗凝治疗可通过活化部分凝血活酶时间(APTT)友活化凝血时间(ACT)来监测.但APTT与ACT对常规皮下注射低分子肝素并不敏感而不能用于其剂量的监测•对于严重肾功能不全，肥胖，妊娠妇女，婴幼儿等特殊的患者人群的抗栓治疗，低分子肝素给予固定剂量或按公斤体重调整剂量疗效均不可靠，而抗Xa因子活性检测可提供有关低分子肝素药代动力学方面的一些信息.关键词:低分子量肝素;抗xa因子活性检测;活化凝血时间Abstract:Low一molecularweightheparin(LMWH)isincreasinglyusedinplaceofunfractionatedheparininpatientswithacutecoro-narysyndrome(ACSJandvenousthromboembolism(VIEJ.WhyandhowmonitoringLMWHhasbeencontradictorilydebatedinrecentyears.MonitoringoftherapeuticdosesofUFHcanbeachievedusingtheactivatedpartialthromboplastintime(AT)andactivatedclotingtime(ACT).ButACTandAtrisgenerallyinsensitivetoLMWHaftersubcutaneousapplicationandcannotbeusedfordosagemonitoring.Useofanti一XaassaysmayprovidesomecluetopharmacokineticsofLMWHwhenusedtotreatthrombosisinthoseinwhomstandardorweight一删usteddosingislikelytobeunreliable,especiallysubjectswithsevererenalfailure,theobese,thepregnant,neonatesandinfants.Keywords:low一molecularweightheparin;anti一Xaassay;activatedclotingtime低分子肝素(LMWH)是临床上应用最为广泛的抗凝药物丄MWH由普通肝素(UFH)通过...