治疗强度非减量肝素的管理:关于关键点的叙述性综述。

TH open : companion journal to thrombosis and haemostasis Pub Date : 2024-10-17 eCollection Date: 2024-07-01 DOI:10.1055/a-2359-0987
Isabelle Gouin-Thibault, Alexandre Mansour, Michael Hardy, Pierre Guéret, Emmanuel de Maistre, Virginie Siguret, Adam Cuker, François Mullier, Thomas Lecompte
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引用次数: 0

摘要

如今,非分数肝素(UFH)的使用仅限于特定的出血和血栓形成高风险患者群体(心脏手术患者、重症监护室患者和严重肾功能损害患者),这使得其管理极具挑战性,尽管已使用数十年,但仍有许多问题悬而未决。在这篇叙述性综述中,我们重温了 UFH 治疗性抗凝的基本概念,并讨论了五个关键点,总结了 UFH 使用中存在的争议,并讨论了该领域近期取得的一些进展:(1) 用于监测 UFH 的实验室检测有很大的局限性;(2) 治疗范围没有很好的依据;(3) 抗凝血酶水平对 UFH 抗凝活性的实际影响尚未得到很好的证实;(4) UFH 耐药性的概念缺乏支持数据;(5) 有关急性静脉血栓栓塞症以外 UFH 使用的数据很少。因此,我们确定了在未来临床研究中需要妥善解决的关键问题:(1) 虽然抗 Xa 检测通常被认为是首选方案,但我们呼吁采取积极行动,进一步了解不同类型抗 Xa 检测之间的差异,并解决添加右旋糖酐是否有用的问题;(2) 几十年前使用不再可用的试剂确定的 UFH 治疗范围尚未得到适当验证,需要确认或重新确定;(3) UFH 剂量调整提名图需要全面验证。
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Management of Therapeutic-intensity Unfractionated Heparin: A Narrative Review on Critical Points.

Nowadays, unfractionated heparin (UFH) use is limited to selected patient groups at high risk of both bleeding and thrombosis (patients in cardiac surgery, in intensive care unit, and patients with severe renal impairment), rendering its management extremely challenging, with many unresolved questions despite decades of use. In this narrative review, we revisit the fundamental concepts of therapeutic anticoagulation with UFH and address five key points, summarizing controversies underlying the use of UFH and discussing the few recent advances in the field: (1) laboratory tests for UFH monitoring have significant limitations; (2) therapeutic ranges are not well grounded; (3) the actual influence of antithrombin levels on UFH's anticoagulant activity is not well established; (4) the concept of UFH resistance lacks supporting data; (5) scarce data are available on UFH use beyond acute venous thromboembolism. We therefore identified key issues to be appropriately addressed in future clinical research: (1) while anti-Xa assays are often considered as the preferred option, we call for a vigorous action to improve understanding of the differences between types of anti-Xa assays and to solve the issue of the usefulness of added dextran; (2) therapeutic ranges for UFH, which were defined decades ago using reagents no longer available, have not been properly validated and need to be confirmed or reestablished; (3) UFH dose adjustment nomograms require full validation.

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Management of Therapeutic-intensity Unfractionated Heparin: A Narrative Review on Critical Points. Impact of Clinical Decision Support with Mandatory versus Voluntary Venous Thromboembolism Risk Assessment in Hospitalized Patients. An Intestinal Microbiome Intervention Affects Biochemical Disease Activity in Patients with Antiphospholipid Syndrome. Corrigendum: Bleeding Risk Prediction in Patients Treated with Antithrombotic Drugs According to the Anatomic Site of Bleeding, Indication for Treatment, and Time Since Treatment Initiation. Establishing Expectancy Values for Fibrin Monomer in Uncomplicated Pregnancy.
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