ACS起始治疗时皮下小分子量肝素加用静脉负荷量对凝血的影响
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文题：The impact on coagulation of an intravenous loading dose in addition to a
subcutaneous regimen of low-molecular-weight heparin in the initial treatment of
acute coronary syndromes.
作者：Bijsterveld NR, Moons AH, Meijers JC, Levi M, Buller HR, Peters RJ.
杂志：J Am Coll Cardiol. 2003 Aug 6;42(3):424-7.
PMID: 12906966 [PubMed - in process]
英文文摘：
OBJECTIVES: We sought to quantify the impact of adding an intravenous loading
dose to a subcutaneous regimen of enoxaparin in patients with an acute coronary
syndrome (ACS). BACKGROUND: It is unclear whether an intravenous (i.v.) loading
dose of enoxaparin should be added to a subcutaneous (s.c.) regimen in patients
with ACS. METHODS: Patients admitted with ACS were randomized to i.v.+s.c.(n =
14) or s.c. alone (n = 11) enoxaparin treatment. Coagulation markers were
measured at nine time points during the first 24 h of treatment. RESULTS: The
i.v.+s.c. therapy immediately resulted in therapeutic anti-Xa levels, which
remained significantly higher for 6 h compared with s.c. alone, without reaching
excessively high levels. A rapid decrease of plasma prothrombin fragments 1+2
(F(1+2)) levels was observed as soon as 5 min after the i.v. injection (33%
lower; p = 0.007), and these levels remained lower up to 2 h after the start of
treatment compared with SQ alone. The ex vivo thrombin generation time was
maximally prolonged at 5 min post-injection in the i.v.+s.c. group and remained
significantly prolonged up to 6 h post-injection compared with s.c. alone. The
tissue factor pathway inhibitor plasma activity was immediately increased by
194% with i.v.+s.c., whereas the maximum increase with s.c. alone was 47% at 3
h. CONCLUSIONS: Therapeutic plasma levels of enoxaparin are achieved
significantly earlier by an i.v.+s.c. regimen compared with s.c. alone, without
leading to unacceptably high levels. As the risk of thrombotic complications is
greatest early after admission, the observed differences in antithrombotic
effects may translate into a clinical benefit. However, this remains to be
established.
中文文摘：
急性冠脉综合征起始治疗时皮下给予小分子量肝素基础上加用静脉负荷量对凝血的影响。
目的：定量分析急性冠脉综合征（ACS）的病人皮下应用依诺肝素基础上加用静脉负荷量的影响。
背景：目前，对ACS病人皮下应用依诺肝素时是否应该给予静脉负荷量还不清楚。
方法：入院的ACS病人随机分为依诺肝素静脉＋皮下组（n＝14）和单纯皮下组（n＝11）。凝血的标志物在治疗的24h内取9个点进行测量。
结果：静脉＋皮下治疗组立即达到抗－因子Xa的治疗水平，并在6h内保持明显高的水平，而单纯皮下组没有达到很高的水平。在静脉给药的5分钟后观察到血浆凝血酶原碎片1＋2（prothrombin fragments 1+2）水平很快降低（下降33%；p＝0.007），并且在治疗开始的2h内都比单纯皮下治疗组低。体外的凝血酶生成时间在静脉＋皮下组静脉注射5分钟后达到峰值，在6h内都比单纯皮下组明显延长。组织因子途径抑制因子的活性在静脉＋皮下组给药即刻增加了194%，而单纯皮下组在3h才增加了47%。
结论：与单纯皮下组比较，静脉＋皮下组血浆中的依诺肝素较早的达到治疗水平，并且没有出现不可接受的高水平。由于ACS病人住院时血栓并发症危险最大，我们观察到用药方式导致的抗栓差异可能对临床有益。但是这需要进一步来确立。
文题：The impact on coagulation of an intravenous loading dose in addition to a
subcutaneous regimen of low-molecular-weight heparin in the initial treatment of
acute coronary syndromes.
作者：Bijsterveld NR, Moons AH, Meijers JC, Levi M, Buller HR, Peters RJ.
杂志：J Am Coll Cardiol. 2003 Aug 6;42(3):424-7.
PMID: 12906966 [PubMed - in process]
英文文摘：
OBJECTIVES: We sought to quantify the impact of adding an intravenous loading
dose to a subcutaneous regimen of enoxaparin in patients with an acute coronary
syndrome (ACS). BACKGROUND: It is unclear whether an intravenous (i.v.) loading
dose of enoxaparin should be added to a subcutaneous (s.c.) regimen in patients
with ACS. METHODS: Patients admitted with ACS were randomized to i.v.+s.c.(n =
14) or s.c. alone (n = 11) enoxaparin treatment. Coagulation markers were
measured at nine time points during the first 24 h of treatment. RESULTS: The
i.v.+s.c. therapy immediately resulted in therapeutic anti-Xa levels, which
remained significantly higher for 6 h compared with s.c. alone, without reaching
excessively high levels. A rapid decrease of plasma prothrombin fragments 1+2
(F(1+2)) levels was observed as soon as 5 min after the i.v. injection (33%
lower; p = 0.007), and these levels remained lower up to 2 h after the start of
treatment compared with SQ alone. The ex vivo thrombin generation time was
maximally prolonged at 5 min post-injection in the i.v.+s.c. group and remained
significantly prolonged up to 6 h post-injection compared with s.c. alone. The
tissue factor pathway inhibitor plasma activity was immediately increased by
194% with i.v.+s.c., whereas the maximum increase with s.c. alone was 47% at 3
h. CONCLUSIONS: Therapeutic plasma levels of enoxaparin are achieved
significantly earlier by an i.v.+s.c. regimen compared with s.c. alone, without
leading to unacceptably high levels. As the risk of thrombotic complications is
greatest early after admission, the observed differences in antithrombotic
effects may translate into a clinical benefit. However, this remains to be
established.
中文文摘：
急性冠脉综合征起始治疗时皮下给予小分子量肝素基础上加用静脉负荷量对凝血的影响。
目的：定量分析急性冠脉综合征（ACS）的病人皮下应用依诺肝素基础上加用静脉负荷量的影响。
背景：目前，对ACS病人皮下应用依诺肝素时是否应该给予静脉负荷量还不清楚。
方法：入院的ACS病人随机分为依诺肝素静脉＋皮下组（n＝14）和单纯皮下组（n＝11）。凝血的标志物在治疗的24h内取9个点进行测量。
结果：静脉＋皮下治疗组立即达到抗－因子Xa的治疗水平，并在6h内保持明显高的水平，而单纯皮下组没有达到很高的水平。在静脉给药的5分钟后观察到血浆凝血酶原碎片1＋2（prothrombin fragments 1+2）水平很快降低（下降33%；p＝0.007），并且在治疗开始的2h内都比单纯皮下治疗组低。体外的凝血酶生成时间在静脉＋皮下组静脉注射5分钟后达到峰值，在6h内都比单纯皮下组明显延长。组织因子途径抑制因子的活性在静脉＋皮下组给药即刻增加了194%，而单纯皮下组在3h才增加了47%。
结论：与单纯皮下组比较，静脉＋皮下组血浆中的依诺肝素较早的达到治疗水平，并且没有出现不可接受的高水平。由于ACS病人住院时血栓并发症危险最大，我们观察到用药方式导致的抗栓差异可能对临床有益。但是这需要进一步来确立。
