阿加曲班治療下肢深靜脈血栓的療效評價_《中國普外基礎與臨床雜志》

作者：

張天華 , 姜維良 , 張英男

哈爾濱醫科大學附屬第二醫院血管外科（哈爾濱 150086）;

關鍵詞：

阿加曲班肝素深靜脈血栓形成治療血小板減少癥

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目的比較常規使用肝素和阿加曲班治療下肢深靜脈血栓（DVT）患者的臨床療效。
方法將188例下肢DVT患者按照隨機數字表分成阿加曲班組（n=94）和對照組（低分子肝素鈣+尿激酶，n=94），比較2組患者治療前、后雙側肢體周徑差和療效的差異，并在治療過程中監測凝血指標（PT、APTT及PLT）變化。
結果阿加曲班組治療10 d后，雙側肢體周徑差較治療前明顯減小（P lt;0.05），總有效率（97.87%）優于對照組（89.37%），P lt;0.05。阿加曲班組無血小板減少癥（HIT）發生，對照組發生2例HIT；阿加曲班組PT、APTT和PLT變化均處于正常范圍，與對照組比較差異無統計學意義（P gt;0.05）。
結論阿加曲班治療下肢DVT安全、有效。

引用本文： 張天華,姜維良,張英男. 阿加曲班治療下肢深靜脈血栓的療效評價. 中國普外基礎與臨床雜志, 2010, 17(7): 683-685. doi: 復制

1.	Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism: A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association [J]. Circulation, 1996; 93(12): 22122245.
2.	Büller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. [J]. Chest, 2004; 126(3 Suppl): 401S428S.
3.	Warkentin TE, Levine MN, Hirsh J, et al. Heparininduced thrombocytopenia in patients treated with lowmolecular weight heparin or unfractionated heparin [J]. N Engl J Med, 1995; 332(20): 13301335.
4.	Warkentin TE, Sheppard JA, Horsewood P, et al. Impact of the patient population on the risk for heparininduced thrombocytopenia [J]. Blood, 2000; 96(5): 17031708.
5.	Shuster TA, Silliman WR, Coats RD, et al. Heparininduced thrombocytopenia: twentynine years later [J]. J Vasc Surg, 2003; 38(6): 13161322.
6.	Gallus AS, Goodall KT, Tillett J, et al. The relative contributions of antithrombin Ⅲ during heparin treatment, and of clinically recognisable risk factors, to early recurrence of venous thromboembolism [J]. Thromb Res, 1987; 46(4): 539553.
7.	孫玉霞, 潘三蔥, 秦中勝. 低分子肝素和普通肝素治療下肢深靜脈血栓的臨床觀察 [J]. 長治醫學院學報, 2008; 22(4): 272274.
8.	陳妍，韓宏，胡佩群，等. 程序化應用低分子肝素對非手術治療老年人髖部骨折下肢深靜脈血栓形成的干預 [J]. 中華老年醫學雜志, 2008; 27(7): 535536.
9.	劉銘，劉蔚. 奧扎格雷鈉聯合低分子肝素治療下肢深靜脈血栓54例分析 [J]. 中國誤診學雜志, 2008; 8(19): 46904691.
10.	LindhoffLast E, Nakov R, Misselwitz F, et al. Incidence and clinical relevance of heparininduced antibodies in patients with deep vein thrombosis treated with unfractionated or lowmolecularweight heparin [J]. Br J Haematol, 2002; 118(4): 11371142.
11.	Breddin HK, HachWunderle V, Nakov R, et al. Effects of a lowmolecularweight heparin on thrombus regression and recurrent thromboembolism in patients with deep vein thrombosis [J]. N Engl J Med, 2001; 344(9): 626631.
12.	Prandoni P, Lensing AW, Büller HR, et al. Comparison of subcutaneous lowmolecularweight heparin with intravenous standard heparin in proximal deepvein thrombosis [J]. Lancet, 1992; 339(8791): 441445.
13.	Hirsh J, Heddle N, Kelton JG. Treatment of heparin induced thrombocytopenia: a critical review [J]. Arch Intern Med, 2004; 164(4): 361369.
14.	Warkentin TE, Greinacher A. Heparininduced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy [J]. Chest, 2004; 126(3 Suppl): 311S337S.
15.	Lewis BE, Wallis DE, Berkowitz SD, et al. Argatroban anticoagulant therapy in patients with heparininduced thrombocytopenia [J]. Circulation, 2001; 103(14): 18381843.
16.	Lewis BE, Wallis DE, Leya F, et al. Argatroban anticoagulation in patients with heparininduced thrombocytopenia [J]. Arch Intern Med, 2003; 163(15): 18491856.
17.	馬玉奎, 趙紀春, 胡志, 等. 下肢深靜脈血栓形成的診斷及綜合治療 [J]. 中國普外基礎與臨床雜志, 2008; 15(1): 5658.
18.	陳鴻強, 李光新, 許崇恩, 等. 急性下肢深靜脈血栓形成的溶栓治療分析（附126例報告） [J]. 中國普外基礎與臨床雜志, 2006; 13(6): 665667.
19.	李曉強, 桑宏飛. 下肢深靜脈血栓形成的外科治療 [J]. 中國普外基礎與臨床雜志, 2006; 13(6): 638639.

1. Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism: A statement for healthcare professionals. Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association [J]. Circulation, 1996; 93(12): 22122245.
2. Büller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. [J]. Chest, 2004; 126(3 Suppl): 401S428S.
3. Warkentin TE, Levine MN, Hirsh J, et al. Heparininduced thrombocytopenia in patients treated with lowmolecular weight heparin or unfractionated heparin [J]. N Engl J Med, 1995; 332(20): 13301335.
4. Warkentin TE, Sheppard JA, Horsewood P, et al. Impact of the patient population on the risk for heparininduced thrombocytopenia [J]. Blood, 2000; 96(5): 17031708.
5. Shuster TA, Silliman WR, Coats RD, et al. Heparininduced thrombocytopenia: twentynine years later [J]. J Vasc Surg, 2003; 38(6): 13161322.
6. Gallus AS, Goodall KT, Tillett J, et al. The relative contributions of antithrombin Ⅲ during heparin treatment, and of clinically recognisable risk factors, to early recurrence of venous thromboembolism [J]. Thromb Res, 1987; 46(4): 539553.
7. 孫玉霞, 潘三蔥, 秦中勝. 低分子肝素和普通肝素治療下肢深靜脈血栓的臨床觀察 [J]. 長治醫學院學報, 2008; 22(4): 272274.
8. 陳妍，韓宏，胡佩群，等. 程序化應用低分子肝素對非手術治療老年人髖部骨折下肢深靜脈血栓形成的干預 [J]. 中華老年醫學雜志, 2008; 27(7): 535536.
9. 劉銘，劉蔚. 奧扎格雷鈉聯合低分子肝素治療下肢深靜脈血栓54例分析 [J]. 中國誤診學雜志, 2008; 8(19): 46904691.
10. LindhoffLast E, Nakov R, Misselwitz F, et al. Incidence and clinical relevance of heparininduced antibodies in patients with deep vein thrombosis treated with unfractionated or lowmolecularweight heparin [J]. Br J Haematol, 2002; 118(4): 11371142.
11. Breddin HK, HachWunderle V, Nakov R, et al. Effects of a lowmolecularweight heparin on thrombus regression and recurrent thromboembolism in patients with deep vein thrombosis [J]. N Engl J Med, 2001; 344(9): 626631.
12. Prandoni P, Lensing AW, Büller HR, et al. Comparison of subcutaneous lowmolecularweight heparin with intravenous standard heparin in proximal deepvein thrombosis [J]. Lancet, 1992; 339(8791): 441445.
13. Hirsh J, Heddle N, Kelton JG. Treatment of heparin induced thrombocytopenia: a critical review [J]. Arch Intern Med, 2004; 164(4): 361369.
14. Warkentin TE, Greinacher A. Heparininduced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy [J]. Chest, 2004; 126(3 Suppl): 311S337S.
15. Lewis BE, Wallis DE, Berkowitz SD, et al. Argatroban anticoagulant therapy in patients with heparininduced thrombocytopenia [J]. Circulation, 2001; 103(14): 18381843.
16. Lewis BE, Wallis DE, Leya F, et al. Argatroban anticoagulation in patients with heparininduced thrombocytopenia [J]. Arch Intern Med, 2003; 163(15): 18491856.
17. 馬玉奎, 趙紀春, 胡志, 等. 下肢深靜脈血栓形成的診斷及綜合治療 [J]. 中國普外基礎與臨床雜志, 2008; 15(1): 5658.
18. 陳鴻強, 李光新, 許崇恩, 等. 急性下肢深靜脈血栓形成的溶栓治療分析（附126例報告） [J]. 中國普外基礎與臨床雜志, 2006; 13(6): 665667.
19. 李曉強, 桑宏飛. 下肢深靜脈血栓形成的外科治療 [J]. 中國普外基礎與臨床雜志, 2006; 13(6): 638639.

《中國普外基礎與臨床雜志》

阿加曲班治療下肢深靜脈血栓的療效評價

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《中國普外基礎與臨床雜志》

阿加曲班治療下肢深靜脈血栓的療效評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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