Pulmonary embolism: Current treatment options

被引：4

作者：

Meysman M. ^{[1
]}

Haentjens P. ^{[2
]}

机构：

[1] Respiratory Division, Department of Medicine, Vrije Universiteit Brussel, Brussels B-1090

[2] Department of Orthopaedics and Traumatology, University Hospital VUB, Vrije Universiteit Brussel, Brussels B-1090

来源：

Current Treatment Options in Cardiovascular Medicine | 2005年 / 7卷 / 6期

关键词：

Pulmonary Embolism; International Normalize Ratio; Enoxaparin; Brain Natriuretic Peptide; Unfractionated Heparin;

D O I：

10.1007/s11936-005-0034-y

中图分类号：

学科分类号：

摘要：

The initial treatment of patients with acute pulmonary embolism has traditionally involved unfractionated heparin. Given the more predictable pharmacodynamic and pharmacokinetic properties of low molecular weight heparins, their simpler (fixed) dosing regimens, and few or no laboratory monitoring requirements, low molecular weight heparins are gradually replacing heparin for the initial treatment of most patients diagnosed with acute pulmonary embolism, except in very obese patients or patients with renal failure. Only selected patients with massive, life-threatening pulmonary embolism should be managed with intravenously administered thrombolytic drugs, surgical embolectomy, or catheter-based embolectomy. Likewise, inferior vena caval filter should be considered only in patients with an absolute contraindication to, or a documented failure of, anticoagulant therapy. New anticoagulants, such as ximelagatran, an oral direct thrombin inhibitor, or fondaparinux and idraparinux, selective factor Xa inhibitors with an almost complete bioavailability after subcutaneous injection are promising alternatives, but these drugs have yet to find a place in the initial treatment of pulmonary embolism in standard day-to-day clinical practice. Long-term anticoagulation treatment is still provided by antivitamin K antagonists (eg, warfarin), which unfortunately have a narrow therapeutic window. Consequently, time-consuming monitoring is required to ensure the therapeutic anticoagutant effect. A target International Normalized Ratio (INR) of 2.5 (INR range: 2.0 to 3.0) is recommended for warfarin therapy. This treatment should be continued for at least 3 months for patients with a first episode of pulmonary embolism secondary to a transient (reversible) risk factor, or up to 6 to 12 months for patients with a first episode of idiopathic pulmonary embolism. Copyright © 2005 by Current Science Inc.

引用

页码：483 / 490

页数：7

共 42 条

[1] Murin S., Romano P.S., White R.H., Comparison of outcomes after hospitalization for deep venous thrombosis or pulmonary embolism, Thromb. Haemost., 88, pp. 407-414, (2002)
[2] Margaglione M., Brancaccio V., De Lucia D., Et al., Inherited thrombophilic risk factors and venous thromboembolism: Distinct role in peripheral deep venous thrombosis and pulmonary embolism, Chest, 118, pp. 1405-1411, (2000)
[3] Quinlan D.J., McQuillan A., Eikelboom J.W., Low-molecular-weight heparin compared with intravenous unfractionated heparin for treatment of pulmonary embolism: A meta-analysis of randomized, controlled trials, Ann. Intern. Med., 140, pp. 175-183, (2004)
[4] Buller H.R., Agnelli G., Hull R.D., Et al., Antithrombotic therapy for venous thromboembolic disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy, Chest, 126, 3 SUPPL., (2004)
[5] Weitz J.I., Low-molecular-weight heparins, N. Engl. J. Med., 337, pp. 688-698, (1997)
[6] Bounameaux H., de Moerloose P., Is laboratory monitoring of low-molecular-weight heparin therapy necessary? No, J. Thromb. Haemost., 2, pp. 551-554, (2004)
[7] Laposata M., Green D., Van Cott E.M., Et al., College of American Pathologists Conference XXXI on laboratory monitoring of anticoagulant therapy: The clinical use and laboratory monitoring of low-molecular-weight heparin, danaparoid, hirudin and related compounds, and argatroban, Arch. Pathol. Lab. Med., 122, pp. 799-807, (1998)
[8] Siguret V., Pautas E., Fevrier M., Et al., Elderly patients treated with tinzaparin (Innohep) administered once daily (175 anti-Xa IU/kg): Anti-Xa and anti-IIa activities over 10 days, Thromb. Haemost., 84, pp. 800-804, (2000)
[9] Mismetti P., Laporte-Simitsidis S., Navarro C., Et al., Aging and venous thromboembolism influence the pharmacodynamics of the anti-factor Xa and anti-thrombin activities of a low molecular weight heparin (nadroparin), Thromb. Haemost., 79, pp. 1162-1165, (1998)
[10] Nagge J., Crowther M., Hirsh J., Is impaired renal function a contraindication to the use of low-molecular-weight heparin?, Arch. Intern. Med., 162, pp. 2605-2609, (2002)

← 1 2 3 4 5 →