Efficacy Evaluation of Argatroban in Treatment of Lower Extremity Deep Vein Thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

张天华 , 姜维良 , 张英男

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Keywords：

阿加曲班; 肝素; 深静脉血栓形成; 治疗; 血小板减少症

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目的比较常规使用肝素和阿加曲班治疗下肢深静脉血栓（DVT）患者的临床疗效。
方法将188例下肢DVT患者按照随机数字表分成阿加曲班组（n=94）和对照组（低分子肝素钙+尿激酶，n=94），比较2组患者治疗前、后双侧肢体周径差和疗效的差异，并在治疗过程中监测凝血指标（PT、APTT及PLT）变化。
结果阿加曲班组治疗10 d后，双侧肢体周径差较治疗前明显减小（P lt;0.05），总有效率（97.87%）优于对照组（89.37%），P lt;0.05。阿加曲班组无血小板减少症（HIT）发生，对照组发生2例HIT；阿加曲班组PT、APTT和PLT变化均处于正常范围，与对照组比较差异无统计学意义（P gt;0.05）。
结论阿加曲班治疗下肢DVT安全、有效。

Citation： 张天华,姜维良,张英男. Efficacy Evaluation of Argatroban in Treatment of Lower Extremity Deep Vein Thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(7): 683-685. doi: Copy

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.	孙玉霞, 潘三葱, 秦中胜. 低分子肝素和普通肝素治疗下肢深静脉血栓的临床观察 [J]. 长治医学院学报, 2008; 22(4): 272274.
8.	陈妍，韩宏，胡佩群，等. 程序化应用低分子肝素对非手术治疗老年人髋部骨折下肢深静脉血栓形成的干预 [J]. 中华老年医学杂志, 2008; 27(7): 535536.
9.	刘铭，刘蔚. 奥扎格雷钠联合低分子肝素治疗下肢深静脉血栓54例分析 [J]. 中国误诊学杂志, 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.	马玉奎, 赵纪春, 胡志, 等. 下肢深静脉血栓形成的诊断及综合治疗 [J]. 中国普外基础与临床杂志, 2008; 15(1): 5658.
18.	陈鸿强, 李光新, 许崇恩, 等. 急性下肢深静脉血栓形成的溶栓治疗分析（附126例报告） [J]. 中国普外基础与临床杂志, 2006; 13(6): 665667.
19.	李晓强, 桑宏飞. 下肢深静脉血栓形成的外科治疗 [J]. 中国普外基础与临床杂志, 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. 孙玉霞, 潘三葱, 秦中胜. 低分子肝素和普通肝素治疗下肢深静脉血栓的临床观察 [J]. 长治医学院学报, 2008; 22(4): 272274.
8. 陈妍，韩宏，胡佩群，等. 程序化应用低分子肝素对非手术治疗老年人髋部骨折下肢深静脉血栓形成的干预 [J]. 中华老年医学杂志, 2008; 27(7): 535536.
9. 刘铭，刘蔚. 奥扎格雷钠联合低分子肝素治疗下肢深静脉血栓54例分析 [J]. 中国误诊学杂志, 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. 马玉奎, 赵纪春, 胡志, 等. 下肢深静脉血栓形成的诊断及综合治疗 [J]. 中国普外基础与临床杂志, 2008; 15(1): 5658.
18. 陈鸿强, 李光新, 许崇恩, 等. 急性下肢深静脉血栓形成的溶栓治疗分析（附126例报告） [J]. 中国普外基础与临床杂志, 2006; 13(6): 665667.
19. 李晓强, 桑宏飞. 下肢深静脉血栓形成的外科治疗 [J]. 中国普外基础与临床杂志, 2006; 13(6): 638639.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Efficacy Evaluation of Argatroban in Treatment of Lower Extremity Deep Vein Thrombosis

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