Danaparoid。审查的药理学和临床使用管理肝素诱发的血小板减少症。
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王尔德MI,马卡姆
Danaparoid。审查的药理学和临床使用管理肝素诱发的血小板减少症。
药。1997年12月,54 (6):903 - 24。
- PubMed ID
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9421696 (在PubMed]
- 文摘
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Danaparoid,低分子量heparinoid组成的乙酰肝素的混合物,dermatan和软骨素硫酸盐,有良好的抗血栓形成的活动。药物有高antifactor Xa antifactor花絮(凝血酶)活动率,较低的倾向,引起出血和最小对纤溶系统的影响。Danaparoid与heparin-associated抗血小板抗体大率低(0到20%;意味着大约10%)。它标志着一个重大的优势低分子量肝素(lmwh)作为潜在的替代代理未分离肝素(能)肝素诱发免疫介导性(II型)患者血小板减少症(打击)。在全世界同情使用计划涉及667患者达到迄今为止,93%的danaparoid疗程被认为是成功的。血小板减少91%的事件得到解决。danaparoid的多中心随机比较试验和患者的右旋糖酐+血栓形成(希特),明显比右旋糖酐danaparoid接受者有血栓形成的决议,和有效的临床反应是实现更多danaparoid接受者。的回顾性病例对照研究结果danaparoid希特显示显著减少患者和安克洛酶新的或进步与danaparoid血栓形成。同情使用计划,danaparoid有关治疗期间的死亡率为10.4%(3.5年),7.8%的人在随访期间(3个月)。 14 of 114 deaths during the follow-up period were considered to be related to danaparoid therapy. A mortality rate of 23.5% was reported in patients accepted for but not treated with, danaparoid. Mortality rates with danaparoid, ancrod and dextran in the comparative studies were similar (7, 11 and 12%, respectively). Severe bleeding was reported in 3.1% of patients in the compassionate-use programme, persistent or recurrent thrombocytopenia in 2.6% and new thromboembolic events/extension of existing thrombosis in 1.7%. The incidence of bleeding was similar with danaparoid and dextran in a comparative trial. Although in vitro cross-reactivity does not always translate into clinical cross-reactivity, testing is currently recommended, when possible, before initiation of danaparoid therapy. Thus, danaparoid appears to be an effective and well tolerated replacement agent for UFH in many patients with HIT who require further anticoagulation. The drug has low cross-reactivity with HIT-associated antibodies. Further comparative trials are needed to confirm these promising findings.
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