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抗Ⅹa活性检测在抗凝治疗中的临床应用现状与前景

邸平 李绵洋

邸平, 李绵洋. 抗Ⅹa活性检测在抗凝治疗中的临床应用现状与前景[J]. 协和医学杂志, 2021, 12(4): 456-459. doi: 10.12290/xhyxzz.2021-0424
引用本文: 邸平, 李绵洋. 抗Ⅹa活性检测在抗凝治疗中的临床应用现状与前景[J]. 协和医学杂志, 2021, 12(4): 456-459. doi: 10.12290/xhyxzz.2021-0424
DI Ping, LI Mianyang. Status and Prospect of Clinical Application of the Evaluation of Anti-Ⅹa Activity in Anticoagulant Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(4): 456-459. doi: 10.12290/xhyxzz.2021-0424
Citation: DI Ping, LI Mianyang. Status and Prospect of Clinical Application of the Evaluation of Anti-Ⅹa Activity in Anticoagulant Therapy[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(4): 456-459. doi: 10.12290/xhyxzz.2021-0424

抗Ⅹa活性检测在抗凝治疗中的临床应用现状与前景

doi: 10.12290/xhyxzz.2021-0424
基金项目: 

国家重点研发计划 2018YFC2000201

详细信息
    通讯作者:

    李绵洋  电话:010-66937772,E-mail:limianyang301@163.com

  • 中图分类号: R446.1

Status and Prospect of Clinical Application of the Evaluation of Anti-Ⅹa Activity in Anticoagulant Therapy

Funds: 

National Key Research and Development Program of China 2018YFC2000201

More Information
  • 摘要: 随着检测技术的进步,临床中各种疾病伴随血栓的检出率越来越高。普通肝素和低分子量肝素是目前临床应用较多的注射用抗凝剂,其中普通肝素的半衰期短、无肾毒性、有拮抗剂;低分子量肝素半衰期较长,需在一些特殊人群如儿童、孕妇、老人中进行监测。口服抗凝剂中,除华法林等传统药物外,靶向活化凝血因子Ⅹa的抗凝药物如利伐沙班亦越来越多地应用于临床。既往采用活化部分凝血活酶时间对普通肝素进行监测,而对低分子量肝素、新型抗Ⅹa类药物监测手段和监测意识不强。随着人们对抗凝治疗认识的不断深入,抗Ⅹa活性检测作为一种新的抗凝监测手段,临床应用越来越广泛,但目前检测结果很难与临床表现相关联,未来仍需大型随机对照试验加以验证。
    作者贡献:邸平负责查阅文献,撰写初稿;李绵洋负责文章构思,提出修改意见。
    利益冲突:
  • 图  1  抗Ⅹa活性检测原理[1]

    表  1  利伐沙班临床适应证及抗Ⅹa监测范围[18]

    适应证 剂量 谷值(范围),μg/L 峰值(范围),μg/L
    全髋关节置换术后VTE预防 10 mg,1次/d 8(1~38) 125(91~196)
    DVT治疗 20 mg,1次/d 26(6~87) 270(189~419)
    非瓣膜性房颤(肌酐清除率≥50 mL/min) 20 mg,1次/d 44(12~137) 249(184~343)
    非瓣膜性房颤(肌酐清除率30~49 mL/min) 15 mg,1次/d 57(18~136) 229(178~313)
    急性冠脉综合征的二级预防 2.5 mg,2次/d 17(6~37) 46(28~70)
    VTE:静脉血栓栓塞症;DVT:深静脉血栓
    下载: 导出CSV

    表  2  抗凝药物监测指征及监测项目

    抗凝药物 监测指征 监测项目
    普通肝素 常规监测 APTT、ACT、抗Ⅹa
    低分子量肝素 妊娠期、严重肾功能不全、严重出血风险、肥胖或体质量过低等 抗Ⅹa
    利伐沙班 有影响药物代谢的因素,如肾肝功能不全、肥胖或体质量过低、胃肠道吸收不良等 抗Ⅹa、PT
    APTT:活化部分凝血活酶时间;ACT:激活凝血时间;PT: 凝血酶原时间
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-05-25
  • 录用日期:  2021-07-08
  • 刊出日期:  2021-07-30

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