凝血机制_精品文档.pptVIP

*华法林的使用过程过需要监测INR的值，读图解释INR，是指国际标准化比值，计算过程如图，房颤患者口服华法林期间，应维持INR值在2-3，监测频率：第1周至少查3次INR，1周后改为每周1次，直到第4周。INR达到目标值并稳定后（连续两次在治疗的目标范围），每4周查一次INR。*Figure:ReprintedwithpermissionCirculation2006;114:e257-e354?2006,AmericanHeartAssociation,Inc.*华法林最大的优点是能口服；当INR调到规定范围时，能产生较好的疗效；且无肝素诱导的血小板减少症风险；但是华法林起效慢，需要用肝素或低分子肝素来进行过渡治疗，治疗窗窄，需要进行常规的凝血功能功能监测，与食物、药物之间的相互作用多。*新型抗凝药物的研发倾向于抑制凝血瀑布中的单一凝血因子。如Xa因子和IIa因子。*利伐沙班，直接抑制Xa因子。WeitzJIBatesSM.Newanticoagulants.JThrombHaemost2005;3:1843–1853*2008年达比加群--口服直接凝血酶抑制剂问世，直接作用抑制凝血酶。组织因子途径抑制剂（TFPI）：Therearemanytargetsfornovelanticoagulantsinthecoagulationpathway:Tissuefactorpathwayinhibitor(TFPI)boundtoFactorXainactivatesthetissuefactor(TF)–FactorVIIacomplex,preventinginitiationofcoagulationActivatedproteinC(APC)degradesFactorsVaandVIIIa,andthrombomodulin(soluble;sTM)convertsthrombin(FactorIIa)fromaprocoagulanttoapotentactivatorofproteinCFondaparinuxandidraparinuxindirectlyinhibitFactorXa,requiringantithrombin(AT)asacofactorDirect(AT-independent)inhibitorsofFactorXaincluderivaroxaban(BAY?59-7939),LY517717,YM150andDU-176b(allorallyavailable),andDX-9065a(intravenous)Oral,directthrombininhibitorsincludeximelagatran(nowwithdrawn)anddabigatranWeitzJIBatesSM.Newanticoagulants.JThrombHaemost2005;3:1843–1853*达比加群--口服直接凝血酶抑制剂：结合于凝血酶的纤维蛋白特异结合位点阻止纤维蛋白原裂解为纤维蛋白从而阻断了凝血瀑布网络的最后步骤及血栓形成。可以从纤维蛋白一凝血酶结合体上解离，发挥可逆的抗凝作用。组织因子途径抑制剂（TFPI）：Therearemanytargetsfornovelanticoagulantsinthecoagulationpathway:Tissuefactorpathwayinhibitor(TFPI)boundtoFactorXainactivatesthetissuefactor(TF)–FactorVIIacomplex,preventinginitiationofcoagulationActivatedproteinC(APC)degradesFactorsVaandVIIIa,andthrombomodulin(soluble;sTM)convertsthrombin(FactorIIa)fromaprocoagulanttoapotentactivatorofproteinCFondaparinuxandidraparinuxindirectlyinhibitFactorXa,requiring