新的口服抗凝剂
现在新出现的许多新口服抗凝剂,如直接凝血酶抑制剂和口服抗-Xa 抑制剂(达比加群、利伐沙班和其他),在少数研究中证明是安全和有效的主要和次要血栓预防制剂。[55]Eriksson BI, Dahl OE, Rosencher N, et al; RE-MODEL Study Group. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost. 2007;5:2178-2185.http://onlinelibrary.wiley.com/doi/10.1111/j.1538-7836.2007.02748.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/17764540?tool=bestpractice.com[56]Eriksson BI, Dahl OE, Rosencher N, et al; RE-NOVATE Study Group. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet. 2007;370:949-956.http://www.ncbi.nlm.nih.gov/pubmed/17869635?tool=bestpractice.com[57]Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet. 2009;373:1673-1680.http://www.ncbi.nlm.nih.gov/pubmed/19411100?tool=bestpractice.com然而,没有研究解决这些制剂在 APS 患者中的安全性和效力问题,因此,它们未来在 APS 患者中的血栓形成治疗和预防方面的作用尚不清楚。英国正在进行一项研究,旨在评估利伐沙班和华法林在有静脉血栓形成既往史患者的二级预防方面的疗效。Current Controlled Trials: rivaroxaban in antiphospholipid syndrome (RAPS)
羟氯喹
羟氯喹已广泛用于治疗有系统性红斑狼疮 (SLE) 的患者,并与 SLE 患者的血栓形成风险降低有关。[16]Erkan D, Lockshin MD. New approaches for managing antiphospholipid syndrome. Nat Clin Pract Rheumatol. 2009;5:160-170.http://www.ncbi.nlm.nih.gov/pubmed/19252521?tool=bestpractice.com[48]Erkan D, Lockshin MD; APS ACTION members. APS ACTION - AntiPhospholipid Syndrome Alliance for Clinical Trials and International Networking. Lupus. 2012;21:695-698.http://lup.sagepub.com/content/21/7/695.longhttp://www.ncbi.nlm.nih.gov/pubmed/22635205?tool=bestpractice.com[58]Wallace DJ. Does hydroxychloroquine sulfate prevent clot formation in systemic lupus erythematosus? Arthritis Rheum. 1987;30:1435-1436.http://www.ncbi.nlm.nih.gov/pubmed/3435574?tool=bestpractice.com羟氯喹已显示可将抗磷脂抗体-β2-糖蛋白 I 复合物逆向拆解为磷脂双分子层——这可能是在 APS 的血栓形成进展中的重要发病机制。[59]Rand JH, Wu XX, Quinn AS, et al. Hydroxychloroquine directly reduces the binding of antiphospholipid antibody-beta2-glycoprotein I complexes to phospholipid bilayers. Blood. 2008;112:1687-1695.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518879/http://www.ncbi.nlm.nih.gov/pubmed/18577708?tool=bestpractice.com
他汀类药物
他汀类药物可能会降低静脉血栓栓塞的风险,但仍需要进一步研究。[16]Erkan D, Lockshin MD. New approaches for managing antiphospholipid syndrome. Nat Clin Pract Rheumatol. 2009;5:160-170.http://www.ncbi.nlm.nih.gov/pubmed/19252521?tool=bestpractice.com[60]Glynn RJ, Danielson E, Fonseca FA, et al. A randomized trial of rosuvastatin in the prevention of venous thromboembolism. N Engl J Med. 2009;360:1851-1861.http://www.nejm.org/doi/full/10.1056/NEJMoa0900241#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/19329822?tool=bestpractice.com