肝素类药物临床监测专家共识 中国研究型医院学会血栓与止血专委会 中国老年医学学会检验分会 通信作者：周洲，中国医学科学院阜外医院实验诊断中心，北京 100037，Email：fwcomd@ 126.com；许俊堂，北京大学人民医院心内科，北京 100044，Email：xujuntang@hotmail. com；宋鉴清，中国医科大学附属第一医院检验科，沈阳 110179，Email：songlisw@yeah. net 【摘要】　肝素类药物是防治血栓栓塞性疾病常用的抗凝药物，该类药物的正确使用及合理监测 对于保证治疗的安全性和有效性尤为重要。本专家共识参考国内外相关文献，充分考虑肝素类药物 应用的现状和进展，组织抗栓领域相关的检验和临床专家，对肝素类药物的适应证、剂量、监测等方面 进行了充分讨论，特别是明确了抗Ⅹa活性等实验室指标的临床应用方法，并形成专家推荐意见，以 期推进肝素类药物的安全、有效使用，及实验室监测的标准化。 【关键词】　肝素；　抗凝监测；　抗Ⅹa活性；　血栓形成；　出血 Expert consensus on clinical monitoring of heparin drugs Chinese Society on Thrombosis and Hemostasis, Laboratory Sciences Devision of Chinese Geriatrics Society Corresponding author: Zhou Zhou, Department of Laboratory Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China,Email: fwcomd@126.com; Xu Juntang,Department of Cardiology, Peking University People's Hospital, Beijing 100044, China, Email: xujuntang@hotmail. com; Song Jianqing, Department of Laboratory Medicine,the First Affiliated Hospital of China Medical University,Shenyang 110179,China,Email: songlisw@yeah.net 【Abstract】 Heparin drugs are commonly used anticoagulants in the prevention and treatment of thromboembolic diseases, and correct use and reasonable monitoring are particularly important to ensure the safety and effectiveness of this treatment. This expert consensus refers to the relevant literature at home and abroad, fully considering the current situation and progress in the application of heparins, and organizes relevant laboratory and clinical experts in the field of antithrombosis, to fully discusses the indications, doses, monitoring and other aspects of heparin drugs, especially to clarify the clinical application methods of laboratory parameters such as anti‑Ⅹa activity, and to forms the expert recommendations, in order to promote the safe and effective use of drugs and the standardization of laboratory monitoring. 【Key words】 Heparins; Anticoagulation monitoring; Anti‑Ⅹa activity; Thrombosis; Bleeding 肝素类药物主要包括普通肝素（unfractionated heparin，UFH）、低分子肝素（low molecular weight heparin， LMWH）、磺达肝癸钠等。普通肝素剂量 反应关系难以精准预测、抗凝效果与安全性在个体 内和个体间均存在差异，用药过量（抗凝过度）存在 出血风险、用量不足（抗凝不足）又无法有效抑制血 栓形成，所以普通肝素使用时需要对抗凝效果进行 监测；LMWH 和磺达肝癸钠虽然常规使用无须监 测，但在特殊人群或者特殊临床情况下需要监测抗 Ⅹa活性，以保证其抗栓的效果和安全性。