Anti factor Xa monitoring for venous thromboprophylaxis in severely burn-injured patients: A systematic review

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE Burns Pub Date : 2024-05-08 DOI:10.1016/j.burns.2024.05.011

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Abstract

Introduction

Patients with severe burn injuries are at risk of venous thromboembolism (VTE) and associated sequelae. Burn-injured patients may require larger doses of VTE prophylaxis so underdosing may occur with standard regimens. Monitoring anti-factor Xa (AFXa) levels may allow tailoring of dosage but is currently uncommon. The purpose of this systematic review was to methodically review the available literature with respect to AFXa in severe burn-injured patients, and thereby assess its efficacy.

Methods

Using PRISMA guidelines, “Xa” and “burns” were used to systematically review MEDLINE (1946 - present) and EMBASE (1974 - present) databases for publications regarding the monitoring of AFXa levels for thromboprophylaxis in burn-injured patients.

Results

Eight studies (432 patients) met inclusion. Peak AFXa level at initial measurement was reported in all studies and was within the range for prophylaxis in 184 of 432 cases (42.6%), below range in 246 of 432 cases (56.9%) and above range for 2/432 (0.5%). Complications were reported in 7 studies (412 patients), with a total of 30 (7.3%) complications, comprising of 16 (53.3%) VTE events and 14 (46.7%) mortalities. Three studies comprising 270 patients compared complications between patients who were within the reference range with patients who were below the range. There were 164 patients from the ‘within the reference range’ groups that had a total of 6 (3.7%) complications, comprised of 4 (66.7%) VTE events and 2 (33.3%) mortalities. There were 106 patients from the ‘below reference range group’ that had a total of 11 (10.4%) complications, comprised of 9 (81.8%) VTE events and 2 (18.2%) mortalities.

Conclusion

Our findings suggest standard prophylactic anticoagulation dosing risks underdosing and therefore, an increased risk in the development of VTE. AFXa monitoring allows individually tailored dose adjustment to reach therapeutic levels, which may be efficacious in reducing VTE events and is therefore recommended where possible.

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对严重烧伤患者进行静脉血栓预防的抗 Xa 因子监测：系统综述

严重烧伤患者面临静脉血栓栓塞（VTE）和相关后遗症的风险。烧伤患者可能需要更大剂量的 VTE 预防药物，因此标准方案可能会出现剂量不足的情况。监测抗因子 Xa（AFXa）水平可以调整剂量，但目前并不常见。本系统性综述旨在有条不紊地回顾有关严重烧伤患者 AFXa 的现有文献，从而评估其疗效。根据 PRISMA 指南，使用 "Xa "和 "烧伤 "对 MEDLINE（1946 年至今）和 EMBASE（1974 年至今）数据库中有关烧伤患者血栓预防中 AFXa 水平监测的文献进行了系统性回顾。八项研究（432 名患者）符合纳入条件。所有研究都报告了初次测量时的 AFXa 峰值水平，432 例中有 184 例（42.6%）在预防范围内，432 例中有 246 例（56.9%）低于预防范围，2/432 例（0.5%）高于预防范围。7项研究（412名患者）报告了并发症，共有30例（7.3%）并发症，包括16例（53.3%）VTE事件和14例（46.7%）死亡。由 270 名患者组成的三项研究比较了在参考值范围内的患者与低于参考值范围的患者之间的并发症情况。在参考值范围内 "组有 164 名患者，共出现 6 例（3.7%）并发症，包括 4 例（66.7%）VTE 事件和 2 例（33.3%）死亡。低于参考范围组 "有 106 名患者，共出现 11 例（10.4%）并发症，包括 9 例（81.8%）VTE 事件和 2 例（18.2%）死亡。我们的研究结果表明，标准预防性抗凝剂量存在剂量不足的风险，因此会增加发生 VTE 的风险。通过监测 AFXa，可以根据个体情况调整剂量，使其达到治疗水平，这可能有效减少 VTE 事件，因此建议尽可能采用这种方法。

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来源期刊

Burns 医学-皮肤病学

CiteScore

4.50

自引率

18.50%

发文量

304

审稿时长

72 days

期刊介绍： Burns aims to foster the exchange of information among all engaged in preventing and treating the effects of burns. The journal focuses on clinical, scientific and social aspects of these injuries and covers the prevention of the injury, the epidemiology of such injuries and all aspects of treatment including development of new techniques and technologies and verification of existing ones. Regular features include clinical and scientific papers, state of the art reviews and descriptions of burn-care in practice. Topics covered by Burns include: the effects of smoke on man and animals, their tissues and cells; the responses to and treatment of patients and animals with chemical injuries to the skin; the biological and clinical effects of cold injuries; surgical techniques which are, or may be relevant to the treatment of burned patients during the acute or reconstructive phase following injury; well controlled laboratory studies of the effectiveness of anti-microbial agents on infection and new materials on scarring and healing; inflammatory responses to injury, effectiveness of related agents and other compounds used to modify the physiological and cellular responses to the injury; experimental studies of burns and the outcome of burn wound healing; regenerative medicine concerning the skin.