低体重患者应用依诺肝素与未分离肝素预防静脉血栓栓塞

IF 0.5 Q4 HEMATOLOGY Plasmatology Pub Date : 2023-01-01 DOI:10.1177/26348535231156848
David Michael Kaylor, Regan Merrell Wade, Kathryn Brinkley Chappell, Meredith Huff Niemann, Vanessa Marie VanArsdale
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引用次数: 0

摘要

背景:虽然在低体重患者中研究了减少剂量的依诺肝素,但没有研究直接比较依诺肝素和未分离肝素在这一人群中预防静脉血栓栓塞(VTE)的效果。目的探讨低体重患者最安全有效的静脉外血栓栓塞预防方案。设计回顾性队列。方法住院患者称重<在两年半的时间里,对55公斤接受依诺肝素或未分割肝素预防静脉血栓栓塞的患者进行了评估。主要结局包括静脉血栓栓塞率和总出血事件。次要结局包括大出血和临床相关小出血的发生率。对给药方案进行分析,以确定剂量、体重、肌酐清除率、静脉血栓栓塞和出血事件之间的关系。使用卡方检验和费舍尔精确检验评估主要和次要结局。结果361例患者提供了400次静脉血栓栓塞预防。大多数患者为女性(88%),Padua评分≥4(82%),住院/外科(76%)。静脉血栓栓塞率在接受依诺肝素治疗的患者中为0.4%,在接受未分离肝素治疗的患者中为2.5% (P = 0.334)。依诺肝素组和未分割肝素组的出血率分别为12%和11% (P = 1)。每日服用依诺肝素30 mg的患者出血率为7.6%,而每日服用40 mg的患者出血率为14.7% (P = 0.134)。每日接受两次肝素治疗的患者无出血事件,而每日接受三次肝素治疗的患者为12.9% (P = 0.222)。结论总体而言,体重和体重的患者静脉血栓栓塞和出血发生率无显著差异;服用依诺肝素与未分离肝素的患者相比,服用每日30毫克依诺肝素的患者在出血或静脉血栓栓塞事件方面没有差异。因此,从经验上看,减少依诺肝素预防静脉血栓栓塞的剂量对体重为100公斤的患者似乎是合理和安全的。55公斤。
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Venous Thromboembolism Prophylaxis with Enoxaparin Versus Unfractionated Heparin in Patients with Low Body Weight
Background Although reduced doses of enoxaparin have been studied in low body weight patients, no study has directly compared enoxaparin to unfractionated heparin for venous thromboembolism (VTE) prophylaxis in this population. Objective To determine the most safe and efficacious parenteral venous thromboembolism prophylaxis regimen for low body weight patients. Design Retrospective cohort. Methods Hospitalized patients weighing < 55 kg receiving either enoxaparin or unfractionated heparin for VTE prophylaxis over a period of two and a half years were evaluated. Primary outcomes included rates of VTE and overall bleeding events. Secondary outcomes included rates of major and clinically relevant minor bleeding. Dosing regimens were analyzed to determine associations between dose, weight, creatinine clearance, VTE, and bleeding events. Primary and secondary outcomes were evaluated using Chi squared and Fischer's Exact tests. Results Three hundred and sixty-one patients contributed 400 episodes of VTE prophylaxis. Most patients were female (88%), had a Padua score ≥ 4 (82%) and were admitted to medical/surgical units (76%). VTE rates were 0.4% in patients receiving enoxaparin and 2.5% in patients receiving unfractionated heparin ( P = 0.334). Bleeding rates were 12% and 11% in the enoxaparin and unfractionated heparin groups, respectively ( P = 1). Patients receiving enoxaparin 30 mg daily had bleeding rates of 7.6% compared to 14.7% in patients receiving 40 mg daily ( P = 0.134). Patients receiving heparin twice daily had no bleeding events compared to 12.9% of patients receiving heparin three times daily ( P = 0.222). Conclusion Overall, no difference in VTE or bleeding rates were found between patients weighing < 55 kg receiving enoxaparin versus unfractionated heparin, and there was no difference in bleeding or VTE events in the patients receiving enoxaparin 30 mg daily. Due to this, empirically reducing the dose of enoxaparin for VTE prophylaxis appears reasonable and safe in patients weighing < 55 kg.
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Plasmatology
Plasmatology HEMATOLOGY-
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