内外科混合型重症监护病房人群中低分子肝素（LMWH）纳度肝素剂量对抗 XA 水平影响的回顾性队列研究：CLOT-Xa。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-12-17 DOI:10.1016/j.jcrc.2024.154991

Lisanne van Berkel , Marnix Kuindersma , Ingrid D. van Iperen , Henk J. Adriaansen , Janine J.J. Hulstein , Peter E. Spronk

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引用次数: 0

摘要

目的：低分子肝素（LMWHs）广泛用于预防和治疗危重患者静脉血栓栓塞（VTE）。本研究的目的是评估在ICU患者中nadroparin剂量与抗xa活性之间的剂量-反应关系。材料和方法：纳入ICU收治的至少三次皮下注射纳红素的危重成人患者。通过混合效应logistic回归模型分析nadroparin剂量与抗xa水平的量效关系。结果：共纳入327例ICU患者。中位抗xa水平为85 IU/kg/天(p)。结论：我们发现nadroparin剂量与抗xa水平之间存在明显的剂量-反应关系。增加nadroparin剂量导致抗xa水平更足，而静脉血栓栓塞或大出血事件的发生没有变化，这表明低分子肝素治疗可以成功和安全地个体化使用抗xa引导剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

A retrospective Cohort study on the effect of the LOw-molecular weighT heparin (LMWH) nadroparin dose on anti-XA levels in a mixed medical-surgical ICU population: CLOT-Xa

查看原文本刊更多论文

A retrospective Cohort study on the effect of the LOw-molecular weighT heparin (LMWH) nadroparin dose on anti-XA levels in a mixed medical-surgical ICU population: CLOT-Xa

Purpose

Low-molecular-weight heparins (LMWHs) are widely used for prevention and treatment of venous thromboembolism (VTE) in critically ill patients. The objective of this study was to assess the dose-response relationship between nadroparin dose and anti-Xa activity in ICU patients.

Materials and methods

Critically ill adult patients who were admitted to the ICU, and received at least three subcutaneous injections of nadroparin were included. The dose-effect relationship between nadroparin dose and anti-Xa level was analysed through a mixed-effects logistic regression model.

Results

In total, 327 ICU patients were included. Median anti-Xa levels ranged from <0.1 IU/mL after nadroparin 0–37 IU/kg/day to 0.6 IU/mL after nadroparin >85 IU/kg/day (p < 0.01). Among all 1520 anti-Xa measurements, 859 (57 %) measurements were in the desired anti-Xa range. The best adequacy of anti-Xa levels was observed in nadroparin doses of 38–85 IU/kg (73 %). No differences in the odds of bleeding events or VTE between different anti-Xa levels were found.

Conclusions

We found a clear dose-response relationship between nadroparin dose and anti-Xa levels. Increasing nadroparin doses led to more adequate anti-Xa levels without a change in the occurrence of VTE or major bleeding events, suggesting that LMWH therapy can be successfully and safely personalized using anti-Xa guided dosing.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.