Steven Atallah, Benjamin J Lee, Andy Lo, Christopher J Limbo, Jefferson W Chen, Jeffry Nahmias
{"title":"平衡安全性和有效性：评估基于体重，抗xa引导依诺肝素静脉血栓栓塞预防给药策略的创伤性脑损伤患者。","authors":"Steven Atallah, Benjamin J Lee, Andy Lo, Christopher J Limbo, Jefferson W Chen, Jeffry Nahmias","doi":"10.1097/TA.0000000000004701","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients with traumatic brain injury (TBI) with intracranial hemorrhage (ICH) are at high risk for venous thromboembolism (VTE) but are also prone to hemorrhagic progression. The efficacy and safety of weight-based, anti-Xa-guided enoxaparin dosing for patients with ICH are unknown. Therefore, this study aimed to compare fixed chemoprophylaxis versus weight-based, anti-Xa-guided enoxaparin dosing in the setting of ICH, hypothesizing reduced VTE incidence with similar ICH progression with weight-based, anti-Xa-guided dosing.</p><p><strong>Methods: </strong>This was a retrospective pre-post, quasi-experimental study conducted at a single, academic, Level I trauma center. Adult TBI patients admitted from December 2017 to May 2023 with ICH identified on computed tomography imaging who received at least 24 hours of chemoprophylaxis were included. A weight-based, anti-Xa-guided enoxaparin arm was compared with fixed doses of enoxaparin (40 mg) daily or unfractionated heparin (5,000 units) two to three times daily. Treatment groups were compared using a 1:1 propensity score matching (PSM), which matched for demographics and injury profile.</p><p><strong>Results: </strong>Of 831 included patients, 252 PSM cohorts were compared. A significantly lower incidence of VTE was observed in the anti-Xa-guided cohort (2.4% vs. 6.4%; p = 0.029), while radiographic ICH progression was equivalent between the two cohorts (4.4% vs. 4.4%; p = 0.99). A subgroup PSM analysis comparing 208 patients each from the anti-Xa-guided versus enoxaparin-only control cohort also demonstrated a significantly lower incidence of VTE with the anti-Xa-guided treatment (1.4% vs. 5.8%; p = 0.032) with no difference in radiographic ICH progression (4.3% vs. 2.4%; p = 0.28).</p><p><strong>Conclusion: </strong>Weight-based, anti-Xa-guided enoxaparin dosing was associated with reduced VTE incidence without increased ICH progression in TBI patients with existing ICH.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>","PeriodicalId":17453,"journal":{"name":"Journal of Trauma and Acute Care Surgery","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Balancing safety and efficacy: Assessment of a weight-based, anti-Xa-guided enoxaparin venous thromboembolism prophylaxis dosing strategy for traumatic brain injury patients.\",\"authors\":\"Steven Atallah, Benjamin J Lee, Andy Lo, Christopher J Limbo, Jefferson W Chen, Jeffry Nahmias\",\"doi\":\"10.1097/TA.0000000000004701\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients with traumatic brain injury (TBI) with intracranial hemorrhage (ICH) are at high risk for venous thromboembolism (VTE) but are also prone to hemorrhagic progression. The efficacy and safety of weight-based, anti-Xa-guided enoxaparin dosing for patients with ICH are unknown. Therefore, this study aimed to compare fixed chemoprophylaxis versus weight-based, anti-Xa-guided enoxaparin dosing in the setting of ICH, hypothesizing reduced VTE incidence with similar ICH progression with weight-based, anti-Xa-guided dosing.</p><p><strong>Methods: </strong>This was a retrospective pre-post, quasi-experimental study conducted at a single, academic, Level I trauma center. Adult TBI patients admitted from December 2017 to May 2023 with ICH identified on computed tomography imaging who received at least 24 hours of chemoprophylaxis were included. A weight-based, anti-Xa-guided enoxaparin arm was compared with fixed doses of enoxaparin (40 mg) daily or unfractionated heparin (5,000 units) two to three times daily. Treatment groups were compared using a 1:1 propensity score matching (PSM), which matched for demographics and injury profile.</p><p><strong>Results: </strong>Of 831 included patients, 252 PSM cohorts were compared. A significantly lower incidence of VTE was observed in the anti-Xa-guided cohort (2.4% vs. 6.4%; p = 0.029), while radiographic ICH progression was equivalent between the two cohorts (4.4% vs. 4.4%; p = 0.99). A subgroup PSM analysis comparing 208 patients each from the anti-Xa-guided versus enoxaparin-only control cohort also demonstrated a significantly lower incidence of VTE with the anti-Xa-guided treatment (1.4% vs. 5.8%; p = 0.032) with no difference in radiographic ICH progression (4.3% vs. 2.4%; p = 0.28).</p><p><strong>Conclusion: </strong>Weight-based, anti-Xa-guided enoxaparin dosing was associated with reduced VTE incidence without increased ICH progression in TBI patients with existing ICH.</p><p><strong>Level of evidence: </strong>Therapeutic/Care Management; Level IV.</p>\",\"PeriodicalId\":17453,\"journal\":{\"name\":\"Journal of Trauma and Acute Care Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-06-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Trauma and Acute Care Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/TA.0000000000004701\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Trauma and Acute Care Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/TA.0000000000004701","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景：外伤性脑损伤（TBI）合并颅内出血（ICH）患者发生静脉血栓栓塞（VTE）的风险很高，但也容易出现出血进展。以体重为基础、抗xa引导的依诺肝素给药对脑出血患者的疗效和安全性尚不清楚。因此，本研究旨在比较脑出血患者使用固定化学预防与以体重为基础、抗xa引导的依诺肝素剂量，假设与以体重为基础、抗xa引导的剂量在脑出血进展相似的情况下降低了静脉血栓栓塞发生率。方法：这是一项回顾性的前后准实验研究，在一个单一的学术一级创伤中心进行。纳入了2017年12月至2023年5月期间接受至少24小时化学预防治疗的计算机断层扫描成像发现脑出血的成年TBI患者。以体重为基础，抗xa引导的依诺肝素组与每日固定剂量的依诺肝素（40毫克）或每日2至3次的未分离肝素（5000单位）进行比较。使用1:1倾向评分匹配（PSM）对治疗组进行比较，该匹配符合人口统计学和损伤概况。结果：在831例纳入的患者中，252个PSM队列进行了比较。抗xa引导组的静脉血栓栓塞发生率显著降低(2.4% vs. 6.4%；p = 0.029)，而两个队列之间的放射学ICH进展相同(4.4% vs. 4.4%；P = 0.99)。一项亚组PSM分析比较了来自抗xa引导组和仅依诺肝素对照组的208例患者，也显示抗xa引导组的静脉血栓栓塞发生率显著降低(1.4% vs 5.8%；p = 0.032)，放射学上ICH进展无差异(4.3% vs. 2.4%；P = 0.28)。结论：以体重为基础，抗xa引导的依诺肝素剂量与已有脑出血的TBI患者的静脉血栓栓塞发生率降低相关，而不增加脑出血进展。证据水平：治疗/护理管理；IV级。
Balancing safety and efficacy: Assessment of a weight-based, anti-Xa-guided enoxaparin venous thromboembolism prophylaxis dosing strategy for traumatic brain injury patients.
Background: Patients with traumatic brain injury (TBI) with intracranial hemorrhage (ICH) are at high risk for venous thromboembolism (VTE) but are also prone to hemorrhagic progression. The efficacy and safety of weight-based, anti-Xa-guided enoxaparin dosing for patients with ICH are unknown. Therefore, this study aimed to compare fixed chemoprophylaxis versus weight-based, anti-Xa-guided enoxaparin dosing in the setting of ICH, hypothesizing reduced VTE incidence with similar ICH progression with weight-based, anti-Xa-guided dosing.
Methods: This was a retrospective pre-post, quasi-experimental study conducted at a single, academic, Level I trauma center. Adult TBI patients admitted from December 2017 to May 2023 with ICH identified on computed tomography imaging who received at least 24 hours of chemoprophylaxis were included. A weight-based, anti-Xa-guided enoxaparin arm was compared with fixed doses of enoxaparin (40 mg) daily or unfractionated heparin (5,000 units) two to three times daily. Treatment groups were compared using a 1:1 propensity score matching (PSM), which matched for demographics and injury profile.
Results: Of 831 included patients, 252 PSM cohorts were compared. A significantly lower incidence of VTE was observed in the anti-Xa-guided cohort (2.4% vs. 6.4%; p = 0.029), while radiographic ICH progression was equivalent between the two cohorts (4.4% vs. 4.4%; p = 0.99). A subgroup PSM analysis comparing 208 patients each from the anti-Xa-guided versus enoxaparin-only control cohort also demonstrated a significantly lower incidence of VTE with the anti-Xa-guided treatment (1.4% vs. 5.8%; p = 0.032) with no difference in radiographic ICH progression (4.3% vs. 2.4%; p = 0.28).
Conclusion: Weight-based, anti-Xa-guided enoxaparin dosing was associated with reduced VTE incidence without increased ICH progression in TBI patients with existing ICH.
Level of evidence: Therapeutic/Care Management; Level IV.
期刊介绍：
The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
