妊娠期间依诺肝素治疗性抗凝时抗因子 Xa 水平的波动。
Fluctuations in anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy.
机构信息
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, Orange, CA 92868, USA.
出版信息
J Perinatol. 2010 Apr;30(4):253-7. doi: 10.1038/jp.2009.164. Epub 2009 Oct 15.
OBJECTIVE
The objective of the study was to evaluate anti-factor Xa levels with therapeutic enoxaparin anticoagulation in pregnancy.
STUDY DESIGN
A total of 15 pregnant subjects on therapeutic doses of enoxaparin (1 mg/kg +/-20% subcutaneously (s.c.) twice daily (b.i.d.)) were enrolled prospectively in this cross-sectional pilot project. Three blood levels for anti-factor Xa activity were examined: before the enoxaparin dose (trough), 3- to 4-h later (peak) and 8-h later. Anti-factor Xa activity level between 0.5 and 1.2 U/ml was considered therapeutic.
RESULT
Mean anti-factor Xa activity levels were: trough 0.45+/-0.18, peak 0.9+/-0.25 and 8-h after dose 0.72+/-0.23 U/ml. All peak levels were therapeutic; 20% (3/15) of the 8 h and 73% (11/15) of the trough levels were sub-therapeutic.
CONCLUSION
Trough and 8-h post-dose anti-factor Xa activity levels were sub-therapeutic in a substantial number of patients receiving a b.i.d. regimen of therapeutic enoxaparin.
目的
本研究旨在评估妊娠患者应用治疗剂量依诺肝素进行抗凝治疗时的抗 Xa 因子水平。
研究设计
本前瞻性横断面初步研究共纳入 15 例接受治疗剂量依诺肝素（1 mg/kg ± 20%皮下注射，每日 2 次）的妊娠患者。检测了 3 种抗 Xa 因子活性血药浓度：依诺肝素给药前（谷值）、给药后 3-4 小时（峰值）和 8 小时后。抗 Xa 因子活性在 0.5-1.2 U/ml 之间被认为是治疗性的。
结果
平均抗 Xa 因子活性水平分别为：谷值 0.45 ± 0.18、峰值 0.9 ± 0.25 和 8 小时后 0.72 ± 0.23 U/ml。所有峰值水平均具有治疗作用；20%（3/15）的 8 小时和 73%（11/15）的谷值水平低于治疗范围。
结论
接受每日 2 次治疗剂量依诺肝素方案的患者中，相当一部分患者的谷值和 8 小时后抗 Xa 因子活性水平低于治疗范围。
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