Department of Pharmacy, Texas Children's Hospital, Houston, TX 77030, USA.
J Pediatr. 2013 Feb;162(2):293-6. doi: 10.1016/j.jpeds.2012.07.047. Epub 2012 Sep 5.
To determine if using actual body weight to dose enoxaparin in obese pediatric patients results in higher anti-Xa levels compared with non-obese pediatric patients.
This was a retrospective case-matched study of obese and non-obese pediatric patients receiving treatment doses of enoxaparin in a tertiary care children's hospital. Patients were included if they were initiated on treatment doses of enoxaparin, had appropriate anti-Xa levels drawn, and were between 2 and 18 years of age. Patients with renal insufficiency, hyperbilirubinemia, goal anti-Xa level <0.5 or >1 unit/mL, or receiving mechanical circulatory support were excluded. Obese patients who met study criteria were matched on a 1:1 basis with non-obese patients.
All baseline characteristics were similar except for body mass index percentile (98.2 ± 2 vs 48.7 ± 15, P < .01). Obese patients had higher initial anti-Xa levels (0.67 ± 0.27 vs 0.53 ± 0.24 unit/mL, P = .028). Over time, obese patients required a lower mean dose to achieve therapeutic anti-Xa levels than non-obese patients (0.81 ± 0.19 vs 1.1 ± 0.4 mg/kg, P = .005).
The mean initial anti-Xa level was higher in obese pediatric patients compared with non-obese pediatric patients, but a dosage adjustment was not required. Obese patients may need closer monitoring over time to avoid supratherapeutic levels and possible bleeding events.
确定在肥胖儿科患者中使用实际体重进行依诺肝素给药是否会导致抗 Xa 水平高于非肥胖儿科患者。
这是一项在一家三级儿童保健医院接受依诺肝素治疗剂量的肥胖和非肥胖儿科患者的回顾性病例匹配研究。纳入标准为：开始接受依诺肝素治疗剂量、有适当的抗 Xa 水平检测、年龄在 2 至 18 岁之间的患者。排除存在肾功能不全、高胆红素血症、目标抗 Xa 水平<0.5 或>1 单位/mL 或接受机械循环支持的患者。符合研究标准的肥胖患者按 1:1 的比例与非肥胖患者进行匹配。
除体重指数百分位数（98.2 ± 2 与 48.7 ± 15，P<.01）外，所有基线特征均相似。肥胖患者的初始抗 Xa 水平更高（0.67 ± 0.27 与 0.53 ± 0.24 单位/mL，P=.028）。随着时间的推移，肥胖患者达到治疗性抗 Xa 水平所需的平均剂量低于非肥胖患者（0.81 ± 0.19 与 1.1 ± 0.4 mg/kg，P=.005）。
与非肥胖儿科患者相比，肥胖儿科患者的平均初始抗 Xa 水平较高，但无需调整剂量。肥胖患者可能需要随着时间的推移进行更密切的监测，以避免出现超治疗水平和可能的出血事件。
