Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
BMC Cardiovasc Disord. 2012 Dec 5;12:118. doi: 10.1186/1471-2261-12-118.
Low-molecular-weight heparins (LMWHs) are safe and effective anticoagulant options for cardiovascular patients when applied as body weight-adjusted doses. However, there are some barriers that make it difficult to implement weight-adjusted doses in clinical practice. Therefore, it is vital to learn the dosing practices of LMWH and its efficacy and safety in clinical practice.
A retrospective study was conducted in cardiovascular inpatients who had received at least one dose of LMWH during a 6-month period. Appropriateness of LMWH dosing was determined and major clinical outcomes (major adverse vascular events and major bleeding) during hospitalization were evaluated.
A total of 376 admissions representing 364 patients received LMWH treatment. Of these, 17.0% (64/376) of admissions did not have body weight records. Of the 312 admissions included for the outcome study, only 34 cases (10.9%) received the recommended doses of LMWH, while 51 cases (16.3%) received mild underdoses, 223 cases (71.5%) received major underdoses and 4 (1.3%) received excess doses. There were 10 major adverse vascular events, which occurred more often in patients receiving excess doses of LMWH than in patients receiving recommended, mild or major underdoses (50%, 2.9%, 2.0% and 2.7%, respectively, P < 0.001). After multivariable analysis, severe renal insufficiency was an independent risk factor for major adverse vascular events [odds ratio (OR), 31.93; 95% confidence interval (CI), 5.99-170.30; P < 0.001]. No major bleeding was recorded.
Underdose of LMWH is commonly used in cardiovascular inpatients, which was suboptimal according to guidelines. Using LMWH at a fixed, low dose for treatment purposes in patients without severe renal insufficiency was not associated with a higher risk of adverse vascular events in the current study, though larger studies with extended follow-ups are required to fully assess the long-term consequences of LMWH underdosing.
低分子肝素（LMWHs）作为体重调整剂量在心血管患者中是安全有效的抗凝选择。然而，在临床实践中实施体重调整剂量存在一些障碍。因此，了解 LMWH 的给药方案及其在临床实践中的疗效和安全性至关重要。
对接受至少一剂 LMWH 的心血管住院患者进行回顾性研究。确定 LMWH 给药的适宜性，并评估住院期间的主要临床结局（主要不良血管事件和主要出血）。
共 376 例住院患者接受 LMWH 治疗，其中 17.0%（64/376）无体重记录。在纳入结局研究的 312 例住院患者中，仅有 34 例（10.9%）接受了推荐剂量的 LMWH，51 例（16.3%）接受了轻度剂量不足，223 例（71.5%）接受了重度剂量不足，4 例（1.3%）接受了剂量过量。发生 10 例主要不良血管事件，接受 LMWH 过量剂量的患者发生不良事件的频率高于接受推荐剂量、轻度剂量不足或重度剂量不足的患者（分别为 50%、2.9%、2.0%和 2.7%，P<0.001）。多变量分析后，严重肾功能不全是主要不良血管事件的独立危险因素[比值比（OR），31.93；95%置信区间（CI），5.99-170.30；P<0.001]。未记录到主要出血。
心血管住院患者中 LMWH 剂量不足较为常见，不符合指南建议。在无严重肾功能不全的患者中，为治疗目的使用固定、低剂量的 LMWH 与本研究中不良血管事件风险增加无关，但需要更大规模、随访时间更长的研究来充分评估 LMWH 剂量不足的长期后果。
