Faraklas Iris, Ghanem Maureen, Brown Amalia, Cochran Amalia
From the Burn Trauma Intensive Care Unit, University of Utah Health Care, Salt Lake City.
J Burn Care Res. 2013 Nov-Dec;34(6):621-7. doi: 10.1097/BCR.0b013e3182a2a855.
Previous research has shown that inadequate antifactor Xa levels (anti-Xa) occur in burn patients and may increase the risk of venous thromboembolic events (VTE). The objective of this retrospective review was to investigate the usefulness of an enoxaparin dosing algorithm using a previously published equation. With institutional review board approval, all acute burn patients at an American Burn Association-verified regional burn center who were treated with enoxaparin for VTE prophylaxis and had at least one anti-Xa from May 1, 2011 to December 15, 2012 were included. Patients with subprophylactic anti-Xa received increased enoxaparin dose per unit protocol with the goal of obtaining a prophylactic anti-Xa (0.2-0.4 U/ml). Sixty-four patients were included in our analysis. The regression equation was used in 33 patients for initial enoxaparin dosing (Eq) whereas 31 patients received traditionally recommended prophylaxis dosing (No-Eq). Groups were comparable in sex, age, weight, inhalation injury, and burn size. Initial enoxaparin dosing in Eq was significantly more likely to reach target than in No-Eq (73 vs 32%; P = .002). No episodes of hemorrhage, thrombocytopenia, or heparin sensitivity were documented in either group. Median final enoxaparin dose required to reach prophylactic level was 40 mg every 12 hours (range, 30-80 mg). Twenty-one No-Eq patients ultimately reached target, and 11 of these final doses were equivalent to or greater than the predicted equation. Ten patients never reached prophylactic anti-Xa before enoxaparin was discontinued (nine from No-Eq). Two patients, one from each group, developed VTE complications despite appropriate anti-Xa for prophylaxis. A strong correlation was shown between weight, burn size, and enoxaparin dose (r = .68; P < .001). Use of the enoxaparin dosing algorithm significantly increased the frequency of obtaining a target initial anti-Xa. There were no bleeding complications. Enoxaparin dosing correlates to burn size and weight, making a standard dose inappropriate because patient habitus and extent of burn injury are highly variable. This simple equation improves enoxaparin dosing for acute adult burn patients.
先前的研究表明，烧伤患者存在抗Xa因子水平（抗Xa）不足的情况，这可能会增加静脉血栓栓塞事件（VTE）的风险。本回顾性研究的目的是调查使用先前发表的公式的依诺肝素给药算法的有效性。经机构审查委员会批准，纳入了2011年5月1日至2012年12月15日期间在美国烧伤协会认证的地区烧伤中心接受依诺肝素预防性治疗VTE且至少有一次抗Xa检测结果的所有急性烧伤患者。抗Xa水平低于预防剂量的患者按照单位方案增加依诺肝素剂量，目标是达到预防性抗Xa水平（0.2 - 0.4 U/ml）。我们的分析纳入了64例患者。33例患者使用回归方程进行依诺肝素初始给药（Eq组），而31例患者接受传统推荐的预防性给药（非Eq组）。两组在性别、年龄、体重、吸入性损伤和烧伤面积方面具有可比性。Eq组初始依诺肝素给药达到目标水平的可能性显著高于非Eq组（73%对32%；P = 0.002）。两组均未记录到出血、血小板减少或肝素敏感性事件。达到预防水平所需的依诺肝素最终中位剂量为每12小时40 mg（范围为30 - 80 mg）。21例非Eq组患者最终达到目标水平，其中11例最终剂量等于或大于预测方程计算的剂量。10例患者在停用依诺肝素前从未达到预防性抗Xa水平（9例来自非Eq组）。每组各有1例患者尽管接受了适当的预防性抗Xa治疗，但仍发生了VTE并发症。体重、烧伤面积和依诺肝素剂量之间显示出很强的相关性（r = 0.68；P < 0.001）。使用依诺肝素给药算法显著增加了达到目标初始抗Xa水平的频率。没有出血并发症。依诺肝素给药与烧伤面积和体重相关，由于患者体型和烧伤损伤程度差异很大，标准剂量并不合适。这个简单的公式改善了急性成年烧伤患者的依诺肝素给药。
