Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa-The Ottawa Hospital, Ottawa, Canada ; Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa, Canada ; Ottawa Hospital-Ottawa Hospital Research Institute, General Campus-Centre for Practice Changing Research, 501 Smyth Road, Rm L2269e, Ottawa ONT K1H 8 L6, Canada.
Thrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa-The Ottawa Hospital, Ottawa, Canada ; Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa, Canada.
Thromb J. 2014 Jun 2;12:12. doi: 10.1186/1477-9560-12-12. eCollection 2014.
Low-molecular-weight heparin (LMWH) is frequently recommended for the treatment of pregnancy associated venous thromboembolism (PAVTE). Given that prior reports have suggested a wide variation in dosing of LMWH in pregnancy and the use of anti-Xa monitoring in pregnancy, the principal aim of this survey was to assess current practices for the management of PAVTE.
An electronic survey was conducted. The target sample was members of the North American Society of Obstetric Medicine and Thrombosis Interest Group of Canada.
The final sample consisted of 27/69 hematologists (39.1%), 30/69 internists (43.5%), 8/69 obstetricians (11.6%), and 4/69 from other specialties (5.7%). For the acute treatment of patients pregnant patients with deep vein thrombosis 42/69 (60.8%) preferred LMWH given twice a day 42/69 (60.8%), whereas 25/69 (36.2%) preferred once daily. These results were similar for patients with pulmonary embolism (PE). For long-term treatment more than 70% of the respondents favoured treatment with full doses of LMWH given once a day or twice a day and 16/69 (23.2%) intermediate doses for patients diagnosed with DVT. These results were similar for patients with PE. Fourteen physicians out of 69 (20.3%) did not measure anti-Xa monitoring during acute treatment period and 24/69 (34.8%) never used anti-Xa levels during the long term treatment period. Management during the peri-partum period varied widely according to the time of the diagnosis of PAVTE.
In conclusion, our survey shows wide variation in practice regarding LMWH dosing and anti-Xa monitoring in pregnancy associated VTE and calls for trials comparing different long term strategies using LMWH in patients with PAVTE.
低分子肝素（LMWH）常用于治疗妊娠相关静脉血栓栓塞症（PAVTE）。鉴于先前的报告表明，妊娠期间 LMWH 的剂量存在广泛差异，并且在妊娠期间使用抗 Xa 监测，因此这项调查的主要目的是评估当前管理 PAVTE 的实践情况。
进行了一项电子调查。目标样本是北美产科医学和血栓形成兴趣小组的成员。
最终样本包括 27/69 名血液科医生（39.1%）、30/69 名内科医生（43.5%）、8/69 名产科医生（11.6%）和 4/69 名来自其他专业的医生（5.7%）。对于患有深静脉血栓形成的妊娠患者的急性治疗，42/69（60.8%）人更喜欢每天两次给予 LMWH，42/69（60.8%）人更喜欢每天一次。对于患有肺栓塞（PE）的患者，结果相似。对于长期治疗，超过 70%的受访者赞成每天一次或两次给予 LMWH 全剂量治疗，16/69（23.2%）患者给予中等剂量治疗。对于患有 PE 的患者，结果相似。在 69 名医生中，有 14 名（20.3%）在急性治疗期间不测量抗 Xa 监测，24 名（34.8%）在长期治疗期间从未使用过抗 Xa 水平。根据 PAVTE 的诊断时间，围产期的管理差异很大。
总之，我们的调查显示，妊娠相关静脉血栓栓塞症中 LMWH 的剂量和抗 Xa 监测的实践存在广泛差异，需要进行比较不同长期策略的试验，以评估在 PAVTE 患者中使用 LMWH。
