Department of Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Intern Med J. 2016 Jul;46(7):826-33. doi: 10.1111/imj.13117.
Therapeutic anticoagulation with enoxaparin in pregnancy is complex due to varying pharmacokinetics and the increasing prevalence of obesity. There is limited evidence to support current dosing and monitoring strategies of enoxaparin in this population.
To describe the current practice in therapeutic anticoagulation in the pregnant population at a tertiary institution.
A retrospective study of pregnant women on therapeutic enoxaparin between January 2007 and December 2011.
Forty-four pregnant women requiring therapeutic anticoagulation were identified and divided into two groups, monitored with anti-factor Xa (AXA) concentrations and unmonitored. Fifty-five percent of monitored women were initiated on the recommended 1 mg/kg twice a day (bd) enoxaparin dose-strategy. Eighty-two percent of women were monitored; however, there was variability regarding the timing, frequency and subsequent dose adjustments from monitoring. Overall, as pregnancies progressed, there was both increasing dose adjustments and increasing frequency of monitoring. Fourteen women had a BMI over 30 kg/m(2) , and 13 of these women were monitored. Nine monitored obese women required doses less than 1 mg/kg/bd to maintain a therapeutic AXA level. Management appeared to be individualised. There were small numbers of toxicity events.
Variation exists in dosing and monitoring practices for therapeutic enoxaparin in the pregnant population. Dosing obese patients using 1 mg/kg twice daily can lead to toxic AXA concentrations, and dose reductions are required to maintain a therapeutic range. A larger prospective study reviewing dose, AXA concentrations and outcome data is necessary to make dosing recommendations in this group.
由于药代动力学的变化和肥胖症的流行率不断增加，妊娠期间使用依诺肝素进行治疗性抗凝治疗较为复杂。目前针对该人群，依诺肝素的剂量和监测策略的证据有限。
描述一家三级医疗机构中妊娠人群的治疗性抗凝现状。
对 2007 年 1 月至 2011 年 12 月期间接受治疗性依诺肝素抗凝的孕妇进行回顾性研究。
确定了 44 名需要治疗性抗凝的孕妇，分为监测抗 Xa 因子（anti-factor Xa，AXA）浓度组和未监测组。55%的监测组孕妇起始剂量为推荐的 1mg/kg，每天两次（bid）。82%的孕妇接受了监测；但是，监测的时间、频率以及随后的剂量调整存在差异。总体而言，随着妊娠的进展，剂量调整和监测频率均增加。14 名孕妇 BMI 超过 30kg/m²，其中 13 名接受了监测。9 名监测的肥胖孕妇需要的剂量低于 1mg/kg/bd，以维持治疗性 AXA 水平。治疗方案似乎是个体化的。只有少数孕妇出现了毒性事件。
妊娠人群中，依诺肝素的治疗剂量和监测实践存在差异。对于肥胖患者，使用 1mg/kg，每天两次可能会导致 AXA 浓度过高，需要减少剂量以维持治疗范围。需要进行更大规模的前瞻性研究，以评估剂量、AXA 浓度和结局数据，为该人群制定剂量推荐。
