Fan Jennifer L, Roberts Laura E, Scheurer Michael E, Yee Donald L, Shah Mona D, Lee-Kim YoungNa J
Baylor College of Medicine, Houston, Texas.
Department of Pediatrics, Texas Children's Hospital, Houston, Texas.
Pediatr Blood Cancer. 2017 Nov;64(11). doi: 10.1002/pbc.26629. Epub 2017 May 18.
There are few data in the pediatric population evaluating the relationship between measured anti-Xa levels during enoxaparin therapy and thrombotic outcomes.
To determine whether there is a difference in outcomes in children who receive enoxaparin with mean anti-Xa levels between 0.45 and 0.79 unit/ml (low therapeutic range) versus between 0.80 and 1.05 unit/ml (high therapeutic range) throughout their course of their treatment.
We retrospectively identified subjects with uncomplicated venous thromboembolism treated with enoxaparin.
Of 69 patients with any response to therapy, 48 (70%) had mean anti-Xa levels in the low therapeutic range and 21 (30%) had mean anti-Xa levels in the high therapeutic range. Of 20 patients with no documented response to therapy, 13 (65%) had mean anti-Xa levels in the low therapeutic range and 7 (35%) had mean anti-Xa levels in the high therapeutic range. Forty-eight (79%) of the 61 patients with low-range mean anti-Xa level had any response to therapy. Twenty-one (75%) of the 28 patients with high-range mean anti-Xa level had any response to therapy. Chi-square test (P = 0.080) and logistic regression (OR = 1.23, P = 0.70) demonstrated no significant association between mean anti-Xa range (lower vs. upper) and therapy response.
There was no statistically significant difference between low-range versus high-range mean anti-Xa levels and thrombus resolution. Empiric clinical practices of targeting anti-Xa levels in the higher therapeutic range to achieve better outcomes may not be warranted.
在儿科人群中，评估依诺肝素治疗期间测得的抗Xa水平与血栓形成结果之间关系的数据很少。
确定在整个治疗过程中接受依诺肝素治疗且平均抗Xa水平在0.45至0.79单位/毫升（低治疗范围）与0.80至1.05单位/毫升（高治疗范围）之间的儿童在治疗结果上是否存在差异。
我们回顾性地确定了接受依诺肝素治疗的无并发症静脉血栓栓塞患者。
在69例对治疗有任何反应的患者中，48例（70%）的平均抗Xa水平处于低治疗范围，21例（30%）的平均抗Xa水平处于高治疗范围。在20例无治疗反应记录的患者中，13例（65%）的平均抗Xa水平处于低治疗范围，7例（35%）的平均抗Xa水平处于高治疗范围。61例平均抗Xa水平处于低范围的患者中有48例（79%）对治疗有任何反应。28例平均抗Xa水平处于高范围的患者中有21例（75%）对治疗有任何反应。卡方检验（P = 0.080）和逻辑回归（OR = 1.23，P = 0.70）表明，平均抗Xa范围（低与高）与治疗反应之间无显著关联。
低范围与高范围的平均抗Xa水平在血栓溶解方面无统计学显著差异。为获得更好结果而将抗Xa水平靶向更高治疗范围的经验性临床实践可能没有必要。
