Rodier Simon Gabriel, Bukur Marko, Moore Samantha, Frangos Spiros George, Tandon Manish, DiMaggio Charles Joseph, Ayoung-Chee Patricia, Marshall Gary Thomas
Department of Surgery, Bellevue Hospital Center, New York University School of Medicine, 462 First Avenue, New York, NY, 10016, USA.
St. John's University College of Pharmacy and Health Sciences, 8000 Utopia Parkway, Queens, NY, 11439, USA.
Eur J Trauma Emerg Surg. 2021 Feb;47(1):145-151. doi: 10.1007/s00068-019-01215-0. Epub 2019 Aug 30.
Venous thromboembolism (VTE) is a common morbidity in trauma patients. Standard VTE chemoprophylaxis is often inadequate. We hypothesized that weight-based dosing would result in appropriate prophylaxis more reliably than fixed dosing.
All patients admitted to a Level 1 trauma center over a 6-month period were included unless contra-indications for VTE prophylaxis existed. A prospective adjusted-dosing group was compared to a retrospective uniform-dosing group. The adjusted-dosing approach consisted of initial weight-based dosing of 0.5 mg/kg subcutaneously (subQ) every 12 h (q12h). Peak anti-factor Xa was measured. Patients outside of the prophylactic range had their dose adjusted by ± 10 mg. The uniform-dosing group received 30 mg subQ q12h, without adjustments.
Eighty-four patients were included: 44 in the retrospective control cohort and 40 in the prospective experimental cohort. More patients were sub-prophylactically dosed in the uniform-dosing group relative to the adjusted-dosing group (25% vs 5%, p = 0.03). There was no difference in overall prophylactic range targeting, because the supra-prophylactically dosed patients in the adjusted-dosing group eliminated the effect (p = 0.173). However, after a single dose adjustment, zero patients were outside of prophylactic range (25% versus 0%, RR = infinite, p = 0.003). In the uniform-dosing group, anti-Xa level correlated with body surface area (BSA; R = 0.33, p < 0.0001) and weight (R = 0.26, p = 0.0005). Weight-based dosing both pre- and post-readjustment normalized the correlation of anti-Xa with BSA (R = 0.07, p = 0.1) and weight (R = 0.07, p = 0.1).
Weight-based VTE prophylaxis with anti-Xa-based dose adjustment improves prophylactic range targeting relative to uniform dosing and eliminates variances secondary to BSA and weight in trauma patients.
静脉血栓栓塞症（VTE）是创伤患者的常见并发症。标准的VTE化学预防措施往往不足。我们假设基于体重的给药方案比固定剂量给药能更可靠地实现适当的预防效果。
纳入在6个月期间入住一级创伤中心的所有患者，除非存在VTE预防的禁忌症。将前瞻性调整剂量组与回顾性统一剂量组进行比较。调整剂量方法包括初始基于体重的给药，每12小时皮下注射（subQ）0.5mg/kg（q12h）。测量抗Xa因子峰值。预防范围内的患者剂量调整±10mg。统一剂量组每12小时接受30mg皮下注射，不进行调整。
纳入84例患者：回顾性对照组44例，前瞻性试验组40例。与调整剂量组相比，统一剂量组中预防性给药不足的患者更多（25%对5%，p=0.03）。总体预防范围目标没有差异，因为调整剂量组中超预防性给药的患者消除了这种影响（p=0.173）。然而，在单次剂量调整后，没有患者超出预防范围（25%对0%，RR=无穷大，p=0.003）。在统一剂量组中，抗Xa水平与体表面积（BSA；R=0.33，p<0.0001）和体重（R=0.26，p=0.0005）相关。调整前后基于体重的给药使抗Xa与BSA（R=0.07，p=0.1）和体重（R=0.07，p=0.1）的相关性正常化。
相对于统一给药，基于体重的VTE预防结合基于抗Xa的剂量调整可改善预防范围目标，并消除创伤患者中因BSA和体重导致的差异。
