Rodier Simon G, Kim Mirhee, Moore Samantha, Frangos Spiros G, Tandon Manish, Klein Michael J, Berry Cherisse D, Huang Paul P, DiMaggio Charles J, Bukur Marko
From the *Department of Surgery, New York University School of Medicine, New York, New York.
‡Department of Neurosurgery, NYC Health and Hospitals/Bellevue, New York, New York.
Am Surg. 2020 Apr 1;86(4):369-376.
This study evaluated the safety of early anti-factor Xa assay-guided enoxaparin dosing for chemoprophylaxis in patients with TBI. We hypothesized that assay-guided chemoprophylaxis would be comparable in the risk of intracranial hemorrhage (ICH) progression to fixed dosing. An observational analysis of adult patients with blunt traumatic brain injury (TBI) was performed at a Level I trauma center from August 2016 to September 2017. Patients in the assay-guided group were treated with an initial enoxaparin dose of 0.5 mg/kg, with peak anti-factor Xa activity measured four hours after the third dose. Prophylactic range was defined as 0.2 to 0.5 IU/mL with a dose adjustment of ± 10 mg based on the assay result. The assay-guided group was compared with historical fixed-dose controls and to a TBI cohort from the most recent Trauma Quality Improvement Project dataset. Of 179 patients included in the study, 85 were in the assay-guided group and 94 were in the fixed-dose group. Compared with the fixed-dose group, the assay-guided group had a lower Glasgow Coma Score and higher Injury Severity Score. The proportion of severe (Abbreviated Injury Score, head ≥3) TBI, ICH progression, and venous thromboembolism rates were similar between all groups. The assay-guided and fixed-dose groups had chemoprophylaxis initiated earlier than the Trauma Quality Improvement Project group. The assay-guided group had the highest percentage of low molecular weight heparin use. Early initiation of enoxaparin anti-factor Xa assay-guided venous thromboembolism chemoprophylaxis has a comparable risk of ICH progression to fixed dosing in patients with TBI. These findings should be validated prospectively in a multicenter study.
本研究评估了早期抗Xa因子检测指导下的依诺肝素给药用于创伤性脑损伤（TBI）患者化学预防的安全性。我们假设检测指导下的化学预防在颅内出血（ICH）进展风险方面与固定剂量相当。2016年8月至2017年9月在一级创伤中心对成年钝性创伤性脑损伤（TBI）患者进行了观察性分析。检测指导组患者初始依诺肝素剂量为0.5mg/kg，在第三次给药后4小时测量抗Xa因子活性峰值。预防范围定义为0.2至0.5IU/mL，并根据检测结果将剂量调整±10mg。将检测指导组与历史固定剂量对照组以及最新创伤质量改进项目数据集中的TBI队列进行比较。在纳入研究的179例患者中，85例在检测指导组，94例在固定剂量组。与固定剂量组相比，检测指导组的格拉斯哥昏迷评分较低，损伤严重程度评分较高。所有组之间严重（简明损伤评分，头部≥3）TBI、ICH进展和静脉血栓栓塞率的比例相似。检测指导组和固定剂量组开始化学预防的时间比创伤质量改进项目组更早。检测指导组使用低分子量肝素的比例最高。早期启动依诺肝素抗Xa因子检测指导的静脉血栓栓塞化学预防在TBI患者中ICH进展风险与固定剂量相当。这些发现应在多中心研究中进行前瞻性验证。
