Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
PLoS One. 2020 Oct 1;15(10):e0239222. doi: 10.1371/journal.pone.0239222. eCollection 2020.
To prevent bio-accumulation of low molecular weight heparins (LMWHs) in patients with decreased kidney function, dosage reduction and anti-Xa monitoring has been suggested. The aim of this study was to investigate the effect of pre-emptive dosage reduction of LMWH on anti-Xa levels. Furthermore, we investigated the association between anti-Xa levels and bleeding, thrombotic events and mortality.
In this single center study, we followed 499 patients with decreased renal function in whom anti-Xa levels were measured. We observed how many patients had anti-Xa levels that fell within the reference range, with a standard protocol of a pre-emptive dosage reduction of LMWH (25% reduction in patients with an estimated glomerular filtration rate (eGFR) between 30 and 60 ml/min/1.73m2 and a reduction of 50% in patients with an eGFR below the 30 ml/min/1.73m2). Furthermore, Cox proportional hazard analyses were used to estimate hazard ratios to investigate the association between anti-Xa levels and major bleeding, thrombotic events and mortality within three months of follow-up.
In a cohort of 499 patients (445 dalteparin and 54 nadroparin users), a pre-emptive dosage reduction of LMWH led to adequate levels of anti-Xa in only 19% of the patients (12% for the dalteparin users and 50% for nadroparin users). We did not find an association between anti-Xa levels and bleeding, thrombosis or mortality.
Pre-emptive dosage reduction of LMWH leads to low anti-Xa levels in a large proportion, but this was not associated with bleeding, thrombosis or mortality.
为了防止肾功能下降的患者体内低分子肝素（LMWH）的生物蓄积，建议减少剂量并进行抗 Xa 监测。本研究旨在调查预先减少 LMWH 剂量对抗 Xa 水平的影响。此外，我们还研究了抗 Xa 水平与出血、血栓形成事件和死亡率之间的关系。
在这项单中心研究中，我们对 499 名肾功能下降的患者进行了抗 Xa 水平检测。我们观察了有多少患者的抗 Xa 水平在参考范围内，采用标准方案预先减少 LMWH 剂量（估算肾小球滤过率（eGFR）在 30 至 60ml/min/1.73m2 之间的患者减少 25%，eGFR 低于 30ml/min/1.73m2 的患者减少 50%）。此外，还使用 Cox 比例风险分析来估计风险比，以调查随访三个月内抗 Xa 水平与大出血、血栓形成事件和死亡率之间的关系。
在 499 名患者（445 名达肝素和 54 名那屈肝素使用者）的队列中，只有 19%的患者（达肝素使用者的 12%和那屈肝素使用者的 50%）的 LMWH 预先减少剂量导致了足够的抗 Xa 水平。我们没有发现抗 Xa 水平与出血、血栓形成或死亡率之间存在关联。
预先减少 LMWH 的剂量会导致很大一部分患者的抗 Xa 水平降低，但这与出血、血栓形成或死亡率无关。
