入院时的血栓弹力图检查不能指导创伤患者依诺肝素的剂量调整。
Admission thrombelastography does not guide dose adjustment of enoxaparin in trauma patients.
作者信息
Hayes Hannah V, Droege Molly E, Furnish Craig J, Goodman Michael D, Ernst Neil E, Droege Christopher A
机构信息
University of Cincinnati Department of Surgery, Cincinnati, OH.
UC Health-University of Cincinnati Medical Center Department of Pharmacy, Cincinnati, OH.
出版信息
Surg Open Sci. 2020 Apr 14;2(4):41-44. doi: 10.1016/j.sopen.2020.03.003. eCollection 2020 Oct.
BACKGROUND
Enoxaparin is used as chemoprophylaxis to reduce incidence of venous thromboembolism and its complications following trauma. Serum anti-Xa monitoring is used to assess efficacy but requires several doses to be administered. Thrombelastography assesses hypercoagulability and may have utility identifying high-risk patients for venous thromboembolism. The objective was to evaluate whether thrombelastography parameters could identify trauma patients requiring enoxaparin dose adjustment earlier than serum anti-Xa concentrations.
METHODS
A single-center, retrospective medical record review evaluated patients admitted to a regional level I trauma center that received an admission thrombelastography and a dose of enoxaparin with a serum trough anti-Xa concentration drawn. Patients were divided into standard-dose or dose-adjusted enoxaparin. Venous thromboembolism incidence between groups and risk factors for enoxaparin dose adjustment and venous thromboembolism development were evaluated.
RESULTS
A total of 204 patients were included. Differences observed between groups included age (standard-dose enoxaparin, 48.5 [29.3-72] vs dose-adjusted enoxaparin, 38.5 [25-55.7] years; = .005), admission creatinine clearance (standard-dose enoxaparin, 92.9 [67.4-113.4] vs dose-adjusted enoxaparin, 102.1 [83.8-129.2] mL/min; = .017), and time to venous thromboembolism prophylaxis initiation (standard-dose enoxaparin, 23.8 [11.2-36.4] vs dose-adjusted enoxaparin, 34.5 [18.3-52.7] hours; = .004). No differences in thrombelastography parameters or venous thromboembolism incidence were observed. No independent risk factors for enoxaparin dose adjustment were identified; however, risk assessment profile score > 10 was an independent risk factor for venous thromboembolism development.
CONCLUSION
No relationship between admission thrombelastography and need for enoxaparin dose adjustment in trauma patients was observed. As thrombelastography continues growing in clinical use, it is prudent to investigate other potential applications. Currently, thrombelastography should not be used to guide enoxaparin dosing.
背景
依诺肝素被用作化学预防药物，以降低创伤后静脉血栓栓塞及其并发症的发生率。血清抗Xa监测用于评估疗效，但需要多次给药。血栓弹力图可评估高凝状态，可能有助于识别静脉血栓栓塞的高危患者。目的是评估血栓弹力图参数是否能比血清抗Xa浓度更早地识别出需要调整依诺肝素剂量的创伤患者。
方法
一项单中心回顾性病历审查评估了入住某地区一级创伤中心的患者，这些患者接受了入院时的血栓弹力图检查，并接受了一剂依诺肝素，同时检测了血清谷浓度抗Xa水平。患者被分为接受标准剂量或调整剂量依诺肝素治疗两组。评估两组之间的静脉血栓栓塞发生率以及依诺肝素剂量调整和静脉血栓栓塞发生的危险因素。
结果
共纳入204例患者。两组之间观察到的差异包括年龄（标准剂量依诺肝素组，48.5[29.3 - 72]岁；调整剂量依诺肝素组，38.5[25 - 55.7]岁；P = 0.005）、入院时肌酐清除率（标准剂量依诺肝素组，92.9[67.4 - 113.4]；调整剂量依诺肝素组，102.1[83.8 - 129.2]mL/min；P = 0.017）以及开始静脉血栓栓塞预防的时间（标准剂量依诺肝素组，23.8[11.2 - 36.4]；调整剂量依诺肝素组，34.5[18.3 - 52.7]小时；P = 0.004）。未观察到血栓弹力图参数或静脉血栓栓塞发生率的差异。未确定依诺肝素剂量调整独立的危险因素；然而，风险评估概况评分>10是静脉血栓栓塞发生的独立危险因素。
结论
未观察到创伤患者入院时血栓弹力图与依诺肝素剂量调整需求之间的关系。随着血栓弹力图在临床应用中的不断增加，谨慎研究其他潜在应用是明智的。目前，血栓弹力图不应被用于指导依诺肝素给药。
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