Andersen Nina Gjerde, Mowinckel Marie-Christine, Sunde Kjetil, Sandset Per Morten, Beitland Sigrid
Department of Anaesthesiology, Oslo University Hospital, Oslo, Norway.
Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway.
Acta Anaesthesiol Scand. 2021 Apr;65(4):489-498. doi: 10.1111/aas.13748. Epub 2020 Nov 26.
The aim of this study was to evaluate the utility of coagulation analyses to assess thromboprophylaxis with dalteparin in intensive care unit (ICU) patients.
Prospective observational study of ICU patients receiving dalteparin prophylaxis at Oslo University Hospital in Norway. Trough and peak antithrombin, protein C, anti-factor Xa activity (aFXa), d-dimer, thromboelastography, calibrated automated thrombogram and microparticles were analysed. Levels were compared in patients with and without venous thromboembolism (VTE), major bleeding, acute kidney injury (AKI) with use of renal replacement therapy (RRT) and variable dalteparin dose.
Among 50 included patients (76% male, mean age 62 years) five (10%) developed VTE and eight (16%) major bleeding. Median through aFXa level was 0.03 (0.02-0.05) IU/mL, and 48 (96%) of patients were within and two (4%) above target range. Peak aFXa level was 0.21 (0.13-0.29) IU/mL, the number of patients below, within and above prophylactic range were 21 (42%), 25 (50%) and four (8%). Peak aFXa levels were similar in patients with and without VTE (0.18 vs 0.21 IU/L, P = .72), major bleeding (0.22 vs 0.21 IU/mL, P = .38) and AKI with RRT (0.18 vs 0.24, P = .13), but lower in patients receiving dalteparin 5000 IU od compared to 7500 IU od (0.19 vs 0.30 IU/mL, P < .01).
Intensive care unit patients receiving dalteparin prophylaxis had half of patients within prophylactic peak aFXa target range. Peak aFXa levels was affected by administered dalteparin dose, but not presence of VTE, major bleeding or AKI with RRT.
本研究旨在评估凝血分析在评估挪威奥斯陆大学医院重症监护病房（ICU）患者使用达肝素进行血栓预防中的效用。
对挪威奥斯陆大学医院接受达肝素预防的ICU患者进行前瞻性观察研究。分析抗凝血酶、蛋白C、抗Xa因子活性（aFXa）、D-二聚体、血栓弹力图、校准自动血栓图和微粒的谷值和峰值水平。比较有和没有静脉血栓栓塞（VTE）、大出血、接受肾脏替代治疗（RRT）的急性肾损伤（AKI）以及不同达肝素剂量患者的各项指标水平。
纳入的50例患者中（76%为男性，平均年龄62岁），5例（10%）发生VTE，8例（16%）发生大出血。aFXa谷值水平中位数为0.03（0.02 - 0.05）IU/mL，48例（96%）患者在目标范围内，2例（4%）高于目标范围。aFXa峰值水平为0.21（0.13 - 0.29）IU/mL，低于、在预防范围内和高于预防范围的患者人数分别为21例（42%）、25例（50%）和4例（8%）。有和没有VTE的患者（0.18对0.21 IU/L，P = 0.72）、大出血患者（0.22对0.21 IU/mL，P = 0.38）以及接受RRT的AKI患者（0.18对0.24，P = 0.13）的aFXa峰值水平相似，但接受每日5000 IU达肝素治疗的患者与接受每日7500 IU治疗的患者相比，aFXa峰值水平较低（0.19对0.30 IU/mL，P < 0.01）。
接受达肝素预防的重症监护病房患者中，有一半患者的aFXa峰值水平在预防目标范围内。aFXa峰值水平受达肝素给药剂量影响，但不受VTE、大出血或接受RRT的AKI的存在影响。
