Children's Hospital & Medical Center/University of Nebraska Medicine Center, United States of America.
Cincinatti Children's Hospital, United States of America.
Thromb Res. 2021 Jul;203:117-120. doi: 10.1016/j.thromres.2021.04.019. Epub 2021 May 1.
Venothrombolism (VTE) prophylaxis is increasingly utilized in pediatric intensive care units (PICUs). Enoxaparin, a low-molecular weight heparin, is frequently used for this purpose. Enoxaparin can also be used for therapeutic anticoagulation in cases of known thrombus. In such cases, monitoring involves obtaining serum anti- Xa levels with a target value of 0.5-1 units/mL. No monitoring recommendations currently exist for enoxaparin when intended for pediatric VTE prophylaxis. We hypothesize that a clinically important number of patients on VTE prophylaxis with enoxaparin have serum anti-Xa levels consistent with values targeted for therapeutic anticoagulation. We found that over 20% of patients on VTE prophylaxis with enoxaparin had serum anti-Xa levels consistent with true therapeutic anticoagulation (anti-Xa level 0.5-1 units/mL) during their enoxaparin course and 5% achieved values of supratherapeutic anticoagulation (anti-Xa level >1 units/mL). Serum anti-Xa level did not correlate with once versus twice daily dosing, body mass index (BMI), or creatinine level. Blood urea nitrogen (BUN) was found to have a positive odds ratio for an anti-Xa level ≥ 0.5 units/mL. We believe that this incidence of unintended therapeutic anticoagulation indicates a clinically significant number and therefore routine anti-Xa evaluation while on VTE prophylaxis is warranted within our population.
静脉血栓栓塞症（VTE）预防在儿科重症监护病房（PICU）中越来越多地被使用。依诺肝素，一种低分子量肝素，常用于此目的。依诺肝素也可用于已知血栓形成的治疗性抗凝。在这种情况下，监测包括通过目标值 0.5-1 单位/ml 获得血清抗 Xa 水平。目前，尚无关于依诺肝素用于儿科 VTE 预防的监测建议。我们假设，在接受依诺肝素 VTE 预防治疗的患者中，有相当数量的患者的血清抗 Xa 水平与治疗性抗凝的目标值一致。我们发现，在依诺肝素疗程中，超过 20%的接受依诺肝素 VTE 预防的患者的血清抗 Xa 水平与真正的治疗性抗凝（抗 Xa 水平 0.5-1 单位/ml）一致，5%的患者达到了超治疗性抗凝（抗 Xa 水平>1 单位/ml）。血清抗 Xa 水平与每日一次或两次给药、体重指数（BMI）或肌酐水平无关。血尿素氮（BUN）被发现对抗 Xa 水平≥0.5 单位/ml 的比值有积极的影响。我们认为，这种意外治疗性抗凝的发生率表明在我们的人群中，有相当数量的患者需要进行常规的抗 Xa 评估。
