与接受开颅手术的患者相比，每日三次而非每日两次使用普通肝素的剂量方案与较低的肺栓塞发生率相关。

Unfractionated Heparin TID Dosing Regimen Is Associated With a Lower Rate of Pulmonary Embolism When Compared With BID Dosing in Patients Undergoing Craniotomy.

机构信息

Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.

出版信息

World Neurosurg. 2021 Sep;153:e147-e152. doi: 10.1016/j.wneu.2021.06.076. Epub 2021 Jun 21.

DOI:10.1016/j.wneu.2021.06.076

PMID:34166830

Abstract

BACKGROUND

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and intracranial hemorrhage (ICH) may complicate the post-operative course of patients undergoing craniotomy. While prophylaxis with unfractionated heparin (UFH) has been shown to reduce VTE rates, twice-daily (BID) and three-times-daily (TID) UFH dosing regimens have not been compared in neurosurgical procedures. The objective of this study was to explore the association between UFH dosing regimen and rates of VTE and ICH in craniotomy patients.

METHODS

A retrospective chart review was conducted for 159 patients at Northwestern University receiving 5000 units/0.5 mL UFH injections either BID (n = 132) or TID (n = 27). General linear regression models were run to predict rates of DVT, PE, and reoperation due to bleeding from UFH dosing regimen while controlling for age at surgery, sex, VTE history, craniotomy for tumor resection, surgery duration, length of stay, reoperation, infections, and IDH/MGMT mutations.

RESULTS

Receiving UFH TID was significantly associated with a lower rate of PE when compared with receiving UFH BID (β = -0.121, P = 0.044; TID rate = 0%, BID rate = 10.6%). UFH TID also showed a trend toward lower rates of DVT (β = -0.0893, P = 0.295; TID rate = 18.5%, BID rate = 21.2%) when compared with UFH BID. UFH TID showed no significant difference in rate of reoperation for bleeding when compared to UFH BID (β = -0.00623, P = 0.725; TID rate = 0%, BID rate = 0.8%).

CONCLUSIONS

UFH TID dosing is associated with lower rates of PE when compared with BID dosing in patients undergoing craniotomy.

摘要

背景

静脉血栓栓塞症（VTE），包括深静脉血栓形成（DVT）和肺栓塞（PE），以及颅内出血（ICH），可能会使接受开颅手术的患者的术后过程复杂化。虽然未分级肝素（UFH）预防已被证明可降低 VTE 发生率，但在神经外科手术中尚未比较每日两次（BID）和每日三次（TID）UFH 给药方案。本研究的目的是探讨 UFH 给药方案与开颅手术患者 VTE 和 ICH 发生率之间的关系。

方法

对西北大学的 159 名接受 5000 单位/0.5 毫升 UFH 注射的患者进行回顾性图表审查，每日两次（n=132）或每日三次（n=27）。在控制手术时的年龄、性别、VTE 病史、肿瘤切除术开颅、手术持续时间、住院时间、再手术、感染和 IDH/MGMT 突变的情况下，使用一般线性回归模型预测 UFH 给药方案与 DVT、PE 和因出血而再次手术的发生率。

结果

与接受 UFH BID 相比，接受 UFH TID 与 PE 发生率较低显著相关（β=-0.121，P=0.044；TID 率=0%，BID 率=10.6%）。与 UFH BID 相比，UFH TID 也显示出较低的 DVT 发生率的趋势（β=-0.0893，P=0.295；TID 率=18.5%，BID 率=21.2%）。与接受 UFH BID 相比，接受 UFH TID 时因出血而再次手术的发生率没有显著差异（β=-0.00623，P=0.725；TID 率=0%，BID 率=0.8%）。