Shukla Ankit, Braunreiter Chi
J Pediatr Pharmacol Ther. 2021;26(8):850-856. doi: 10.5863/1551-6776-26.8.850. Epub 2021 Nov 10.
The optimal antithrombin (AT) activity for low-molecular-weight heparin efficacy and the benefits of antithrombin III (ATIII) supplementation in premature infants diagnosed with venous thromboembolism are unknown. Currently, there are no neonatal-specific guidelines directing the appropriate target AT activity during supplementation. This case report describes a critically ill premature infant with a progressive, occlusive inferior vena cava thrombus who received supplemental ATIII during enoxaparin treatment. The patient did not achieve therapeutic anti-Xa levels despite increasing enoxaparin dosing to 3 mg/kg every 12 hours. ATIII supplementation sufficient to attain an AT activity of >40%, in combination with an enoxaparin dosing of >2 mg/kg every 12 hours, was needed to achieve therapeutic anti-Xa levels. Future large studies are needed to determine if there is an optimal target AT activity for critically ill premature infants.
低分子量肝素疗效所需的最佳抗凝血酶（AT）活性以及补充抗凝血酶III（ATIII）对诊断为静脉血栓栓塞的早产儿的益处尚不清楚。目前，尚无针对新生儿在补充期间指导适当目标AT活性的特定指南。本病例报告描述了一名患有进行性、闭塞性下腔静脉血栓的危重新生儿，在依诺肝素治疗期间接受了ATIII补充。尽管将依诺肝素剂量增加至每12小时3mg/kg，但患者未达到治疗性抗Xa水平。需要补充足够的ATIII以达到>40%的AT活性，并结合每12小时>2mg/kg的依诺肝素剂量，才能达到治疗性抗Xa水平。未来需要进行大型研究，以确定危重新生儿是否存在最佳目标AT活性。
