From the Central Adelaide Local Health Network (A.E.), Adelaide, Australia; Centre for Trauma Sciences (E.C.), Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; and Women's and Children's Hospital (C.S.-.H.), Adelaide, Australia.
J Trauma Acute Care Surg. 2022 Aug 1;93(2):e71-e79. doi: 10.1097/TA.0000000000003707. Epub 2022 May 18.
Trauma patients are at high risk of developing venous thromboembolism (VTE), and standard dosing enoxaparin regimens may be inadequate for prophylaxis. This meta-analysis was performed to clarify the efficacy of alternative dosing regimens for VTE prophylaxis in this high-risk group. The objective of this systematic review was to review the evidence regarding weight-based dosing of enoxaparin for VTE prophylaxis in trauma patients.
A systematic database search was undertaken for studies comparing standard versus weight-based dosing of enoxaparin for VTE prophylaxis in adult trauma patients, 18 years or older. The primary outcome was the achievement of anti-factor Xa (AFXa) levels within the prophylactic range. Secondary outcomes included subprophylactic AFXa levels, supraprophylactic AFXa levels, VTE incidence, and bleeding events. Meta-analysis was conducted using both fixed- and random-effects models, and presented as odds ratios, risk ratios (RRs), and risk differences (RDs) with 95% confidence intervals (CIs).
Four cohort studies were eligible for inclusion. Compared with standard dosing, weight-based enoxaparin prophylaxis dosing was associated with increased odds of prophylactic AFXa levels (odds ratio, 5.85; 95% CI, 3.02-11.30; p < 0.00001) and reduced risk of subprophylactic AFXa levels (RR, 3.97; 95% CI, 3.02-5.22; p < 0.00001). Standard dosing was associated with a reduced risk of supratherapeutic AFXa levels (RR, 0.23; 95% CI, 0.11-0.50; p = 0.0002), but this was not associated with a difference in risk of bleeding events (RD, -0.00; 95% CI, -0.02 to 0.01; p = 0.55). There was no statistical difference in incidence VTE between the two groups (RD, 0.01; 95% CI, -0.02 to 0.03; p = 0.64).
Compared with standard dosing, weight-based enoxaparin dosing regimens are associated with increased odds of prophylactic range AFXa levels. Further investigation is required to determine if this translates into improved VTE prophylaxis and reduced VTE incidence.
Systematic Review and Meta-Analysis; Level III.
创伤患者发生静脉血栓栓塞症（VTE）的风险较高，标准剂量依诺肝素预防方案可能不够充分。本荟萃分析旨在明确用于高危人群 VTE 预防的替代剂量方案的疗效。本系统评价的目的是回顾关于依诺肝素用于创伤患者 VTE 预防的体重剂量的证据。
对比较成人创伤患者标准剂量与依诺肝素体重剂量用于 VTE 预防的研究进行系统数据库检索，纳入年龄≥18 岁的患者。主要结局为达到抗因子 Xa（AFXa）的预防范围内水平。次要结局包括亚预防 AFXa 水平、超预防 AFXa 水平、VTE 发生率和出血事件。采用固定效应模型和随机效应模型进行荟萃分析，结果表示为比值比、风险比（RR）和风险差异（RD）及其 95%置信区间（CI）。
共有 4 项队列研究符合纳入标准。与标准剂量相比，依诺肝素预防剂量与增加预防 AFXa 水平的几率相关（比值比，5.85；95%CI，3.02-11.30；p<0.00001）和降低亚预防 AFXa 水平的风险（RR，3.97；95%CI，3.02-5.22；p<0.00001）。标准剂量与超治疗性 AFXa 水平的风险降低相关（RR，0.23；95%CI，0.11-0.50；p=0.0002），但与出血事件风险无差异（RD，-0.00；95%CI，-0.02 至 0.01；p=0.55）。两组间 VTE 发生率无统计学差异（RD，0.01；95%CI，-0.02 至 0.03；p=0.64）。
与标准剂量相比，依诺肝素剂量方案与增加预防范围内 AFXa 水平的几率相关。需要进一步研究以确定这是否能转化为改善 VTE 预防和降低 VTE 发生率。
系统评价和荟萃分析；III 级。
