Anthony Hawkins W, Smith Susan E, Stitt Tia M, Abdulla Aliya, Branan Trisha N, Hall Ronald G
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy and Department of Pharmacology; Toxicology, Medical College of Georgia at Augusta University.
Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy.
Innov Pharm. 2021 Sep 22;12(4). doi: 10.24926/iip.v12i4.4288. eCollection 2021.
Pharmacologic thromboprophylaxis (PTP) is the mainstay prevention strategy for venous thromboembolism (VTE). PTP agents traditionally dosed, like unfractionated heparin (UFH) and enoxaparin (ENOX), are associated with failure and bleeding in obese and underweight patients, respectively. This study aimed to describe the prevalence of unadjusted ENOX and UFH dosing for PTP based on anthropometric measures. :This was a post-hoc, multicenter, cross-sectional analysis of critically ill adults receiving PTP with ENOX or UFH. The primary outcome was the prevalence of unadjusted PTP based on body mass index (BMI) and total body weight (TBW). Definitions for dose adjustments were developed based on existing literature. A secondary outcome was to identify factors associated with unadjusted dosing per BMI and TBW using multivariable generalized linear mixed-effect models. The nested cohort included 172 patients (ENOX=46, UFH=126). Unadjusted PTP was observed in 118 patients (68.6%) based on BMI and 74 (43%) per TBW. When comparing UFH to ENOX, more patients who received UFH had doses unadjusted by BMI (78.6% vs. 41.3%, p<0.05) but not TBW (43.7% vs. 41.3%). Factors independently associated with unadjusted PTP per BMI were receipt of UFH (OR 6.93, 95% CI 1.06-8.77) or a BMI underweight or overweight/obese (OR 10.45, 95% CI 4.38-24.92). Having a TBW <50kg or >100kg (OR 4.85, 95% CI 2.15-10.96) were independently associated with unadjusted PTP based on TBW. Unadjusted dosing of PTP occurs frequently in critically ill adults receiving ENOX or UFH. This was seen in body size extremes by both BMI and TBW.
药物性血栓预防（PTP）是静脉血栓栓塞症（VTE）的主要预防策略。传统给药剂量的PTP药物，如普通肝素（UFH）和依诺肝素（ENOX），分别与肥胖和体重过轻患者的预防失败及出血相关。本研究旨在描述基于人体测量指标的未调整依诺肝素和普通肝素用于PTP的给药情况。这是一项对接受依诺肝素或普通肝素进行PTP的危重症成年患者的事后、多中心横断面分析。主要结局是基于体重指数（BMI）和总体重（TBW）的未调整PTP的发生率。根据现有文献制定了剂量调整的定义。次要结局是使用多变量广义线性混合效应模型确定与基于BMI和TBW的未调整给药相关的因素。该嵌套队列包括172例患者（依诺肝素组=46例，普通肝素组=126例）。基于BMI，118例患者（68.6%）观察到未调整的PTP，基于TBW则有74例（43%）。将普通肝素与依诺肝素进行比较时，更多接受普通肝素的患者其剂量未根据BMI调整（78.6%对41.3%，p<0.05），但未根据TBW调整（43.7%对41.3%）。与基于BMI的未调整PTP独立相关的因素是接受普通肝素（比值比6.93，95%置信区间1.06 - 8.77）或BMI体重过轻或超重/肥胖（比值比10.45，95%置信区间4.38 - 24.92）。TBW<50kg或>100kg（比值比4.85，95%置信区间2.15 - 10.96）与基于TBW的未调整PTP独立相关。在接受依诺肝素或普通肝素的危重症成年患者中，PTP的未调整给药情况频繁发生。在BMI和TBW的体型极端情况下均可见到这种情况。
