Lombardo Sarah, McCrum Marta, Knudson M Margaret, Moore Ernest E, Kornblith Lucy, Brakenridge Scott, Bruns Brandon, Cipolle Mark D, Costantini Todd W, Crookes Bruce, Haut Elliott R, Kerwin Andrew J, Kiraly Laszlo N, Knowlton Lisa Marie, Martin Matthew J, McNutt Michelle K, Milia David J, Mohr Alicia, Rogers Frederick, Scalea Thomas, Sixta Sherry, Spain David, Wade Charles E, Velmahos George C, Nirula Ram, Nunez Jade
Surgery, University of Utah, Salt Lake City, Utah, USA.
Surgery, University of California San Francisco, San Francisco, California, USA.
Trauma Surg Acute Care Open. 2024 Feb 26;9(1):e001230. doi: 10.1136/tsaco-2023-001230. eCollection 2024.
Optimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE risk compared with standard fixed dosing (SFD).
Patients from the prospective, observational CLOTT-1 registry receiving prophylactic enoxaparin (n=5539) were categorized as WB (0.45-0.55 mg/kg two times per day) or SFD (30 mg two times per day, 40 mg once a day). Multivariate logistic regression was used to generate a predicted probability of VTE for WB and SFD patients.
Of 4360 patients analyzed, 1065 (24.4%) were WB and 3295 (75.6%) were SFD. WB patients were younger, female, more severely injured, and underwent major operation or major venous repair at a higher rate than individuals in the SFD group. Obesity was more common among the SFD group. Unadjusted VTE rates were comparable (WB 3.1% vs. SFD 3.9%; p=0.221). Early prophylaxis was associated with lower VTE rate (1.4% vs. 5.0%; p=0.001) and deep vein thrombosis (0.9% vs. 4.4%; p<0.001), but not pulmonary embolism (0.7% vs. 1.4%; p=0.259). After adjustment, VTE incidence did not differ by dosing strategy (adjusted OR (aOR) 0.75, 95% CI 0.38 to 1.48); however, early administration was associated with a significant reduction in VTE (aOR 0.47, 95% CI 0.30 to 0.74).
In young trauma patients, WB prophylaxis is not associated with reduced VTE rate when compared with SFD. The timing of the initiation of chemoprophylaxis may be more important than the dosing strategy. Further studies need to evaluate these findings across a wider age and comorbidity spectrum.
Level IV, therapeutic/care management.
最佳的静脉血栓栓塞症（VTE）依诺肝素预防剂量仍不明确。基于体重（WB）的给药方式可安全提高抗Xa因子水平，无需常规监测，但尚不清楚其是否能降低VTE风险。我们假设与标准固定剂量（SFD）相比，WB给药可降低VTE风险。
前瞻性观察性CLOTT-1登记研究中接受依诺肝素预防治疗的患者（n = 5539）被分为WB组（0.45 - 0.55 mg/kg，每日两次）或SFD组（30 mg，每日两次；40 mg，每日一次）。采用多因素逻辑回归分析来预测WB组和SFD组患者发生VTE的概率。
在分析的4360例患者中，1065例（24.4%）为WB组，3295例（75.6%）为SFD组。WB组患者较年轻，女性居多，损伤更严重，且接受大手术或大静脉修复的比例高于SFD组。肥胖在SFD组更为常见。未调整的VTE发生率相当（WB组3.1% vs. SFD组3.9%；p = 0.221）。早期预防与较低的VTE发生率（1.4% vs. 5.0%；p = 0.001）和深静脉血栓形成（0.9% vs. 4.4%；p < 0.001）相关，但与肺栓塞无关（0.7% vs. 1.4%；p = 0.259）。调整后，不同给药策略的VTE发生率无差异（调整后的比值比（aOR）为0.75，95%置信区间为0.38至1.48）；然而，早期给药与VTE显著降低相关（aOR为0.47，95%置信区间为0.30至0.74）。
在年轻创伤患者中，与SFD相比，WB预防并未降低VTE发生率。化学预防的起始时间可能比给药策略更重要。需要进一步研究以在更广泛的年龄和合并症范围内评估这些发现。
IV级，治疗/护理管理。
