Watanabe Kozo, Hasegawa Hiroki, Katoh Jun, Hayashi Yutaka, Saku Isaku, Ohshima Kazunori, Hishida Akira, Seki George, Ikegaya Naoki
Department of Pharmacy, Yaizu City Hospital, 1000 Dobara, Yaizu, Shizuoka, Japan.
Department of Orthopedics, Yaizu City Hospital, Shizuoka, Japan.
Clin Exp Nephrol. 2025 Apr;29(4):405-413. doi: 10.1007/s10157-024-02580-w. Epub 2024 Oct 28.
Anticoagulation is recommended for thromboprophylaxis after lower-limb orthopedic surgery. The suggested dosage is based on creatinine clearance (CCr) in the labels. However, most facilities only provide estimated glomerular filtration rate (eGFR) as laboratory data. Because the eGFR equation adjusts for a body surface area (BSA) of 1.73 m, it may overestimate renal function in patients with a small BSA. This retrospective study aimed to determine whether different renal function estimation formulas affect the incidences of venous thromboembolism (VTE) and bleeding when determining anticoagulant dosages.
This study included patients who underwent lower-limb orthopedic surgery and received anticoagulants (edoxaban, enoxaparin, and fondaparinux) between 2017 and 2020 at Yaizu City Hospital. Anticoagulant dosing was evaluated using CCr, eGFR, and de-indexed eGFR (without correction for BSA), and the incidences of VTE and bleeding were compared among these formulas.
The median values for BSA, CCr, eGFR, and de-indexed eGFR were 1.40 m, 56.0 mL/min, 73.0 mL/min/1.73m, and 60.9 mL/min, respectively. There was no significant difference in the VTE incidence among these formulas. However, when dose reduction or contraindication threshold was determined by eGFR vs. CCr, the bleeding incidence was significantly higher in the group that was overdosed by CCr (6.0% vs. 25.7%, p < 0.05). Similarly, using de-indexed eGFR vs. CCr, the bleeding incidence was significantly higher in the group that was overdosed by CCr (7.5% vs. 28.6%, p < 0.05).
In orthopedic surgery, anticoagulant dosages should be based on CCr for patients with a small BSA to avoid bleeding risks.
下肢骨科手术后建议进行抗凝预防血栓形成。标签中的建议剂量基于肌酐清除率（CCr）。然而，大多数机构仅提供估算肾小球滤过率（eGFR）作为实验室数据。由于eGFR公式针对1.73 m²的体表面积（BSA）进行了校正，它可能会高估小BSA患者的肾功能。这项回顾性研究旨在确定在确定抗凝剂量时，不同的肾功能估算公式是否会影响静脉血栓栓塞（VTE）和出血的发生率。
本研究纳入了2017年至2020年在八代市医院接受下肢骨科手术并接受抗凝剂（依度沙班、依诺肝素和磺达肝癸钠）治疗的患者。使用CCr、eGFR和去指数化eGFR（未校正BSA）评估抗凝剂剂量，并比较这些公式之间VTE和出血的发生率。
BSA、CCr、eGFR和去指数化eGFR的中位数分别为1.40 m²、56.0 mL/min、73.0 mL/min/1.73m²和60.9 mL/min。这些公式之间的VTE发生率没有显著差异。然而，当通过eGFR与CCr确定剂量减少或禁忌阈值时，CCr过量组的出血发生率显著更高（6.0%对25.7%，p < 0.05）。同样，使用去指数化eGFR与CCr时，CCr过量组的出血发生率显著更高（7.5%对28.6%，p < 0.05）。
在骨科手术中，对于小BSA患者，抗凝剂量应基于CCr，以避免出血风险。
