Damiani Anthony, De Menezes Caceres Viviane, Roberts Greg, Coddo Jessica, Scarfo Nicholas, Willliams Desmond B, Tharmathurai Vinosshini, Tadros Rami, Fitzgerald Stephen, O'Connell Alice, Kaur Sandhu Amrit, Vanlint Andrew, Mangoni Arduino A, Hofmann Dirk, Bony Hosam, Faunt Jeff, Boey Jir Ping, Farinola Nicholas, Wells Rachel, Hedger Stephen, Hewage Udul, Sharma Yogesh, Jabbar Zuhair, Thomas Josephine, Flabouris Katerina, Gilbert Toby, Thompson Campbell, Russell Patrick
SA Pharmacy, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
School of Allied Health Science and Practice, The University of Adelaide, Adelaide, South Australia, Australia.
Pharmacol Res Perspect. 2025 Feb;13(1):e70039. doi: 10.1002/prp2.70039.
To understand differences in anti-factor-Xa levels produced by two different dosing strategies (conventional and individualized) for therapeutic enoxaparin in a cohort of hospital inpatients. A multicenter, retrospective cohort study over a two- and a half-year period for inpatients with stable renal function and on therapeutic enoxaparin. Anti-factor-Xa levels were taken 3-5 h after enoxaparin administration and a minimum of 48 h of dosing. The final analysis included 278 patients from five hospitals: conventional dosing was used for 141, while 137 were given an unconventional dose, that is, individualized for their renal function and weight. Out-of-range levels were frequent (35% to 40% of all inpatients). After adjustment for age, renal function, and body mass index (BMI), the conventional group was more likely to experience above-range levels (> 1.0 IU/mL; OR 2.50 [95% CI 1.38-4.56], p < 0.003) than the individualized group. Individualized dosing was independently associated with higher odds of a below-range anti-Xa level (< 0.5 IU/mL) compared to conventional dosing (OR 2.27 [95% CI 1.07-4.76], p = 0.03). Within the conventional group, above-range levels were significantly and independently associated with decreasing renal function (OR 0.97, 95% CI 0.96-0.99, p = 0.004) and with increasing BMI (OR 1.06, 95% CI 1.01-1.10, p = 0.02). No such associations were seen with an individualized approach. Clinical event rates were low and not different between groups (p > 0.24). Conventional therapeutic dosing of enoxaparin exposed people with obesity or renal impairment to more frequent above-range anti-factor-Xa levels; individualizing the dose could improve this but might expose people to subtherapeutic levels. More research is needed.
为了解在一组住院患者中，两种不同的治疗性依诺肝素给药策略（传统给药和个体化给药）所产生的抗Xa因子水平的差异。这是一项为期两年半的多中心回顾性队列研究，研究对象为肾功能稳定且正在接受治疗性依诺肝素的住院患者。在依诺肝素给药后3 - 5小时以及至少48小时给药后测定抗Xa因子水平。最终分析纳入了来自五家医院的278名患者：141名采用传统给药，137名给予非常规剂量，即根据其肾功能和体重进行个体化给药。超出范围的水平很常见（占所有住院患者的35%至40%）。在对年龄、肾功能和体重指数（BMI）进行调整后，传统给药组比个体化给药组更有可能出现高于范围的水平（>1.0 IU/mL；比值比2.50 [95%置信区间1.38 - 4.56]，p<0.003）。与传统给药相比，个体化给药与低于范围的抗Xa水平（<0.5 IU/mL）的较高几率独立相关（比值比2.27 [95%置信区间1.07 - 4.76]，p = 0.03）。在传统给药组中，高于范围的水平与肾功能下降（比值比0.97，95%置信区间0.96 - 0.99，p = 0.004）和BMI增加（比值比1.06，95%置信区间1.01 - 1.10，p = 0.02）显著且独立相关。个体化给药方法未发现此类关联。临床事件发生率较低，且两组之间无差异（p>0.24）。依诺肝素的传统治疗给药使肥胖或肾功能损害患者更频繁地出现高于范围的抗Xa因子水平；个体化给药剂量可能会改善这种情况，但可能会使患者处于治疗不足的水平。需要更多的研究。
