The Impact of Once- versus Twice-Daily Enoxaparin Prophylaxis on Risk for Venous Thromboembolism and Clinically Relevant Bleeding.
The Impact of Once- versus Twice-Daily Enoxaparin Prophylaxis on Risk for Venous Thromboembolism and Clinically Relevant Bleeding.
复制标题
一次与每日两次依诺肝素预防对静脉血栓栓塞和临床相关出血风险的影响。
DOI：
10.1097/prs.0000000000004517
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发表时间：
2018
影响因子：
3.6
通讯作者：
Momeni,Arash
中科院分区：
文献类型：
--
作者：
Pannucci,ChristopherJ;Fleming,KoryI;Agarwal,Jayant;Rockwell,WBradford;Prazak,AnnMarie;Momeni,Arash
背景：静脉血栓栓塞症是一种发生在整形手术患者身上的危及生命或肢体的并发症。目前，平衡静脉血栓栓塞症风险和药物相关不良药物事件风险(特别是出血)的最佳剂量依诺肝素尚不清楚。方法：这项研究比较了两个前瞻性临床试验的药效学和临床结果，包括90天静脉血栓栓塞症和90天临床相关出血，唯一不同的是术后抗凝策略。试验1的患者在住院期间每天服用依诺肝素40毫克，试验2的患者在住院期间每天服用依诺肝素40毫克。这项研究还检测了基于体重的每日两次预防策略对达到范围内抗凝血因子Xa水平的潜在影响。结果：该研究比较了94名每天接受一次依诺肝素的患者和118名每天接受两次依诺肝素的患者。每天服用两次依诺肝素与90天急性静脉血栓栓塞症的显著减少(0%对5.3%；p=0.012)和90天临床相关出血的非显著增加(6.8%对3.2%；p=0.25)有关。根据抗凝血因子Xa水平，每天两次的依诺肝素0.4~0.5 mg/kg可使患者避免抗凝不足和过度凝血的比例增加。结论：每天两次的依诺肝素治疗90天急性静脉血栓栓塞症的风险优于每天一次的依诺肝素。每天服用两次依诺肝素可能会增加临床相关出血，尽管在本研究中观察到的差异并不显著。每天两次按体重服用依诺肝素可能会优化整形和重建手术后预防性抗凝的风险和好处。
Background:Venous thromboembolism is a life-or limb-threatening complication that occurs in plastic surgery patients. At present, the optimal dose of enoxaparin that balances the risk of venous thromboembolism and the risk of medication-related adverse drug events—specifically, bleeding—remains unknown.Methods:This study compared pharmacodynamic and clinical outcomes, including 90-day venous thromboembolism and 90-day clinically relevant bleeding, between two prospectively performed clinical trials whose sole difference was postoperative anticoagulation strategy. Patients in trial 1 received enoxaparin 40 mg once daily for the duration of inpatient stay, and patients in trial 2 received enoxaparin 40 mg twice daily for the duration of inpatient stay. The study also examined the potential impact of a weight-based twice-daily prophylaxis strategy to achieve in-range anti–factor Xa levels.Results:The study compared 94 patients who received once-daily enoxaparin to 118 patients who received twice-daily enoxaparin. Twice-daily enoxaparin was associated with a significant decrease in 90-day acute venous thromboembolism (0 percent versus 5.3 percent; p= 0.012) and a nonsignificant increase in 90-day clinically relevant bleeding (6.8 percent versus 3.2 percent; p= 0.25). Twice-daily enoxaparin at 0.4 to 0.5 mg/kg may allow an increased proportion of patients to avoid both inadequate anticoagulation and overanticoagulation, based on anti–factor Xa levels.Conclusions:Twice-daily enoxaparin is superior to once-daily enoxaparin for 90-day acute venous thromboembolism risk reduction. Twice-daily enoxaparin may increase clinically relevant bleeding, although observed differences in this study were not significant. Weight-based twice-daily enoxaparin dosing may optimize the risks and benefits of prophylactic anticoagulation after plastic and reconstructive surgery.