A case series of LMWH use in pregnancy: Should trough anti-Xa levels guide dosing?
A case series of LMWH use in pregnancy: Should trough anti-Xa levels guide dosing?
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DOI：
10.1016/j.thromres.2014.09.033
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发表时间：
2014-12-01
影响因子：
7.5
通讯作者：
Bungard, Tammy J.
中科院分区：
文献类型：
--
作者：
Berresheim, Michelle;Wilkie, Jodi;Bungard, Tammy J.
简介：妊娠是一种血栓形成状态，增加了静脉血栓栓塞症(VTE)的风险，并增加了患有机械心脏瓣膜(MHV)的女性瓣膜血栓形成的风险。虽然低分子肝素(LMWH)通常根据体重(即每12小时依诺肝素1毫克/公斤)剂量，但孕妇的数据表明，基于体重的剂量并不能始终如一地达到目标抗Xa水平。在患有MHV的女性中，我们的做法包括滴定LMWH剂量以同时针对低谷和峰值抗-Xa水平，而对于VTE峰值抗-Xa水平的患者则指导剂量。材料/方法：这一回顾性病例系列包括需要LMWH治疗剂量的孕妇，至少有3个峰值(+/-谷值)抗-Xa水平。我们的主要目标是描述在MHV患者中达到靶向抗Xa水平所需的实际低分子肝素剂量与基于重量的剂量相比。其次，我们对VTE患者进行了同样的比较；比较了MHV患者和VTE患者之间的实际剂量；并检查了母体和胎儿的结局。结果/结论：MHV患者(N=4)需要比按体重计算的依诺肝素剂量(1.35 mg/kg Q12H)更多地达到靶向抗Xa水平。重要的是，达到目标峰值的抗Xa水平并不总是确保维持最低谷值。VTE患者(N=12)不需要比体重剂量更多的依诺肝素(0.96 mg/kg Q12h)。与静脉血栓栓塞症患者相比，重型肝炎患者接受更多依诺肝素治疗(P<；0.001)。低分子肝素治疗无出血或凝血并发症。对于血栓栓塞症风险较高的MHV孕妇，应考虑以谷值和峰值抗-Xa水平为指导的低分子肝素剂量。(C)2014爱思唯尔有限公司。保留所有权利。
Introduction: Pregnancy is a thrombogenic state, increasing the risk for venous thromboembolism (VTE), and the risk of valve thrombosis amongst women with mechanical heart valves (MHV). While low molecular weight heparins (LMWH) are generally dosed based on weight (i.e., enoxaparin 1 mg/kg every 12 hours), data in pregnant women have shown that weight-based dosing does not consistently achieve target anti-Xa levels. In women with MHV, our practice includes titrating LMWH doses to target both trough and peak anti-Xa levels, while for those with VTE peak anti-Xa levels guide dosing.Materials/Methods: This retrospective case series included pregnant women requiring LMWH treatment doses with at least 3 peak (+/-trough) anti-Xa levels. Our primary objective was to describe the actual LMWH dose required to achieve targeted anti-Xa levels relative to weight-based dosing in patients with MHV. Secondarily, we compared the same for VTE patients; compared actual dosing between those with MHV and VTE; and examined maternal and fetal outcomes.Results/Conclusion: Women with MHV (N = 4) required greater than weight-based dosing of enoxaparin (1.35 mg/kg Q12H) to achieve targeted anti-Xa levels. Importantly, achieving target peak anti-Xa levels did not always ensure maintenance of minimum trough levels. VTE patients (N = 12) did not require more enoxaparin (0.96 mg/kg Q12H) than weight based dosing. MHV patients received more enoxaparin compared to VTE patients (P < 0.001). No bleeding or clotting complications were associated with LMWH administration. In pregnant women with MHV at high risk of thromboembolism, LMWH dosing guided by trough and peak anti-Xa levels should be considered. (C) 2014 Elsevier Ltd. All rights reserved.