Thrombelastography Versus AntiFactor Xa Levels in the Assessment of Prophylactic-Dose Enoxaparin in Critically Ill Patients
Thrombelastography Versus AntiFactor Xa Levels in the Assessment of Prophylactic-Dose Enoxaparin in Critically Ill Patients
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DOI：
10.1097/ta.0b013e3181a51e33
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发表时间：
2009-06-01
影响因子：
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通讯作者：
Schreiber, Martin A.
中科院分区：
文献类型：
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作者：
Van, Philbert Y.;Cho, S. David;Schreiber, Martin A.
背景标准剂量的依诺肝素常用于预防深静脉血栓形成（DVT）。有证据表明重症监护病房（ICU）患者的生物利用度不一致。抗Xa因子活性（抗Xa）已用于监测依诺肝素剂量，但其准确性和可用性存在问题。血栓弹力图（TEG）用于评价不同环境下的凝血。本研究的目的是分析TEG是否可以用来预测依诺肝素治疗的患者将发展DVT。方法：二百六十一同时依诺肝素活性（活性）和依诺肝素中和（中性）TEG进行了连续四天在61外科ICU患者。收集患者特征和抗Xa抗体。按照ICU方案进行DVT筛查。平均（+/- SEM）年龄为54（+/- 2.3）岁，急性生理学和慢性健康评估H评分为17（+/- 0.7）。有30例创伤和31例普外科患者（69%男性）。DVT发生率为28%。活性血液与中和血液之间的凝块形成时间（R）和30分钟时的溶解百分比不同（p < 0.001）。DVT患者的R时间比无DVT患者短1.5分钟（p < 0.001），提示DVT患者存在高凝状态。抗Xa水平在DVT患者（0.135 +/- 0.012）和无DVT患者（0.135 +/- 0.007）中相似（p = 0.97）。年龄，体重指数，损伤严重程度评分，急性生理学和慢性健康评价H评分，或DVT和非DVT groups.Conclusions之间的创伤状态没有差异：TEG显示依诺肝素中和和依诺肝素活性血液在ICU患者，可用于指导剂量之间的差异。TEG可区分依诺肝素治疗的患者，后者随后发生DVT，而抗Xa水平则不会。TEG显示依诺肝素相关的纤维蛋白溶解增加。
Background. A standard dose of enoxaparin is frequently used for deep venous thrombosis (DVT) prophylaxis. Evidence suggests inconsistent bioavailability in intensive care unit (ICU) patients. Antifactor Xa activity (anti-Xa) has been used to monitor enoxaparin dosing but its accuracy and availability are problematic. Thrombelastography (TEG) is used to evaluate coagulation in diverse settings. The purpose of this study was to analyze whether TEG could be used to predict which enoxaparin-treated patients would develop DVT.Methods: Two hundred sixty-one simultaneous enoxaparin-active (active) and enoxaparin-neutratized (neutral) TEGs were performed in 61 surgical ICU patients over four consecutive days. Patient characteristics and anti-Xa were collected. DVT screening was per ICU protocol.Results. Mean (+/- SEM) age was 54 (+/- 2.3) years and Acute Physiology and Chronic Health Evaluation H score was 17 (+/- 0.7). There were 30 trauma and 31 general surgery patients (69% men). The DVT rate was 28%. Time to clot formation (R) and percent lysis at 30 minutes were different between active versus neutralized blood (p < 0.001). R time was 1.5 minutes shorter in patients with DVT versus those without (p < 0.001) indicating hypercoagulability in DVT patients.Anti-Xa levels were similar in patients with (0.135 +/- 0.012) and without (0.135 +/- 0.007) DVT (p = 0.97). There were no differences in age, body mass in dex, injury severity score, Acute Physiology and Chronic Health Evaluation H score, or trauma status between DVT and non-DVT groups.Conclusions: TEG demonstrates differences between enoxaparin-neutralized and enoxaparin-active blood in ICU patients that may be used to guide dosing. TEG differentiates enoxaparin-treated patients who subsequently develop DVT while anti-Xa levels do not. TEG demonstrates an enoxaparin-related increase in fibrinolysis.