Dosing and monitoring of low-molecular-weight heparin in high-risk pregnancy: single-center experience.
Dosing and monitoring of low-molecular-weight heparin in high-risk pregnancy: single-center experience.
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DOI：
10.1592/phco.31.7.678
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发表时间：
2011-07
期刊：
影响因子：
4.1
通讯作者：
Hibbard JU
中科院分区：
文献类型：
--
作者：
Shapiro NL;Kominiarek MA;Nutescu EA;Chevalier AB;Hibbard JU
评估用于高危妊娠时 LMWH 的剂量要求和监测模式。伊利诺伊大学芝加哥医学中心的一项回顾性观察队列研究 2001 年至 2005 年期间接受 LMWH 治疗以预防或治疗妊娠期间 VTE 的患者，并监测抗 Xa 因子活性。数据来自 49 名女性 53 次怀孕。预防组和治疗组的平均起始剂量（mg）和每日两次依诺肝素的最接近剂量分别为 39.2（范围 30-60）和 55.0（范围 30-100），p = 0.06； 83.0（范围 30-180）和 85.7（范围 30-160），p = 0.41。对于预防组和治疗组，基于体重的平均起始剂量（mg/kg）和最接近分娩的剂量分别为0.46 vs. 0.62（p=0.03）和0.90 vs. 0.87（p=0.29）。预防组和治疗组中分别有 9/13 (69.2%) 和 21/38 (55.2%) 的患者需要改变剂量以达到目标抗 Xa 因子活性。在所有三个妊娠期中，基于体重的预防剂量始终为 0.6 mg/kg，以实现 0.39 ± 0.18 IU/ml 的目标抗 Xa 因子活性，而治疗剂量为 0.9 mg/kg，以维持 0.71 ± 0.22 IU/ml 的抗 Xa 因子活性。在整个怀孕期间，以抗 Xa 因子活性为指导的 LMWH 剂量变化很常见。预防组中 LMWH 剂量需求的显着增加表明，怀孕患者可能需要更频繁地监测抗 Xa 因子活性，以维持目标抗凝水平。
To evaluate dosing requirements and monitoring patterns of LMWH when used in high-risk pregnancy. A retrospective observational cohort study University of Illinois at Chicago Medical Center Those treated with LMWH from 2001 – 2005 for either prophylaxis or treatment of VTE during pregnancy and monitored with anti-factor Xa activity. Data was obtained on 53 pregnancies in 49 women. Mean starting doses (mg) and doses most proximate to delivery of twice daily enoxaparin were, for prophylaxis and therapeutic groups, respectively, 39.2 (range 30–60) and 55.0 (range 30–100), p = 0.06; and 83.0 (range 30–180) and 85.7 (range 30–160), p = 0.41. Weight-based mean starting doses (mg/kg) and doses most proximate to delivery were 0.46 vs. 0.62 (p =0.03), and 0.90 vs. 0.87 (p=0.29), for prophylaxis and therapeutic groups, respectively. Dose changes were required in 9/13 (69.2%) and 21/38 (55.2%) patients in the prophylaxis and therapeutic groups, respectively to achieve target anti-Factor Xa activity. The weight-based prophylactic dose was consistently 0.6 mg/kg in all three trimesters achieving a target anti-Factor Xa activity of 0.39 ± 0.18 IU/ml, while the therapeutic dose was 0.9 mg/kg to maintain anti-Factor Xa activity of 0.71 ± 0.22 IU/ml. Dose changes for LMWH throughout pregnancy as guided by anti-Factor Xa activity were common. A significant increase in the LMWH dose requirements in the prophylactic group suggests that more frequent monitoring of anti-Factor Xa activity may be appropriate in pregnant patients to maintain target anticoagulant levels.
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