对于患有功能障碍的患者,需要减少较小的纳德罗巴林剂量:多中心队列研究
Renate C A E van Uden1, Tessa C C Jaspers2, Karina Meijer3
1Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands; Pharmacy Foundation of Haarlem Hospitals, Haarlem, the Netherlands; Department of Clinical Pharmacy, Spaarne Gasthuis Hospital, Haarlem/Hoofddorp, the Netherlands.
Thrombosis research
|February 20, 2024
概括
在功能受损的患者中,纳德罗巴林的剂量需要仔细考虑. 目前的指导方针可能无法确保治疗性抗Xa水平,这表明需要基于个体eGFR的修订剂量策略.
科学领域:
- 药理学 药理学是指药理学的学科.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临床药房 临床药房
背景情况:
- 目前的指导方针建议对EGFR分别为15-29和30-60毫升/分钟的患者减少50%和25%的纳德罗巴林剂量.
- 建议监测高峰抗Xa水平,但缺乏关于这些剂量是否达到治疗水平或与没有功能障碍的患者可比的水平的数据.
研究的目的:
- 为了确定患有功能障碍的患者的纳德罗巴林剂量范围,从而产生治疗性抗Xa水平.
- 确定标准的86 IU/kg剂量的百分比达到通常在正常功能患者中看到的抗Xa水平.
主要方法:
- 这是一项回顾性队列研究,涉及770名成年患者的eGFR≥15毫升/分钟在五家医院.
- 对第一个正确采样的抗Xa峰值水平 (3-5小时后) 的分析.
- 开发使用多重线性回归的模拟预测模型,考虑eGFR和医院变异.
主要成果:
- 估计的淋巴细胞过率 (eGFR) 和医院位置显著影响了剂量-抗Xa水平关系.
- 达到0.75 IU/ml的高峰抗Xa水平所需的剂量在各医院之间差异很大,从55-91 IU/kg (eGFR 15-29),65-359 IU/kg (eGFR 30-60),68-168 IU/kg (eGFR >60) 之间.
- 患有eGFR 15-29和30-60毫升/分钟的患者需要分别75%和91%的86 IU/kg剂量,以达到与患有eGFR>60毫升/分钟的患者相似的抗Xa水平.
结论:
- 在实施抗Xa导向纳德罗巴林剂量调整之前,对抗Xa测定协调和验证的目标范围至关重要.
- 针对类似于eGFR>60毫升/分钟患者的抗Xa水平,通过较小的剂量减少实现,可能是一个更有效的策略.
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