在住院的肥胖儿科患者中进行埃诺克萨巴林血栓预防
Juwon Yim1, Afrin Jahan2, Nikolay Braykov2
1Department of Pharmacy, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Pediatric blood & cancer
|March 15, 2024
概括
患有严重肥胖症的儿科患者通常需要更高的埃诺沙巴林剂量以获得有效的血栓预防. 监测抗Xa因子 (anti-Xa) 水平对于优化这种人群中的埃诺沙巴林治疗至关重要.
科学领域:
- 儿科药理学 儿科药理学
- 进行血栓预防治疗.
- 肥胖医学 肥胖医学
背景情况:
- 埃诺沙巴林是预防儿童血栓的关键抗凝剂.
- 肥胖可以显著改变身体如何处理enoxaparin.
- 目前针对肥胖儿童的儿科血栓预防的沙剂量指导方针尚未确立.
研究的目的:
- 为了确定肥胖儿科患者血栓预防的最佳埃诺沙巴林剂量.
- 评估肥胖严重程度 (BMI百分位数和体重) 与埃诺沙巴林剂量要求之间的关系.
- 评估在标准剂量下达到治疗性抗Xa (抗Xa) 水平.
主要方法:
- 在2013-2022年期间接受埃诺沙巴林用于血栓预防的儿科患者 (≥60公斤,BMI≥95百分位) 的回顾性评估.
- 分析最初每12小时接受30毫克埃诺沙林治疗的患者的抗Xa水平.
- 计算达到目标抗Xa水平 (0.2-0.4单位/毫升) 所需的平均每日埃诺沙巴林剂量,按BMI百分位数和体重分层.
主要成果:
- 在116名患者中,53%的BMI>99百分位数,54%的BMI超过100公斤,在初始剂量时具有亚治疗性抗Xa水平 (<0.2单位/毫升).
- 91名患者获得了治疗性抗Xa水平 (0.2-0.4单位/毫升),平均每日剂量为66毫克.
- 与较低体重/BMI类别相比,BMI>99百分点 (67.8毫克/天) 和>100千克 (69.1毫克/天) 的患者需要显著更高的埃诺沙巴林剂量.
结论:
- 标准的埃诺沙巴林剂量可能不足以达到严重肥胖的儿科患者的治疗水平.
- 建议在患有严重肥胖的青少年中考虑增加初始埃诺沙巴林剂量.
- 定期监测抗Xa水平对于在这个高风险儿科群体中有效的埃诺沙巴林血栓预防是必不可少的.
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