静脉血栓栓塞的抗Xa水平在重症监护中的预防:系统性审查和元分析
Kevin M Durr1,2, Alexa Ehlebracht3, Bram Rochwerg4,5,6
1Department of Critical Care, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Critical care medicine
|March 11, 2026
概括
不到一半的重症患者通过低分子量肝素预防达到治疗性抗Xa因子水平,增加静脉血栓栓塞的风险. 男性性别,体重较高和BMI预测了亚预防水平.
科学领域:
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
- 血栓形成研究研究
背景情况:
- 低分子量肝素 (LMWH) 是严峻病情的成年人静脉血栓塞栓症 (VTE) 预防的标准.
- 治疗性抗因子Xa (抗Xa) 水平对于有效的LMWH预防至关重要.
- 亚预防性抗Xa水平可能会危及这种脆弱人群的静脉瘤预防.
研究的目的:
- 在接受LMWH的重症患者中,研究亚预防性抗Xa水平与VTE风险之间的关联.
- 在这个患者群体中确定亚预防性抗Xa水平的预测因子.
主要方法:
- 对Medline和Embase数据库进行系统审查和元分析.
- 包括39项研究,其中包括7124名接受LMWH的重症成年人.
- 提取关于抗Xa水平,VTE事件和患者特征的数据;使用GRADE评估证据确定性.
主要成果:
- 只有47%的患者达到目标抗Xa水平.
- 亚预防性抗Xa水平与VTE风险增加2.87倍 (低确定性) 有关.
- 男性性别,体重增加和BMI升高与亚预防性抗Xa水平相关 (中度确定性).
结论:
- 低于最佳的抗Xa水平在LMWH的重症患者中很常见,可能会增加VTE风险.
- 监测抗Xa水平并考虑患者的性别,体重和BMI等因素是临床上重要的.
- 需要进一步的随机对照试验来优化LMWH剂量和监测策略.
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