重症患者低分子肝素预防静脉血栓栓塞症需要监测抗Ⅹa因子水平吗?
Is monitoring of anti-factor Ⅹa levels required for low molecular weight heparin prophylaxis of venous thromboembolism in critically ill patients?
丁梦希 1宁雅婵 2宋礼坡 2李佩娟 3谢芳菲 4李双玲 4王春梅2
作者信息
- 1. 首都医科大学宣武医院全科医学科,北京 100053
- 2. 首都医科大学宣武医院重症医学科,北京 100053
- 3. 四川大学华西医院全科医学科,成都 610044
- 4. 北京大学第一医院重症医学科,北京 100191
- 折叠
摘要
危重症患者静脉血栓栓塞症(VTE)发生率高、病死率高,使用固定剂量低分子肝素(LMWH)预防后仍有VTE发生和出血风险.手术或外伤患者使用LMWH预防后抗Ⅹa因子水平多不达标.危重症患者病情复杂,且抗凝血酶Ⅲ水平低的患者比例较高,抗凝血酶Ⅲ水平低可影响LMWH的预防效果,导致VTE发生.根据抗Ⅹa因子水平调整LMWH剂量能否减少危重症患者VTE发生尚无定论.未来还需要进行高质量的多中心随机对照试验,以建立危重症患者精准预防VTE的新方法.
Abstract
The incidence and mortality of venous thromboembolism(VTE)are high in critically ill patients,and there is still a risk of VTE and bleeding after the use of fixed-dose low molecular weight heparin(LMWH)for prophylaxis.The level of anti-factorⅩa is not up to standard after LMWH prophylaxis in patients with surgery or trauma.The condition of critically ill patients is complicated,and the proportion of patients with low antithrombin Ⅲ is high,which can affect the prophylactic efficacy of LMWH and contribute to VTE occurrence.There is currently no consensus on whether adjusting LMWH dose according to anti-factorⅩa levels can reduce VTE occurrence in critically ill patients.High-quality multicenter randomized controlled studies are needed in the future to establish new approaches for precise prevention of VTE in critically ill patients.
关键词
危重症患者/低分子肝素/静脉血栓栓塞症/抗Ⅹa因子水平Key words
Critically ill patient/Low molecular weight heparin/Venous thromboembolism/Anti-factor Ⅹa level引用本文复制引用
基金项目
首都卫生发展科研专项(首发2022-2-2016)
出版年
2024
NETL
NSTL
万方数据