急性冠状动脉综合征采用依诺肝素抗凝治疗抗FXa水平达标率及危险因素分析  

Analysis of the rate and Risk Factors of Anti-Fxa Level of Enoxaparin in Patients with Acute Coronary Syndrome

作　　者：曾成林[1] 李胜 吴丽静[1] 陈锋文[1] ZENG Cheng-lin;LI Sheng;WU Li-jing;CHEN Feng-wen(Guangdong Province Huazhou City Hospital,Huazhou,525100,China)

机构地区：[1]广东省化州市人民医院检验科,化州525100

出　　处：《血栓与止血学》2020年第6期907-910,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的在使用依诺肝素抗凝治疗的内科患者中研究亚治疗抗FXa水平的发生率,并指出与抗FXa亚治疗水平风险相关的潜在危险因素。方法对60例有依诺肝素用药指征的患者进行抗FXa水平测定。根据抗FXa水平将患者分为:抗凝不足(<0.5 IU/ml)、抗凝达标(0.5~1.2 IU/ml)与过度抗凝(>1.2 IU/ml)组。对各组的影像学和临床资料以及合并用药情况进行了统计。采用单因素和多因素分析评价抗凝不足与潜在预测变量的关系。采用线性回归分析评价抗FXa活性、年龄、体重、体重指数、给药剂量/体重与肌酐清除率的关系。结果抗FXa活性平均为0.71±0.32 IU/ml,31%的患者抗FXa水平超出治疗范围,大部分(28%)的患者处于亚治疗水平。其中研究变量年龄>65;体重指数;肌酐清除率<40 ml/min都与抗FXa水平低于0.5 IU/ml的风险相关(p<0.05),线性回归分析显示抗FXa水平与年龄(r^2=0.01,p=0.04)、体重(r^2=0.002,p=0.05)、体重指数(r^2=0.006,p=0.05)和肌酐清除率(r^2=0.032,p=0.01)之间有显著关系。结论近三分之一接受依诺肝素治疗的患者抗FXa水平超出治疗范围。并且再体重超标,高龄患者,及肌酐清除率过低得患者中抗FXa水平提示患者药效达标率不足。Objective The aim of this study is to determine the prevalence of non-therapeutic anti-FXa levels among medical patients using enoxaparin as anticoagulant therapy and to point out potential risk factors related to the risk of having a sub-therapeutic level.Methods Anti-FXa levels were measured in a cohort of sixty patients with medical indication for enoxaparin.Patients were categorized according to anti-FXa levels as follows:suboptimal anticoagulation(<0.5 IU/ml),optimal anticoagulation(between 0.5 and 1.2 IU/ml)or overanticoagulated(>1.2 IU/ml).De-mographic and clinical variables and the use of concomitant medications were described for each group.Univariate and multivariate analysis were performed to assess the relationship between sub-optimal anticoagulation and potential predictive variables.A linear regression analysis was done to assess the rela-tionship between anti-FXa activity,age,weight,body mass index,administered dose/weight and creatinine clearance.Results The mean anti-FXa activity was 0.71±0.32 UI/ml.Thirty one percent of patients had anti-FXa levels out of the therapeutic range,most of them(28%)with a sub-therapeutic level.Among them,age>65,body mass index and creatinine clearance<40 ml/min were all related to the risk of anti-FXa level lower than 0.5 IU/ml(P<0.05).Linear regression analysis showed that anti-FXa level was significantly related to age(R^2=0.01,P=0.04),body weight(R^2=0.002,P=0.05),body mass index(R^2=0.006,P=0.05)and creatinine clearance(R^2=0.032,P=0.01).Conclusion Almost one third of patients receiving enoxaparin had anti-FXa levels out of the therapeutic range.In addition,the anti-FXa level in the patients with overweight,old age and low creatinine clearance rate suggests that the drug efficacy rate is insufficient.

关 键 词：急性冠脉综合征 依诺肝素 抗FXa水平 

分 类 号：R541.4[医药卫生—心血管疾病]