Heparin trọng lượng phân tử thấp được liều trị trong suy thận: một khảo sát quốc gia

European Journal of Clinical Pharmacology - Tập 78 - Trang 1469-1479 - 2022
Tessa Corrine Catherina Jaspers1,2, A. Keyany1, B. Maat1, K. Meijer3, P. M. L. A. van den Bemt2, N. Khorsand4
1Department of Hospital Pharmacy, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
2Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
3Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
4Department of Hospital Pharmacy, OLVG, Amsterdam, The Netherlands

Tóm tắt

Các hướng dẫn quốc tế khác nhau về việc có nên giảm liều điều trị của heparin trọng lượng phân tử thấp (LMWH) trong trường hợp suy thận hay không. Việc sử dụng theo dõi anti-Xa như một cơ sở để điều chỉnh liều cũng là một vấn đề gây tranh cãi. Điều này có thể dẫn đến sự biến đổi trong chính sách điều trị, vì vậy chúng tôi đã tiến hành nghiên cứu chính sách điều trị của các LMWH được liều trị trong trường hợp suy thận tại các bệnh viện Hà Lan. Một khảo sát gồm 11 câu hỏi đã được phát đi từ tháng 6 năm 2020 đến tháng 3 năm 2021 dành cho các dược sĩ bệnh viện, đại diện cho các tổ chức bệnh viện Hà Lan. Kết quả chính là các phác đồ liều lượng của LMWH được liều trị cho bệnh nhân suy thận. Kết quả thứ cấp là tỷ lệ các bệnh viện sử dụng theo dõi anti-Xa và khoảng mục tiêu anti-Xa được sử dụng. Đã có phản hồi từ 56 trên 69 (81%) tổ chức bệnh viện Hà Lan, trong đó mỗi trường hợp có một dược sĩ bệnh viện hoàn thành khảo sát. Tại các bệnh viện này, có 77 phác đồ LMWH đang được sử dụng. Trong 76 trên 77 (99%) phác đồ, một sự giảm liều đều đặn đã được sử dụng ngay từ đầu điều trị. Năm mươi lăm bệnh viện trong số này sử dụng giảm liều nếu tốc độ lọc cầu thận ước tính (eGFR) < 50 ml/phút và 17 bệnh viện sử dụng giảm liều nếu eGFR < 30 ml/phút. Mức độ anti-Xa không được theo dõi thường xuyên ở 40% các phác đồ, trong khi 22% theo dõi anti-Xa nếu eGFR < 50 ml/phút, 27% nếu eGFR < 30 ml/phút và 10% với các giá trị cắt khác của eGFR. Các khoảng mục tiêu 1.0–2.0 IU/ml (một lần mỗi ngày) và 0.5/0.6–1.0 IU/ml (hai lần mỗi ngày) được sử dụng trong 69% các phác đồ bao gồm theo dõi anti-Xa. Các chính sách điều trị cho thấy sự đa dạng đáng kể trong các LMWH được liều trị cho bệnh nhân suy thận. Phác đồ điều trị thường được sử dụng nhất là giảm liều đều đặn nếu eGFR < 50 ml/phút, không có theo dõi anti-Xa.

Từ khóa


Tài liệu tham khảo

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