Renal function and thromboprophylaxis in critically ill patients 英文参考文献.docVIP

Scholey et al. Critical Care 2010,14:416 /content/14/3/416 LET TER Renal function and thromboprophylaxis in critically ill patients Gareth M Scholey, Anton G Saayman, Christopher D Hingston and Matt P Wise See related research by Robinson et al., /content/14/2/R41 Robinson and colleagues [1] recently examined the e? ec- tive dose of enoxaparin for thromboprophylaxis in co kinetics of di? erent LMWHs varies [3,4], and excessive critically ill patients recorded over 24 hours e study not tinzaparin accumulated over 8 da e pharma- anticoagulation over time might occur with a 60 mg daily concluded that the standard dose of 40 mg led to sub- dose of enoxaparin, especially if renal function is therapeutic anti-factor Xa activity (aFXa) and 60 mg daily impaired. wa e high rate of thromboembolic disease Perturbations of renal function may also explain why standard dose enoxaparin is subtherapeutic in many critically ill patients [1]. Fuster-Lluch and colleagues [5] observed in critically ill patients could thus be explained by inadequate aFXa with the standard 40 mg dose. Low molecular weight heparins (LMWHs) are renally reported that 30% of patients show augmented renal excreted and Robinson and colleagues excluded patients clearance during the ? rst week of critical illness. Typically, receiving renal replacement therapy as this may have those with supranormal creatinine clearance were post- in? uenced aFXa [1]. Douketis and colleagues [2] operative patients or had sepsis or trauma is patient group is hypercoagulable and at high risk of thrombo- documented that excessive anticoagulation did not occur with prophylactic doses of dalteparin in critically ill embolic disease; however, augmented renal clearance patients with severe renal impairment. However, in a