Enoxaparin for Deep-Vein Thrombosis (DVT)

想到DVT就想到Virchow's triad,也就是 - damage to vessel wall - venous stasis - hypercoagulability 發作的部位通常是calf vein ( 腓 靜脈),偶爾有會有較近端靜脈發作的可能性,近...


想到DVT就想到Virchow's triad,也就是

- damage to vessel wall
- venous stasis
- hypercoagulability

發作的部位通常是calf vein (
靜脈),偶爾有會有較近端靜脈發作的可能性,近端發作通常與重大手術或外傷有關.

引發DVT的危險因子很多..基本上可以分為先天異常或後天失調..

先天: antithrombin deficiency, protein C or S deficiency, factor V Leiden mutation, G20210A prothrombin gene mutation

後天: major surgery or trauma, history of DVT, APS, active cancer, medical illness, elderly

藥物: oral contraceptive, HRT, tamoxifen, raloxifene

Adapted from N Engl J Med. 2004; 351: 268-77.

臨床上診斷DVT的工具很多..提供一個predict model供參考(見圖)

Adapted from JAMA. 2006; 295: 199-207.

基本上有些部分是ICU病患常見的,包括paralysis, bed-ridden與documented history of DVT..

這樣的病患基本上是需要進行DVT prophylaxis的..

Enoxaparin可以使用於預防或治療DVT,但要注意,使用於預防與治療的劑量並不同!!

預防: 40 mg SC QD
治療: 1 mg/kg SC Q12H (單日最大劑量180 mg)

另外,想到heparin或LMWH就要想到heparin-induced thrombocytopenia (HIT)阿..別說我沒說阿..

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