Personalized Anticoagulation of Distal Deep Vein Thrombosis After Combat Gunshot Injury

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OBJECTIVE

To evaluate the efficacy and safety of individual selection of low-molecular-weight heparin (LMWH) doses for distal deep vein thrombosis (DVT) after combat gunshot injury.

MATERIAL AND METHODS

The main group included 30 men (mean age 36.9±9.8 years, body weight 77.7±8.12 kg, body mass index 23.9±3.28 kg/m²) with gunshot injuries of the lower extremities and distal DVT. In this group, we selected enoxaparin sodium dose to achieve the recommended clot growth rate (V) and target anti-Xa activity (aXa). The control group included 30 patients (mean age 35.3±9.1 years, body weight 80.9±8.41 kg, body mass index 24.7±3.76 kg/m2) who were prescribed anticoagulant therapy depending on body weight (1 mg/kg 2 times a day). We analyzed clot growth rate and anti-Xa activity at the peak (3—4 hours after administration) and end (before the next injection to assess the effectiveness) of the drug action.

RESULTS

There were no DVT recurrence, progression or bleeding in either group. Partial (9 [7; 12] days compared to 15 [11; 17] days) and complete recanalization (15 [13; 19] days compared to 24 [18; 29] days) occurred significantly earlier in the main group.

CONCLUSION

Correction of LMWH doses does not affect the incidence of recurrences and progression of distal DVT. A personalized approach is associated with earlier recanalization.

Keywords:

low molecular weight heparin

anti-Xa activity

hypocoagulation

clot growth rate

anticoagulation monitoring

wounded

combat gunshot injury

Authors:

Varavin N.A.

Kirov Military Medical Academy

ORCID: 0000-0001-9389-6018

Kryukov E.V.

Kirov Military Medical Academy

ORCID: 0000-0002-8396-1936

Salukhov V.V.

Kirov Military Medical Academy

ORCID: 0000-0003-1851-0941

Gavrilov E.K.

Kirov Military Medical Academy

ORCID: 0000-0002-6653-2320

Received:

29.09.2023

Accepted:

26.12.2023

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