Changes in coagulation parameters in polytrauma patients with different body mass index according to the enoxaparin-sodium dosing strategy under conventional versus restrictive fluid therapy regimens
Background. Coagulopathy associated with fluid resuscitation and disseminated intravascular coagulation constitutes a devastating complication of polytrauma, leading to the development of multiple organ dysfunction syndrome. Purpose – to conduct a comparative study of the effects of intravenous f...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
V. N. Karazin Kharkiv National University
2025-04-01
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| Series: | Journal of V. N. Karazin Kharkiv National University: Series Medicine |
| Subjects: | |
| Online Access: | https://ukrmedsci.com/index.php/visnyk/article/view/183 |
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| Summary: | Background. Coagulopathy associated with fluid resuscitation and disseminated intravascular coagulation constitutes a devastating complication of polytrauma, leading to the development of multiple organ dysfunction syndrome.
Purpose – to conduct a comparative study of the effects of intravenous fluid therapy and prophylactic low-molecular-weight heparin therapy in polytrauma patients with varying body mass indices, depending on the method of calculating infusion volume and anticoagulant dosage.
Materials and Methods. A total of 201 patients with polytrauma and closed abdominal injury were enrolled and allocated to six groups. All groups received enoxaparinsodium and infusion therapy according to different protocols. Treatment regimens were selected on the basis of actual body weight, adjusted body weight, or ideal body weight. Coagulation parameters were measured on admission to the operating room, 24 hours after surgery, and on postoperative days 3, 5, 7, and 10.
Results. Our study showed that a fixed fluid infusion of 30 mL/kg based on actual body weight, combined with a «universal» enoxaparin-sodium dose of 40 mg twice daily, produced a moderate yet statistically significant prolongation of prothrombin time (PT) and activated partial thromboplastin time (aPTT) from day 3 to day 10 after injury in polytrauma patients with class I obesity. Switching to adjusted body weight for low-molecular-weight heparin dosing and administering fluids at 40 mL/kg of ideal body weight corrected these coagulation deviations. Reducing the infusion volume to 40 mL/kg of ideal body weight in our sixth group likely lessened hemodilution and normalised PT and aPTT.
Conclusions. The administration of enoxaparin sodium, dosed based on adjusted body weight, in conjunction with a restrictive infusion volume of 40 mL/kg IBW, effectively prevents dilutional coagulopathy and maintains coagulation balance in polytrauma patients with a BMI ≥ 25 kg/m². |
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| ISSN: | 2313-6693 2313-2396 |