Abstract：
BACKGROUND: Patients with severe burn injuries are at risk of venous thromboembolism (VTE) and associated sequelae. Burn-injured patients may require larger doses of VTE prophylaxis so underdosing may occur with standard regimens. Monitoring anti-factor Xa (AFXa) levels may allow tailoring of dosage but is currently uncommon. The purpose of this systematic review was to methodically review the available literature with respect to AFXa in severe burn-injured patients, and thereby assess its efficacy.
METHODS: Using PRISMA guidelines, \"Xa\" and \"burns\" were used to systematically review MEDLINE (1946 - present) and EMBASE (1974 - present) databases for publications regarding the monitoring of AFXa levels for thromboprophylaxis in burn-injured patients.
RESULTS: Eight studies (432 patients) met inclusion. Peak AFXa level at initial measurement was reported in all studies and was within the range for prophylaxis in 184 of 432 cases (42.6%), below range in 246 of 432 cases (56.9%) and above range for 2/432 (0.5%). Complications were reported in 7 studies (412 patients), with a total of 30 (7.3%) complications, comprising of 16 (53.3%) VTE events and 14 (46.7%) mortalities. Three studies comprising 270 patients compared complications between patients who were within the reference range with patients who were below the range. There were 164 patients from the \'within the reference range\' groups that had a total of 6 (3.7%) complications, comprised of 4 (66.7%) VTE events and 2 (33.3%) mortalities. There were 106 patients from the \'below reference range group\' that had a total of 11 (10.4%) complications, comprised of 9 (81.8%) VTE events and 2 (18.2%) mortalities.
CONCLUSIONS: Our findings suggest standard prophylactic anticoagulation dosing risks underdosing and therefore, an increased risk in the development of VTE. AFXa monitoring allows individually tailored dose adjustment to reach therapeutic levels, which may be efficacious in reducing VTE events and is therefore recommended where possible.
METHODS: Using PRISMA guidelines, \"Xa\" and \"burns\" were used to systematically review MEDLINE (1946 - present) and EMBASE (1974 - present) databases for publications regarding the monitoring of AFXa levels for thromboprophylaxis in burn-injured patients.
RESULTS: Eight studies (432 patients) met inclusion. Peak AFXa level at initial measurement was reported in all studies and was within the range for prophylaxis in 184 of 432 cases (42.6%), below range in 246 of 432 cases (56.9%) and above range for 2/432 (0.5%). Complications were reported in 7 studies (412 patients), with a total of 30 (7.3%) complications, comprising of 16 (53.3%) VTE events and 14 (46.7%) mortalities. Three studies comprising 270 patients compared complications between patients who were within the reference range with patients who were below the range. There were 164 patients from the \'within the reference range\' groups that had a total of 6 (3.7%) complications, comprised of 4 (66.7%) VTE events and 2 (33.3%) mortalities. There were 106 patients from the \'below reference range group\' that had a total of 11 (10.4%) complications, comprised of 9 (81.8%) VTE events and 2 (18.2%) mortalities.
CONCLUSIONS: Our findings suggest standard prophylactic anticoagulation dosing risks underdosing and therefore, an increased risk in the development of VTE. AFXa monitoring allows individually tailored dose adjustment to reach therapeutic levels, which may be efficacious in reducing VTE events and is therefore recommended where possible.
摘要：
背景：严重烧伤患者存在静脉血栓栓塞（VTE）和相关后遗症的风险。烧伤患者可能需要更大剂量的VTE预防，因此标准方案可能会出现剂量不足。监测抗因子Xa（AFXa）水平可能允许调整剂量，但目前并不常见。本系统综述的目的是有条理地回顾严重烧伤患者中有关AFXa的现有文献，从而评估其功效。
方法：使用PRISMA指南，使用“Xa”和“烧伤”系统地审查了MEDLINE（1946年至今）和EMBASE（1974年至今）数据库中有关监测AFXa水平以预防烧伤患者血栓的出版物。
结果：8项研究（432名患者）符合纳入。在所有研究中都报告了初始测量时的AFXa峰值水平，并且在432例中的184例中（42.6％）处于预防范围内。低于432例病例中的246例（56.9%），高于2/432例（0.5%）。7项研究报告了并发症（412例患者），共有30例(7.3%)并发症，包括16例（53.3%）VTE事件和14例（46.7%）死亡率。包括270名患者的三项研究比较了在参考范围内的患者与低于参考范围的患者之间的并发症。在参考范围内的组共有164名患者出现6例（3.7%）并发症，包括4例（66.7％）VTE事件和2例（33.3％）死亡率。来自“低于参考范围”组的106名患者共有11名（10.4%）并发症，包括9例（81.8%）VTE事件和2例（18.2%）死亡率。
结论：我们的研究结果表明，标准预防性抗凝剂量存在剂量不足的风险，因此，VTE发展风险增加。AFXa监测允许单独定制的剂量调整，以达到治疗水平，这可能是有效地减少VTE事件，因此建议在可能的情况下。
方法：使用PRISMA指南，使用“Xa”和“烧伤”系统地审查了MEDLINE（1946年至今）和EMBASE（1974年至今）数据库中有关监测AFXa水平以预防烧伤患者血栓的出版物。
结果：8项研究（432名患者）符合纳入。在所有研究中都报告了初始测量时的AFXa峰值水平，并且在432例中的184例中（42.6％）处于预防范围内。低于432例病例中的246例（56.9%），高于2/432例（0.5%）。7项研究报告了并发症（412例患者），共有30例(7.3%)并发症，包括16例（53.3%）VTE事件和14例（46.7%）死亡率。包括270名患者的三项研究比较了在参考范围内的患者与低于参考范围的患者之间的并发症。在参考范围内的组共有164名患者出现6例（3.7%）并发症，包括4例（66.7％）VTE事件和2例（33.3％）死亡率。来自“低于参考范围”组的106名患者共有11名（10.4%）并发症，包括9例（81.8%）VTE事件和2例（18.2%）死亡率。
结论：我们的研究结果表明，标准预防性抗凝剂量存在剂量不足的风险，因此，VTE发展风险增加。AFXa监测允许单独定制的剂量调整，以达到治疗水平，这可能是有效地减少VTE事件，因此建议在可能的情况下。
