在非ICU入院的急性损伤患者中进行血小板造影和传统凝血检测:观察性队列研究
Jiajia Liu1,2, Zhongyuan Liu1, Tao Zhao1,2
1Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
American journal of nephrology
|June 26, 2023
概括
患有急性损伤 (AKI) 的非ICU患者通常具有正常到增强的凝血,但在没有肝素的间歇性置换疗法 (KRT) 中面临高电路凝血. 区域酸盐抗凝药 (RCA) 显著降低了这种风险.
科学领域:
- 腎病學和重症醫療醫學 腎病學和重症醫學
- 血液学和凝血科学 血液学和凝血科学
背景情况:
- 急性损伤 (AKI) 患者不入院ICU需要间歇性置换疗法 (KRT) 可能具有复杂的凝血形状.
- 了解凝血状态对于优化KRT和预防与凝血相关的并发症至关重要,特别是当全身抗凝血是禁忌时.
研究的目的:
- 在非ICU AKI患者中调查凝血障碍,非ICU AKI患者接受间歇性KRT.
- 评估这些疾病对KRT期间与凝血相关的结果的贡献.
- 评估不同抗凝策略的有效性,特别是无肝素协议与区域酸盐抗凝药 (RCA) 的有效性.
主要方法:
- 在2018年4月至12月期间需要间歇性KRT的64名非ICU AKI患者的回顾性分析.
- 使用传统参数 (PT/INR,aPTT,纤维素) 和血栓形成显微镜 (TEG) 衍生的参数 (反应时间,K-时间,α角,MA,CI) 评估凝血.
- 在无肝素和RCA协议之间对电路凝血结果的比较,由于凝血导致的过早终止被定义为糟糕的结果.
主要成果:
- 虽然传统的测试显示了小比例的低凝血性,但TEG显示了普遍的高凝血性 (12.5%-48.4%) 和激活的血小板功能,尽管很大一部分 (37.5%) 患有血小板缺血.
- 与正常血小板计数患者相比,患有血小板衰竭的患者表现出不同的凝血概况.
- 在无肝素组 (41.5%) 的过早终结率明显高于RCA组 (8.7%) (p = 0.006). 没有氨酸的KRT是导致不良结果的最强的不良因素.
结论:
- 非ICU的AKI患者在KRT上经常呈现正常到增强的血液静止和激活的血小板功能,这与基于一些传统参数的预期相反.
- 没有氨酸的协议与高率的过早循环凝结有关,即使存在血栓细胞衰减.
- 区域酸盐抗凝剂 (RCA) 在这个患者队列中,与无氨酸的KRT相比,在电路凝血方面表现出更高的安全性.
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