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通过皮肤肝输液 (PHP) 后用胺硫酸逆转肝素:更少是更多吗?

Nadia Facchetti¹, Jan B Hinrichs¹, Lena S Becker¹

¹Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.

Cancer imaging : the official publication of the International Cancer Imaging Society

|July 14, 2023

概括

透皮肝输液 (PHP) 后,用蛋白胺硫酸盐逆转未分离的肝素 (UFH) 可能会增加血栓栓塞事件和血栓塞缩的风险. 在PHP期间减少或省略蛋白胺硫酸盐可能会提高患者的安全性.

科学领域:

在瘤学瘤学.
肝病学肝病学是一种肝病学.
干预性放射学干预性放射学

背景情况:

透皮肝输液 (PHP) 是一种缓解性动脉内疗法,用于无法切除的肝癌.
在PHP期间注入高剂量的梅尔法兰,需要用未分离的肝素 (UFH) 进行抗凝血,以防止过器凝血.
胺硫酸盐通常用于在术后逆转UFH的影响.

研究的目的:

评估胺硫酸盐给药对PHP后并发症发生率的影响.
分析UFH逆转策略与术后不良事件之间的关联.

主要方法:

在2014年10月至2021年4月期间,对236个 PHP 程序进行了回顾性分析.
根据UFH逆转,患者被分为三组:全蛋白质胺,减少蛋白质胺或没有蛋白质胺.
使用常用术语对不良事件的标准 (CTCAE v5.0) 评估并发症.

主要成果:

减少或不服用原氨酸的患者中没有发生血栓栓塞事件,而在全原氨酸组中为5%.
出血事件发生在13%的全质胺组中,与减少质胺组的轻微事件相比,在没有质胺组中发生了2%的小事件.
两组之间观察到干预后血小板缺血的显著差异 (39%的全质素与14-23%的其他). 在全蛋白胺组中发生了一次过敏性休克.

结论:

在PHP后给予胺硫酸盐可能与血栓栓塞事件的风险增加和显著的血栓塞缩症有关.
在低风险患者中减少或省略蛋白胺硫酸盐,而在PHP后没有活跃出血,需要严格重新评估.
应重新考虑UFH在PHP后逆转的现有做法,以潜在地提高患者的安全性.

关键词:

化学和化学和乙氨酸中和化乙氨酸中和化通过皮肤的肝输液.程序周边的安全安全.蛋白胺硫酸盐是什么蛋白胺硫酸盐是什么血栓塞栓症血栓塞栓症血栓塞栓症

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