对抗凝血考虑在体外膜氧化支持中的审查
Sydney D T Graboyes1, Phillip S Owen2, Rickey A Evans3
1Department of Pharmacy, University of California, Davis Medical Center, Sacramento, California, USA.
Pharmacotherapy
|July 31, 2023
概括
在体外膜氧化 (ECMO) 期间管理抗凝血仍然具有挑战性,尽管使用越来越多,但国际共识有限. 本综述审查了VA或VVECMO的成年患者目前的抗凝策略.
科学领域:
- 关键护理医学 关键护理医学
- 心血管外科心血管外科
- 血液学 血液学 血液学
背景情况:
- 自1975年以来,体外膜氧化 (ECMO) 的使用急剧增加,特别是在2000年代初以来的成年人中,用于肺和心肺旁路术.
- 尽管静脉动脉 (VA) 和静脉静脉 (VV) ECMO在国际上得到广泛应用,但与血液相容性相关的重大不良事件仍然存在.
- 目前的抗凝管理依赖于体外生命支持组织 (ELSO) 的指导,最后一次更新于2022年,但国际共识仍然有限.
研究的目的:
- 提供对目前对接受VV或VA ECMO的成年患者抗凝管理的理解的全面审查.
- 综合现有证据,以告知临床实践,并解决缺乏关于ECMO抗凝药的国际共识的问题.
主要方法:
- 在多个电子数据库中进行了全面的文献搜索.
- 确定了专注于对VV或VAECMO成年患者抗凝药的研究.
- 优先考虑的是前性,随机化,受控研究,并补充了观察性研究,追溯性不受控制的研究和病例系列/报告.
主要成果:
- 该综述综合了各种研究设计中关于ECMO中抗凝策略的研究结果.
- 确定了管理抗凝血药物的关键挑战和考虑因素,以减轻与血红相容性相关的不良事件.
- 强调目前需要对最佳抗凝血方案进行改进的指导方针和共识.
结论:
- 有效的抗凝管理对于患者的安全和ECMO治疗期间的最佳结果至关重要.
- 需要进一步的研究,特别是高质量的前性研究,以建立关于ECMO抗凝药的最终国际共识.
- 本综述是临床医生管理成年ECMO患者抗凝药的宝贵资源.
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