是时候切换到比瓦利鲁丁用于ECMO抗凝药吗?
Amir Navaei1,2, Vadim Kostousov2, Jun Teruya1,2,3
1Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States.
Frontiers in medicine
|September 6, 2023
概括
在体外膜氧化 (ECMO) 过程中,未分离的氨酸和比瓦利鲁丁显示出类似的出血和血栓形成率. 一些研究表明,比瓦利鲁丁可以减少ECMO患者的严重出血和输血.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 未分离的氨酸一直是体外膜氧化 (ECMO) 的标准抗凝剂.
- 比瓦利鲁丁是一种直接的血栓抑制剂,越来越多地被用作ECMO中的替代抗凝剂.
- 在ECMO中缺乏出血和血栓形成的标准化定义,这使直接比较变得复杂.
研究的目的:
- 在ECMO中系统地审查和比较肝素与比瓦利鲁丁作为抗凝剂的疗效和安全性.
- 在ECMO中总结了比较研究,元分析和关于肝素和双鲁丁的综述文章的发现.
- 为ECMO患者提供关于抗凝剂选择和监测的指导.
主要方法:
- 在遵守PRISMA指南的基础上进行系统审查.
- 包括16个比较研究和8个元分析/评论文章.
- 从2011年1月到2023年5月的文献搜索,重点是ECMO中肝素和双鲁丁的直接比较.
主要成果:
- 总的来说,对于ECMO来说,肝素和双立鲁丁之间的出血或血栓形成率没有统计学上显著的差异.
- 一些研究表明,比瓦利鲁丁在减少严重出血和血栓形成方面具有统计上的优势.
- 在某些研究中,使用比瓦利鲁丁与减少对输血的需求有关.
结论:
- 氨酸和比瓦利鲁丁在ECMO期间表现出可比的抗凝血剂的安全性和有效性.
- 在特定的ECMO病例中,比瓦利鲁丁可能有助于减少严重出血和输血需求.
- 精心选择和监测抗凝剂对于最佳ECMO管理至关重要.
相关概念视频
Venous Thrombosis III: Interprofessional Care
10
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
10
Anticoagulant Drugs: Low-Molecular-Weight Heparins
749
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
749
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.2K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.2K
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
10
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
10


