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接受ECMO支持的COVID-19感染患者的抗凝血策略
Dayne Diaz1, Jenny Martinez1, Grant Bushman1
1Department of Pharmacy, Mount Sinai Medical Center, Pharmacy Suite 2020, 4300 Alton Rd., Miami Beach, FL 33140, United States.
The journal of extra-corporeal technology
|September 8, 2023
概括
比瓦利鲁丁是一种可行的替代品,用于COVID-19患者的异体膜氧化 (ECMO) 的抗凝血,显示较低的血栓和出血事件. 这项研究比较了比瓦利鲁丁与UFH在需要毒性ECMO的患者中的疗效和安全性.
科学领域:
- 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.
- 心血管研究研究心血管研究
背景情况:
- 当侵入性机械通风失败时,患有缺血性呼吸衰竭的住院COVID-19患者可能需要体外膜氧化 (ECMO).
- 未分离的氨酸 (UFH) 是标准的抗凝剂,但比瓦利鲁丁可能提供更可预测的药理动力学和更好的安全性.
- 这项研究旨在比较比瓦利鲁丁与UFH在接受毒性 (VV) ECMO的患者中的疗效和安全性.
研究的目的:
- 与UFH相比,评估比瓦利鲁丁在需要VV ECMO的COVID-19患者中的疗效和安全性.
- 评估结果,如治疗抗凝剂的时间,血栓事件,出血发生率和死亡率.
主要方法:
- 一个回顾性,单中心的观察性队列研究.
- 包括COVID-19患者需要VV ECMO支持的UFH或比瓦利鲁丁抗凝药.
- 主要终点:治疗aPTT的时间,aPTT范围内的百分比时间,以及血栓事件. 二级终点:出血,ECMO断奶,死亡率和停留时间.
主要成果:
- 分析了22名患者 (10名UFH,12名比瓦利鲁丁).
- 与bivalirudin (33%) 相比,UFH (80%的氧化器血栓) 的血栓事件显著增加.
- 在UFH组,出血率 (90%与75%相比) 和死亡率 (90%与58%) 较高.
结论:
- 比瓦利鲁丁是一种可行的抗凝药替代品,用于VV ECMO的COVID-19患者.
- 比瓦利鲁丁的疗效与UFH相当,安全性更为有利.
- 随着比瓦利鲁丁的使用,观察到更低的出血和血栓事件率.
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