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在对外围动脉疾病的干预期间,激活凝血时间引导肝素化的附加价值
Liliane C Roosendaal1,2,3, Mila Radović1, Max Hoebink1,2,3
1Department of Vascular Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands.
概括
在外围动脉疾病 (PAD) 干预期间,ACT引导的肝激素化可能会减少动脉血栓栓塞并发症 (ATEC). 与标准剂量相比,这种方法显示出较少的ATEC和类似的出血风险的趋势,这表明PAD程序的安全性有所改善.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在外围动脉疾病 (PAD) 干预期间,未分离的肝素对于预防动脉血栓栓塞并发症 (ATEC) 至关重要.
- 在PAD手术中平衡ATEC预防和出血风险的最佳肝素剂量尚不清楚.
- 激活凝血时间 (ACT) 监测提供了一种方法来个性化肝素抗凝药.
研究的目的:
- 为了在PAD干预中比较标准肝素剂量和ACT引导肝素化之间的ATEC和出血并发症的发生率.
- 调查ACT值与并发症率之间的关系.
- 在PAD干预中提供优化肝素协议的证据.
主要方法:
- 一项前性多中心队列研究 (n=355) 的回顾性分析,涉及接受PAD干预的患者.
- 第1组:标准的肝素剂量 (5000 IU). 第二组:ACT引导的肝素化 (初始100 IU/kg加可能的额外剂量).
- 收集了关于ACT值和30天术后ATEC和出血并发症的数据.
主要成果:
- 总体而言,6.8%的患者经历了ATEC,14%有出血并发症.
- 与标准剂量 (8.7%) 相比,ACT引导的肝素化 (2组) 显示出较低ATEC (5.7%) 的趋势.
- 在高峰ACT>250秒 (24%) 与200-250秒 (9.8%) 相比,观察到更高的出血并发症率. 较低的ATEC与ACT200-250秒相比,与<200秒相比,与ACT200-250秒相关.
结论:
- 在PAD干预期间减少ATEC,ACT引导的肝素化可能更安全.
- 峰值ACT值<200秒与更高的ATEC风险有关,而值>250秒增加出血风险.
- 需要进一步的大规模研究来证实PAD程序的最佳肝素化策略.
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