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在心脏手术期间用于心肺旁路的比瓦利鲁丁抗凝剂
Noy Meshulami1, Raghav Murthy1,2, Maisy Meyer1
1Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Perfusion
|December 12, 2023
概括
比瓦利鲁丁在心脏外科手术中显示出作为心肺绕道 (CPB) 的安全有效的替代抗凝剂的承诺,特别是在肝素诱导的血小板缺血 (HIT) 或耐药性患者中. 建议进行进一步的研究以优化其使用.
科学领域:
- 心血管外科心血管外科
- 麻醉学 麻醉学
- 药理学 药理学是指药理学的学科.
背景情况:
- 氨酸是心肺旁路术 (CPB) 的标准抗凝剂,但诸如氨酸诱导的血小板缺血 (HIT) 和耐药性等并发症会影响4-26%的患者.
- 比瓦利鲁丁是一种替代性抗凝剂,主要用于穿皮冠状动脉干预.
研究的目的:
- 审查有关比瓦利鲁丁在心脏手术中CPB期间作为抗凝剂的有效性和安全性的现有文献.
- 探索比瓦利鲁丁作为氨酸的潜在替代品,特别是对于患有氨酸不良反应的患者.
主要方法:
- 对PubMed和Embase数据库进行了范围审查,对2010年至2023年间发表的研究进行了范围审查.
- 包括的研究包括2个随机对照试验,1个回顾性比较,3个试点研究和30个病例报告,涵盖成人和儿科人口.
主要成果:
- 有限的数据表明,比瓦利鲁丁在CPB抗凝剂中与肝素具有可比的有效性和安全性.
- 与肝素相比,比较性研究表明,在比瓦利鲁丁队列中,死亡率 (0-3% vs. 0-9%) 和重大出血/复发率 (0-6% vs. 0-27%) 较低.
- 比瓦利鲁丁在各种CPB手术中成功应用,包括心脏移植和门修复,具体的输液方案和监测策略有助于取得积极的结果.
结论:
- 比瓦利鲁丁是一种安全有效的抗凝固药物选择,对于CPB来说,特别有利于HIT或氨酸耐药性患者.
- 需要进行进一步的比较研究,以确定心脏手术期间在CPB中使用比瓦利鲁丁的最佳方案.
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