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暂时逆转华法林与低剂量4因子原组合度在左心室辅助器件患者接受侵入性手术的患者
Byron Stevenson1, A Joshua Roberts1, William E Dager1
1Davis Medical Center, University of California, Sacramento, CA, USA.
The Annals of pharmacotherapy
|April 28, 2024
概括
四因子前激素复合缩物 (PCC4) 有效且安全地逆转左心室辅助器件 (LVAD) 用于选择性手术的患者的华法林. 这种策略在30天内没有出现不良血栓事件,支持其用于管理LVAD患者的使用.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 血液学 血液学 血液学
背景情况:
- 目前的指导方针建议华法林用于连续流动的左心室辅助装置 (LVAD) 患者,以预防血栓形成和栓塞.
- LVAD患者经常需要在手术中暂时中断抗凝剂,因此需要有效的华法林逆转策略.
- 在接受紧急手术的LVAD患者中,华法林逆转的最佳方法仍然是可变的.
研究的目的:
- 描述在LVAD患者中用于华法林逆转的4因子前素复合缩物 (PCC4) 的利用.
- 评估PCC4在接受选择性和紧急手术的患者的安全性和有效性.
主要方法:
- 需要华法林逆转的LVAD患者的回顾性,单中心队列审查.
- 对可选和紧急程序的PCC4管理的分析.
- 主要结局:PCC4.4后30天内血栓,静脉血栓栓塞和缺血性中风的复合发病率.
主要成果:
- 14名患者接受了17次PCC4治疗;中位数剂量为500单位 (6.6单位/公斤).
- 82%的管理是低流血风险程序,76%是可选程序.
- 在30天内没有观察到血栓,静脉血栓栓塞或中风的情况.
结论:
- 低剂量PCC4是LVAD患者的安全有效的临时华法林逆转策略.
- 这种方法特别适用于接受低出血风险选择性手术的患者.
- 进一步的研究可能会在LVAD患者的新兴情景中探索PCC4.
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