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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...
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在开放的AAA手术中激活凝血时间引导肝素化:试点研究.

Liliane C Roosendaal1,2,3, Max Hoebink1,2,3, Arno M Wiersema1,2,3

  • 1Department of Vascular Surgery, Dijklander Ziekenhuis, Maelsonstraat 3, 1624 NP, Hoorn, The Netherlands.

Pilot and feasibility studies
|May 9, 2024
PubMed
概括

这项试点研究表明,激活凝血时间 (ACT) 导向的肝激素化可用于在开放腹腔大动脉动脉瘤 (AAA) 手术期间预防动脉血栓栓塞并发症 (TEC). 需要进行进一步的试验,以确认这种方法是否与标准氨酸剂量相比改善了患者的治疗结果.

关键词:
激活的凝血时间动脉瘤是一个动脉瘤.肝素是一种肝素.其他非心脏动脉手术

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科学领域:

  • 血管外科 血管外科
  • 麻醉学 麻醉学
  • 心血管研究研究心血管研究

背景情况:

  • 动脉血栓栓塞并发症 (TEC) 在非心脏动脉手术 (NCAP) 期间仍然是一个重要的风险.
  • 目前用于TEC预防的未分离的肝素协议缺乏标准化剂量策略.
  • 这项研究解决了在开放腹腔大动脉动脉瘤 (AAA) 手术中优化肝化的需求.

研究的目的:

  • 评估激活凝血时间 (ACT) 引导的肝素化方案的有效性和可行性.
  • 在开放的AAA修复中,将ACT引导的肝素化与标准的5000 IU肝素玻尿酸进行比较.
  • 建立未来对肝素剂量策略的随机对照试验 (RCT) 的基础.

主要方法:

  • 一项前性的多中心试点研究包括接受选择性开放AAA修复的患者.
  • 两个组进行了比较:ACT引导的肝激素化 (100 IU/kg初始剂量) 与单个5000 IU肝激素玻尿酸.
  • 主要结局是ACT指导协议的可行性和有效性;安全结果包括出血,TEC和死亡率.

主要成果:

  • 在ACT指导方案中,所有32名患者都实现了目标ACT (>200秒).
  • 血栓栓塞并发症 (TEC) 在ACT指导组的9.4%发生,而标准组的17%.
  • 出血并发症相似 (28%对33%),两组都没有死亡率.

结论:

  • 使用100 IU/kg的ACT导向肝化是可行的,并且在开放的AAA手术中实现了足够的抗凝.
  • 该方案显示了有效管理抗凝血的潜力.
  • 需要进一步的随机研究来确认临床益处,并优化肝素剂量以改善患者的治疗结果.