在体外膜氧化支持 (ARES) 中的抗血素限制:一个多学科的方法
Jade C Lam1, Erwin H Lam1, Sai Pidathala2
1Pharmacy Department, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
Perfusion
|June 6, 2024
概括
实施抗血素 (AT) 限制方案显著降低了患者在体外膜氧化 (ECMO) 的成本,而不会增加出血或凝血风险. 这一策略优化了在重症监护机构的抗凝管理.
科学领域:
- 关键护理医学 关键护理医学
- 药物经济学 药物经济学
- 血液学 血液学 血液学
背景情况:
- 抗血素 (AT) 用于在体外膜氧化 (ECMO) 过程中治疗肝素耐药性.
- 已知AT补充剂的高成本和有限的益处,但缺乏防止过度使用的策略.
研究的目的:
- 评估AT限制协议对成年ECMO患者的成本,疗效和安全的影响.
- 为了确定限制AT使用是否会影响抗凝成本,出血或血栓塞栓事件.
主要方法:
- 追溯性研究比较AT限制协议实施前三年和之后的结果.
- 主要终点:每天ECMO的抗凝药和AT的成本.
- 二级终点:血栓栓塞和出血结果 (例如,VTE,ISTH大出血).
主要成果:
- 限制AT消除了AT的使用,并大大降低了抗凝成本,从每天ECMO1009.20美元降至42.99美元 (p < .001).
- 在新的静脉血栓栓塞 (VTE) 发生率上没有显著变化 (p = .099).
- 在限制后的组中,输血和ISTH大出血率降低 (p < .001).
结论:
- 可以成功地实施AT限制,以降低ECMO患者的抗凝成本.
- 这一策略不会损害患者在出血或血栓形成风险方面的安全.
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