用于口服Xa抑制剂患者的紧急手术的前列红素复合缩物
Sam Schulman1, Vinai Bhagirath2, Noel Chan2
1Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Department of Obstetrics and Gynecology and Perinatal Medicine, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia.
Journal of thrombosis and haemostasis : JTH
|July 13, 2024
概括
血栓复合缩剂 (PCC) 可以有效控制口服XA抑制剂 (XaI) 接受紧急手术的患者的出血. 这项研究发现,固定的PCC剂量有助于在80%的患者中实现正常或轻度血静.
科学领域:
- 麻醉学 麻醉学
- 血液学 血液学 血液学
- 紧急医疗 紧急医疗
背景情况:
- 存在不确定性,关于前血组复合缩剂 (PCC) 在治疗需要紧急手术的口服因子Xa抑制剂 (XaI) 患者的出血的疗效.
- 口服XaI,包括阿皮克萨班和里瓦罗克萨班,越来越多地使用,这给外科手术期间的血液静止带来了挑战.
- 有效的静血策略对于接受抗凝药治疗,面临紧急外科手术的患者至关重要.
研究的目的:
- 评估手术前的PCC给药是否能防止在紧急手术期间和之后的过度出血,这些患者口服XaI的治疗水平.
- 评估PCC在该患者群体中的安全性,特别是寻找血栓性并发症发生率的增加.
主要方法:
- 一项前性队列研究,涉及20名患者口服XaI,血XaI水平≥75 ng/mL.
- 在紧急手术之前,在手术前给定2000 IU的4因子PCC剂量,预计血液损失≥50mL.
- 患者被监测了30天,主要结果是手术血液静止评估和7天内发生的血栓栓塞事件.
主要成果:
- 在20名患者中 (75%服用阿皮克萨班,25%服用里瓦罗克萨班),16名 (80%) 患者实现了正常或轻微异常的血液静止.
- 两名患者有中度异常,两名患者有严重异常血静,归因于局部或技术因素.
- 由于潜在疾病导致的死亡人数为4人 (20%),并注意到1例偶然的肺栓塞.
结论:
- 固定的4因子PCC剂量似乎是控制血液静止的有效策略,在接受紧急手术的apixaban或rivaroxaban治疗水平的患者中.
- 这些发现表明PCC可以在这种情况下安全地使用,尽管需要对更大的队列进行进一步研究.
- 这种方法可能有助于减轻在关键手术情况下与口服XAI相关的出血风险.
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