八因子抑制剂绕道活动在心脏手术中的使用:对安全结果的倾向匹配分析
Joshua A Nicholas1, Natasha Harrison2, Dipro Chakraborty2
1Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
Anesthesiology
|August 26, 2024
概括
低剂量八因子抑制剂绕道活动 (FEIBA) 对于控制心脏手术出血是安全的,没有增加血栓或死亡风险. 然而,较高剂量可能导致急性损伤和输血增加.
科学领域:
- 心脏病学 心脏病学
- 血液学 血液学 血液学
- 临界护理医学 临界护理医学
背景情况:
- 在心脏手术期间耐火性出血构成了重大的临床挑战.
- 在非标签使用的第八因子抑制剂绕道活动 (FEIBA) 进行了探索,以控制这种出血.
- 现有的安全数据,特别是关于血栓栓塞事件的数据,是有限的,显示混合的结果.
研究的目的:
- 评估FEIBA在接受心脏手术的成年患者中使用FEIBA的安全性和结果.
- 评估FEIBA的使用与血栓栓塞并发症,功能衰竭和死亡率之间的关联.
- 为了比较接受FEIBA的患者和倾向匹配的对照组之间的结果.
主要方法:
- 从2018年7月到2023年6月进行心肺旁路术的成人心脏手术患者的回顾性审查.
- 倾向性得分匹配 (1:1比) 用于创建接受FEIBA和未接受FEIBA的患者的可比组 (n=352每组).
- 主要结局:术后血栓栓塞并发症的组合;次要结局:功能衰竭,重新手术,输血需要,ICU住院和30天死亡率.
主要成果:
- 在FEIBA和对照组之间,血栓栓塞结局,ICU停留时间或死亡率没有显著差异.
- 接受超过750UFEIBA的患者患急性功能衰竭的几率显著增加 (OR,4.14).
- 接受FEIBA的患者需要更多的血和冷沉积物;501-750U的剂量与红细胞和血小板输血的增加相关.
结论:
- 在心脏手术中低剂量FEIBA的使用与血栓栓塞事件,ICU停留或死亡率的增加无关.
- 更高的FEIBA剂量 (>750U) 与急性功能衰竭的增加有关.
- 需要进一步的研究来证实活性因子缩剂在心脏手术中耐火性出血的疗效.
更多相关视频
相关概念视频
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.2K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.2K
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
501
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
501
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
654
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...
654