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在A型急性大动脉剖析的紧急手术中去除阿皮克萨班:一项前性队列研究

Henriette Røed-Undlien¹, Nina H Schultz^2,3, Inger M Husebråten⁴

¹Institute of Clinical Medicine, University of Oslo.

International journal of surgery (London, England)

|January 14, 2025

概括

在急救大动脉修复手术期间,手术内血吸显著降低了阿皮克萨班水平. 需要进行进一步的研究,以评估其对急性甲型大动脉剖析患者出血和死亡率的影响.

科学领域:

心血管外科心血管外科
药理学药理学是指药理学的学科.
关键护理医学关键护理医学

背景情况:

急性A型大动脉解剖 (ATAAD) 携带高死亡率,需要紧急的手术修复.
在ATAAD修复期间管理FXa抑制剂抗凝药 (例如,阿皮克萨班) 需要平衡出血风险与血栓事件.
术内血吸血是一种减轻出血的潜在策略,但其对抗凝血效应需要评估.

研究的目的:

为了研究手术内血液吸收对血阿皮克萨班度的影响,在患者接受紧急胸前大动脉修复的ATAAD.

主要方法:

一个单一中心前性队列研究,涉及八名ATAAD患者接受阿皮克萨班治疗.
使用UPLC-MS在多个时间点测量阿皮克萨班水平,在心肺绕道 (CPB) 期间和之后与血液吸收 (CytoSorb).

主要成果:

在30分钟的CPB (108至44μg/l) 后,血吸降低了59%的阿皮克萨班平均度.
在CPB断奶后观察到进一步降低至37μg/l,术后24小时水平增加至56μg/l.
住院死亡率为25%,平均24小时胸管排水量为621毫升.

结论:

在接受紧急ATAAD修复的患者中,手术内血液吸收有效降低了手术内阿皮克萨班水平.
这种减少外科手术期间出血和死亡率的临床意义需要进一步调查.
这项研究强调了在ATAAD患者使用血吸时需要量身定制的抗凝管理策略.

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