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在更新的抗凝血方案后,在体外膜氧化支持下减少出血和血栓并发症
Michael Dorsey1, Katherine Phillips1, Les James1
1Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY.
JTCVS open
|March 10, 2025
概括
对体外膜氧化 (ECMO) 患者的修订后的肝素协议,具有较低的抗Xa因子标和PTT切断值,成功减少出血和血栓性并发症. 这种改进的抗凝血监测提高了ECMO支持期间的患者安全.
科学领域:
- 关键护理医学 关键护理医学
- 心血管外科心血管外科
- 药理学 药理学是指药理学的学科.
背景情况:
- 在体外膜氧化 (ECMO) 患者的抗凝血监测是复杂的,平衡出血和血栓形成的风险.
- 现有的肝素方案需要仔细调整,以优化患者的治疗结果.
研究的目的:
- 评估修订的肝素监测协议对ECMO患者出血和血栓性并发症的影响.
- 评估抗凝血治疗范围的坚持率和并发症率之间的相关性.
主要方法:
- 一个单一中心的回顾性研究分析了2015年1月至2022年8月的302名成年ECMO患者.
- 根据修改的肝素协议,患者被分为前修订 (2015-2018) 和后修订 (2019-2022) 组.
- 主要终点是出血/血栓并发症的发生率;Poisson回归分析了治疗范围相关性的时间.
主要成果:
- 修订后的方案 (较低的抗Xa因子目标:0.15-0.5U/mL,PTT截止值:70s) 与降低出血并发症有关,特别是手术部位出血 (5%与14%) 和肠道出血 (2%与6%).
- 在大多数类别中,血栓性并发症也减少了.
- 后修订抗Xa因子测定范围显著相关于降低出血和复合出血/血栓并发症 (P < .05).
结论:
- 一种经过修改的肝素监测方案,其特点是较低的抗Xa因子测定目标和定义的部分血栓塑时间截止,有效地减少ECMO患者的出血和血栓并发症.
- 这一修订后的协议增强了抗凝管理,并改善了ECMO支持患者的安全性.
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