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在体外膜氧化中直接血素抑制剂的剂量可靠性:系统性审查和元分析
Patrick M Wieruszewski1,2, Hannah M Brinkman2, Jamel P Ortoleva3
1From the Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
概括
直接血栓抑制剂 (DTIs) 实现更快的治疗抗凝固作用,并使其比肝素在体外膜氧化 (ECMO) 患者中保持更长时间. 比瓦利鲁丁是一种DTI,在这个患者群体中显示出显著的益处.
科学领域:
- 心脏病学 心脏病学
- 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:
- 身体外膜氧化 (ECMO) 需要抗凝剂,肝素是标准.
- 直接血栓抑制剂 (DTIs) 建议在ECMO期间与肝素相比,提供更好的血液静止.
- 在ECMO患者中DTI疗效的基础机制尚不清楚.
研究的目的:
- 在接受ECMO的患者中,系统地比较DTI与肝素的疗效.
- 在ECMO的支持下,阐明受DTI影响的特定抗凝参数.
主要方法:
- 对数据库和注册表进行系统的文献搜索,以进行比较研究.
- 对28项已识别的研究进行随机效应元分析 (25个是比瓦利鲁丁,3个是阿格拉斯罗班).
- 亚组和敏感性分析,以评估稳定性和特定的DTI效应.
主要成果:
- 与肝素相比,DTI显著减少了实现治疗性抗凝剂的时间 (MD = -6.96小时).
- 在更多的时间 (MD = 18.6%) 中,DTI 维持了治疗性抗凝剂范围.
- 比瓦利鲁丁在成年人中显示出显著的益处;在儿科患者或阿斯巴特罗班患者中,影响并不显著.
结论:
- 与肝素相比,直接的血栓激素抑制剂,特别是比瓦利鲁丁,在ECMO期间提供了较好的抗凝血控制.
- 治疗性抗凝剂的更快的实现和更长的维持表明ECMO中DTI的潜在临床优势.
- 进一步的研究可能是有必要的,以澄清儿童ECMO和 argatroban的DTI疗效.
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