直接口服抗凝剂过渡策略使用抗Xa度在重症监护病房入院后
Mariah I Sigala1, Corey V Dinunno1, Chelsea N Lopez1
1Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA.
概括
使用XA因子抑制剂 (FXaI) 度来指导ICU中的抗凝过渡并没有减少严重出血或血栓塞栓事件. 需要进一步的研究来规范FXaI过渡策略,为重症患者.
科学领域:
- 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
- 血液学 血液学 血液学
背景情况:
- 口服XA因子抑制剂 (FXaI) 的使用越来越多,引起了对FXaI特定抗Xa度的兴趣.
- 患有末端器官功能障碍的重症患者面临来自FXaI积累的出血风险.
- 探索FXaI抗Xa度引导过渡以减轻出血风险.
研究的目的:
- 为了比较FXaI过渡策略的度指导和非度指导之间的重症监护室 (ICU) 入院的出血发生率.
- 评估FXaI度监测对重大出血和血栓塞栓事件的影响.
主要方法:
- 在ICU入院后48小时内,对433名FXaI暴露的患者进行了回顾性图表审查 (2019年1月 - 2022年5月).
- 排除标准包括入院时的出血诊断,非FXaI抗凝剂或最近的手术.
- 主要结局:在ICU入院后5天内发生严重出血;次要结局:血栓栓塞事件.
主要成果:
- 度指导 (2.7%) 和非度指导 (3.6%) 组之间主要出血率没有显著差异 (P=0.79).
- 血栓栓塞的并发症是相似的 (1.6%对2.0%,P=1.00).
- 度引导过渡涉及从最后一次FXaI剂量 (29.9小时 vs 19.4小时,P<0.01) 开始的时间较长.
结论:
- 使用FXaI度指导抗凝过渡并没有影响ICU中的重大出血或血栓栓塞并发症.
- 对于重症患者,需要标准化的抗Xa切断值和经验证的度导向策略.
- 目前的证据不支持在这个人群中常规使用FXaI度用于抗凝过渡.
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