基于抗xa测定的肝素给药方案在儿科体外膜氧合患者中的应用效果评价。

IF 1.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS World Journal for Pediatric and Congenital Heart Surgery Pub Date : 2023-11-01 Epub Date: 2023-09-01 DOI:10.1177/21501351231178761
Abdulrazaq S Al-Jazairi, Eman M Shorog, Tarek M Owaidah, Hani Al Dalaty, Yasser A Alheriash, Rayd A Almehizia, Mamdouh D Alahmadi
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引用次数: 0

摘要

背景:体外膜肺氧合(ECMO)在术后心脏重症监护环境中的应用正在发展。抗凝监测是儿科最具挑战性的方面之一。然而,在这种情况下,普通肝素的最佳给药和监测尚未达成共识。为了解决这一问题,我们根据ECMO使用的最佳临床和轶事证据,开发了一种基于抗Xa测定的方案,并评估了其在实现抗Xa检测治疗目标方面的有效性。方法:这项前瞻性单臂研究在一家大型三级医院的儿科心脏外科重症监护室进行。根据患者的出血情况,我们使用了两种不同的抗Xa检测强度水平。结果:患者年龄中位数为7个月(四分位间距[IQR]:5-11.25),体重中位数为5.7(IQR:3.8-13.82)kg。ECMO持续时间中位数为6(IQR:4.5-7.5)天。大多数患者采用出血方案。在研究期间,70%的患者达到了抗Xa检测的治疗目标(中位数:75.5 h、 IQR:60.5-117.5 h) 。40%的患者出现出血并发症,25%的患者出现血栓并发症。中位住院时间为37天(IQR:22-43),从存活到出院率为75%。此外,使用两种不同的抗Xa检测水平可以减少血栓并发症。
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Performance Assessment of Anti-Xa Assay-Based Heparin Dosing Protocol in Pediatric Patients on Extracorporeal Membrane Oxygenation.

Background: The use of extracorporeal membrane oxygenation (ECMO) in the postoperative cardiac critical care setting is evolving. Anticoagulation monitoring is among the most challenging aspects of pediatrics. However, there is no consensus on the optimal dosing and monitoring of unfractionated heparin in this setting. To address this, we developed an anti-Xa assay-based protocol derived from the best available clinical and anecdotal evidence of ECMO use and assessed its effectiveness in achieving the anti-Xa assay therapeutic target.

Methods: This prospective single-arm study was conducted in the pediatric carcardiac-surgery intensive care unit of a large tertiary hospital. We used two different anti-Xa assay intensity levels based on the patients' bleeding status.

Results: The median patient age was 7 (interquartile range [IQR]: 5-11.25) months, and the median weight was 5.7 (IQR: 3.8-13.82) kg. The median ECMO duration was 6 (IQR: 4.5-7.5) days. The bleeding protocol was used for most patients. Seventy percent achieved the anti-Xa assay therapeutic target during the study period (median: 75.5 h, IQR: 60.5-117.5 h). Hemorrhagic complications were reported in 40% of the patients, and thrombotic complications were reported in 25%. The median length of stay was 37 (IQR: 22-43) days, with a survival-to-discharge rate of 75%.

Conclusions: Despite a failure to achieve the anti-Xa assay target within the first ECMO days, most patients achieved the target by the median ECMO duration. Moreover, using two different anti-Xa assay levels reduced thrombotic complications.

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