欧洲成人经皮机械循环支持过程中的抗血栓管理实践:ESC急性心血管护理协会(ACVC)和体外生命支持组织欧洲分会(EuroELSO)调查。

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal: Acute Cardiovascular Care Pub Date : 2024-06-30 DOI:10.1093/ehjacc/zuae040
Charlotte J Van Edom, Justyna Swol, Thomas Castelein, Mario Gramegna, Kurt Huber, Sergio Leonardi, Thomas Mueller, Federico Pappalardo, Susanna Price, Hannah Schaubroeck, Benedikt Schrage, Guido Tavazzi, Leen Vercaemst, Pascal Vranckx, Christophe Vandenbriele
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引用次数: 0

摘要

背景:使用静脉-动脉体外膜氧合(V-A ECMO)和/或 Impella™ 等微轴流泵接受经皮机械循环支持(pMCS)治疗的患者,出血和血栓并发症会影响治疗效果。抗血栓治疗是决定凝血病理风险的重要因素,但目前缺乏对 pMCS 期间抗血栓治疗的标准化管理。这项调查概述了欧洲对接受 pMCS 的成人进行抗血栓治疗的做法,为规范做法、为未来试验提供信息和提高疗效做出了初步努力:这项在线横断面调查由急性心血管护理协会和体外生命支持组织欧洲分会通过数字通讯和社交媒体平台发布。调查时间为 2023 年 4 月 17 日至 5 月 23 日。调查对象为欧洲参与成人体外生命支持系统护理的临床医生:我们共收到来自 26 个欧洲国家的 105 份回复。值得注意的是,72.4% 的受访者遵守了当地制定的抗凝方案,其中最主要的抗凝剂为非分数肝素 (UFH)(Impella™:97.0% 和 V-A ECMO:96.1%)。少数人(分别为 10.8% 和 14.5%)在 Impella™ 和 V-A ECMO 支持期间使用抗因子-Xa 检测与活化部分凝血活酶时间并行监测 UFH。各机构的抗凝目标各不相同。未经经皮冠状动脉介入治疗(PCI)的急性冠状动脉综合征患者中,54.0% 和 42.7% 在 Impella™ 和 V-A ECMO 支持期间接受了双重抗血小板治疗,PCI 后这一比例分别增至 93.7% 和 84.0%:结论:从参与者的回答中可以看出,抗血栓治疗方法存在很大的差异,这可能是导致不同器械相关出血和血栓并发症的原因。
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European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: a survey of the Association for Acute CardioVascular Care of the ESC and the European branch of the Extracorporeal Life Support Organization.

Aims: Bleeding and thrombotic complications compromise outcomes in patients undergoing percutaneous mechanical circulatory support (pMCS) with veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and/or microaxial flow pumps like Impella™. Antithrombotic practices are an important determinant of the coagulopathic risk, but standardization in the antithrombotic management during pMCS is lacking. This survey outlines European practices in antithrombotic management in adults on pMCS, making an initial effort to standardize practices, inform future trials, and enhance outcomes.

Methods and results: This online cross-sectional survey was distributed through digital newsletters and social media platforms by the Association of Acute Cardiovascular Care and the European branch of the Extracorporeal Life Support Organization. The survey was available from 17 April 2023 to 23 May 2023. The target population were European clinicians involved in care for adults on pMCS. We included 105 responses from 26 European countries. Notably, 72.4% of the respondents adhered to locally established anticoagulation protocols, with unfractionated heparin (UFH) being the predominant anticoagulant (Impella™: 97.0% and V-A ECMO: 96.1%). A minority of the respondents, 10.8 and 14.5%, respectively, utilized the anti-factor-Xa assay in parallel with activated partial thromboplastin time for UFH monitoring during Impella™ and V-A ECMO support. Anticoagulant targets varied across institutions. Following acute coronary syndrome without percutaneous coronary intervention (PCI), 54.0 and 42.7% were administered dual antiplatelet therapy during Impella™ and V-A ECMO support, increasing to 93.7 and 84.0% after PCI.

Conclusion: Substantial heterogeneity in antithrombotic practices emerged from participants' responses, potentially contributing to variable device-associated bleeding and thrombotic complications.

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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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