静脉体外膜氧合过程中持续抗凝与间断抗凝的血栓栓塞并发症:一项多中心研究。

Q4 Medicine Critical care explorations Pub Date : 2024-09-25 eCollection Date: 2024-10-01 DOI:10.1097/CCE.0000000000001155
William Miller, Jacob Braaten, Anna Rauzi, Jillian Wothe, Kristiana Sather, Angela Phillips, Danika Evans, Ramiro Saavedra-Romero, Matthew Prekker, Melissa E Brunsvold
{"title":"静脉体外膜氧合过程中持续抗凝与间断抗凝的血栓栓塞并发症:一项多中心研究。","authors":"William Miller, Jacob Braaten, Anna Rauzi, Jillian Wothe, Kristiana Sather, Angela Phillips, Danika Evans, Ramiro Saavedra-Romero, Matthew Prekker, Melissa E Brunsvold","doi":"10.1097/CCE.0000000000001155","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Continuous, therapeutic anticoagulation is the standard of care for patients on extracorporeal membrane oxygenation (ECMO). The risks of hemorrhage exacerbated by anticoagulation must be weighed with the thrombotic risks associated with ECMO. We hypothesized increased thrombotic events in patients who had interrupted (vs. continuous) anticoagulation during venovenous ECMO.</p><p><strong>Design: </strong>This is a retrospective, observational study.</p><p><strong>Setting: </strong>Enrollment of individuals took place at three adult ECMO centers in Minnesota from 2013 to 2022.</p><p><strong>Patients: </strong>This study consists of 346 patients supported with venovenous ECMO.</p><p><strong>Interventions: </strong>Anticoagulation administration was collected from electronic health records, including frequency and duration of anticoagulation interruptions (IAs) and timing and type of thrombotic events, and data were analyzed using descriptive statistics.</p><p><strong>Measurements and main results: </strong>A total of 156 patients had IA during their ECMO run and 190 had continuous anticoagulation. Risk adjusted logistic regression demonstrated that individuals in the IA group were not statistically more likely to experience a thrombotic complication (odds ratio [OR], 0.69; 95% CI, 0.27-1.70) or require ECMO circuit change (OR, 1.36; 95% CI, 0.52-3.49). Subgroup analysis demonstrated greater frequency of overall thrombotic events with increasing frequency and duration of anticoagulation being interrupted (p = 0.001).</p><p><strong>Conclusions: </strong>Our multicenter analysis found a similar frequency of thrombotic events in patients on ECMO when anticoagulation was interrupted vs. administered continuously. Further investigation into the impact of the frequency and duration of these interruptions is warranted.</p>","PeriodicalId":93957,"journal":{"name":"Critical care explorations","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427029/pdf/","citationCount":"0","resultStr":"{\"title\":\"Thromboembolic Complications in Continuous Versus Interrupted Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Study.\",\"authors\":\"William Miller, Jacob Braaten, Anna Rauzi, Jillian Wothe, Kristiana Sather, Angela Phillips, Danika Evans, Ramiro Saavedra-Romero, Matthew Prekker, Melissa E Brunsvold\",\"doi\":\"10.1097/CCE.0000000000001155\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Continuous, therapeutic anticoagulation is the standard of care for patients on extracorporeal membrane oxygenation (ECMO). The risks of hemorrhage exacerbated by anticoagulation must be weighed with the thrombotic risks associated with ECMO. We hypothesized increased thrombotic events in patients who had interrupted (vs. continuous) anticoagulation during venovenous ECMO.</p><p><strong>Design: </strong>This is a retrospective, observational study.</p><p><strong>Setting: </strong>Enrollment of individuals took place at three adult ECMO centers in Minnesota from 2013 to 2022.</p><p><strong>Patients: </strong>This study consists of 346 patients supported with venovenous ECMO.</p><p><strong>Interventions: </strong>Anticoagulation administration was collected from electronic health records, including frequency and duration of anticoagulation interruptions (IAs) and timing and type of thrombotic events, and data were analyzed using descriptive statistics.</p><p><strong>Measurements and main results: </strong>A total of 156 patients had IA during their ECMO run and 190 had continuous anticoagulation. Risk adjusted logistic regression demonstrated that individuals in the IA group were not statistically more likely to experience a thrombotic complication (odds ratio [OR], 0.69; 95% CI, 0.27-1.70) or require ECMO circuit change (OR, 1.36; 95% CI, 0.52-3.49). Subgroup analysis demonstrated greater frequency of overall thrombotic events with increasing frequency and duration of anticoagulation being interrupted (p = 0.001).</p><p><strong>Conclusions: </strong>Our multicenter analysis found a similar frequency of thrombotic events in patients on ECMO when anticoagulation was interrupted vs. administered continuously. Further investigation into the impact of the frequency and duration of these interruptions is warranted.</p>\",\"PeriodicalId\":93957,\"journal\":{\"name\":\"Critical care explorations\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-09-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427029/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical care explorations\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/CCE.0000000000001155\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical care explorations","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/CCE.0000000000001155","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

摘要

目的:持续治疗性抗凝是体外膜氧合(ECMO)患者的标准护理方法。必须权衡抗凝加重出血的风险和与 ECMO 相关的血栓风险。我们假设在静脉 ECMO 期间间断(与持续)抗凝的患者血栓事件会增加:这是一项回顾性观察研究:2013年至2022年期间,明尼苏达州的三家成人ECMO中心招募了患者:本研究包括 346 名接受静脉 ECMO 支持的患者:从电子健康记录中收集抗凝管理,包括抗凝中断(IAs)的频率和持续时间以及血栓事件的时间和类型,并使用描述性统计对数据进行分析:共有 156 名患者在 ECMO 运行期间发生过 IA,190 名患者进行了持续抗凝治疗。风险调整后的逻辑回归显示,IA 组患者发生血栓并发症(几率比 [OR],0.69;95% CI,0.27-1.70)或需要更换 ECMO 电路(OR,1.36;95% CI,0.52-3.49)的可能性并不高。亚组分析表明,随着抗凝治疗中断频率和持续时间的增加,血栓事件的发生频率也会增加(P = 0.001):我们的多中心分析发现,ECMO 患者中断抗凝与持续抗凝发生血栓事件的频率相似。我们有必要进一步研究这些中断的频率和持续时间的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Thromboembolic Complications in Continuous Versus Interrupted Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Study.

Objectives: Continuous, therapeutic anticoagulation is the standard of care for patients on extracorporeal membrane oxygenation (ECMO). The risks of hemorrhage exacerbated by anticoagulation must be weighed with the thrombotic risks associated with ECMO. We hypothesized increased thrombotic events in patients who had interrupted (vs. continuous) anticoagulation during venovenous ECMO.

Design: This is a retrospective, observational study.

Setting: Enrollment of individuals took place at three adult ECMO centers in Minnesota from 2013 to 2022.

Patients: This study consists of 346 patients supported with venovenous ECMO.

Interventions: Anticoagulation administration was collected from electronic health records, including frequency and duration of anticoagulation interruptions (IAs) and timing and type of thrombotic events, and data were analyzed using descriptive statistics.

Measurements and main results: A total of 156 patients had IA during their ECMO run and 190 had continuous anticoagulation. Risk adjusted logistic regression demonstrated that individuals in the IA group were not statistically more likely to experience a thrombotic complication (odds ratio [OR], 0.69; 95% CI, 0.27-1.70) or require ECMO circuit change (OR, 1.36; 95% CI, 0.52-3.49). Subgroup analysis demonstrated greater frequency of overall thrombotic events with increasing frequency and duration of anticoagulation being interrupted (p = 0.001).

Conclusions: Our multicenter analysis found a similar frequency of thrombotic events in patients on ECMO when anticoagulation was interrupted vs. administered continuously. Further investigation into the impact of the frequency and duration of these interruptions is warranted.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
5.70
自引率
0.00%
发文量
0
审稿时长
8 weeks
期刊最新文献
Septic Shock Requiring Three Vasopressors: Patient Demographics and Outcomes. Risk Factors for Increased Opioid Use During Postoperative Intensive Care. Travel Distances for Interhospital Transfers of Critically Ill Children: A Geospatial Analysis. Mindfulness Exercises Reduce Acute Physiologic Stress Among Female Clinicians. A Continuous and Noninvasive Method to Estimate Pao2/Fio2 Ratio.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1