Anthony Del Vecchio, Lam-Phong Pham, John McNeil, Karen Singh, Kenichi Tanaka, Michael Eaton, Michael Mazzeffi
{"title":"治疗性血浆置换或康瑞洛作为辅助策略促进肝素诱发血小板减少症患者心肺搭桥的疗效:系统回顾与元分析》。","authors":"Anthony Del Vecchio, Lam-Phong Pham, John McNeil, Karen Singh, Kenichi Tanaka, Michael Eaton, Michael Mazzeffi","doi":"10.1053/j.jvca.2024.09.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Conduct a systematic review and meta-analysis of the efficacy of therapeutic plasma exchange (TPE) or intravenous cangrelor to prevent thromboembolism in patients with heparin-induced thrombocytopenia (HIT) who undergo cardiopulmonary bypass (CPB) with heparin.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting: </strong>N/A.</p><p><strong>Participants: </strong>Adults having cardiac surgery with a history of HIT who received preoperative or intraoperative TPE or intravenous cangrelor as an adjunct to CPB with heparin.</p><p><strong>Interventions: </strong>None MEASUREMENTS AND MAIN RESULTS: A systematic review was performed using MEDLINE, PubMed, and Google Scholar. The primary outcome was avoidance of thromboembolism (venous or arterial) during or after CPB. Proportional meta-analysis with a random effects model was used to calculate a weighted-pooled proportion/efficacy for the study's primary outcome. Fifty-seven patients in 17 reports received TPE as an adjunctive treatment to prevent HIT-related thrombosis related to heparinization during CPB and 3 (5.3%) experienced thrombosis. Proportional meta-analysis suggested a weighted-pooled freedom from perioperative thromboembolism rate of 91.0% (95% CI 82.6%-96.9%). Fifteen patients in 6 reports received intravenous cangrelor as an adjunctive treatment to prevent HIT-related thrombosis related to heparinization during CPB and 2 (13.3%) experienced thrombosis. Proportional meta-analysis suggested a weighted-pooled freedom from perioperative thromboembolism rate of 83.0% (95% CI 61.2%- 97.6%).</p><p><strong>Conclusions: </strong>TPE and cangrelor are feasible strategies to prevent thromboembolism in adults with HIT who require CPB with heparin. Given the relatively small number of cases in the published literature and a high likelihood for publication and detection biases, prudence remains warranted when using these strategies.</p>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of Therapeutic Plasma Exchange or Cangrelor as an Adjunctive Strategy to Facilitate Cardiopulmonary Bypass in Patients with Heparin-Induced Thrombocytopenia: A Systematic Review and Meta-Analysis.\",\"authors\":\"Anthony Del Vecchio, Lam-Phong Pham, John McNeil, Karen Singh, Kenichi Tanaka, Michael Eaton, Michael Mazzeffi\",\"doi\":\"10.1053/j.jvca.2024.09.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Conduct a systematic review and meta-analysis of the efficacy of therapeutic plasma exchange (TPE) or intravenous cangrelor to prevent thromboembolism in patients with heparin-induced thrombocytopenia (HIT) who undergo cardiopulmonary bypass (CPB) with heparin.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting: </strong>N/A.</p><p><strong>Participants: </strong>Adults having cardiac surgery with a history of HIT who received preoperative or intraoperative TPE or intravenous cangrelor as an adjunct to CPB with heparin.</p><p><strong>Interventions: </strong>None MEASUREMENTS AND MAIN RESULTS: A systematic review was performed using MEDLINE, PubMed, and Google Scholar. 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引用次数: 0
摘要
目的对使用肝素进行心肺旁路(CPB)的肝素诱导血小板减少症(HIT)患者使用治疗性血浆置换(TPE)或静脉注射坎格雷罗预防血栓栓塞的疗效进行系统综述和荟萃分析:设计:系统回顾和荟萃分析:不适用:有 HIT 病史的成人心脏手术患者,术前或术中接受 TPE 或静脉注射坎格雷罗作为使用肝素进行 CPB 的辅助治疗:测量和主要结果:使用 MEDLINE、PubMed 和 Google Scholar 进行了系统性回顾。主要结果是在 CPB 期间或之后避免血栓栓塞(静脉或动脉)。采用随机效应模型进行比例荟萃分析,计算出研究主要结果的加权汇总比例/疗效。17 份报告中的 57 名患者接受了 TPE 作为辅助治疗,以预防与 CPB 期间肝素化相关的 HIT 相关血栓形成,其中 3 人(5.3%)出现了血栓形成。比例荟萃分析表明,加权汇总的围手术期血栓栓塞发生率为 91.0%(95% CI 82.6%-96.9%)。6份报告中的15名患者接受了静脉注射坎格雷罗作为辅助治疗,以预防CPB期间肝素化引起的HIT相关血栓形成,其中2人(13.3%)出现了血栓形成。比例荟萃分析表明,加权汇总的围手术期血栓栓塞发生率为 83.0% (95% CI 61.2%- 97.6%):TPE和坎格雷罗是预防需要使用肝素进行CPB的成人HIT患者血栓栓塞的可行策略。鉴于已发表文献中的病例数相对较少,且很可能存在发表和检测偏差,因此在使用这些策略时仍需谨慎。
Efficacy of Therapeutic Plasma Exchange or Cangrelor as an Adjunctive Strategy to Facilitate Cardiopulmonary Bypass in Patients with Heparin-Induced Thrombocytopenia: A Systematic Review and Meta-Analysis.
Objective: Conduct a systematic review and meta-analysis of the efficacy of therapeutic plasma exchange (TPE) or intravenous cangrelor to prevent thromboembolism in patients with heparin-induced thrombocytopenia (HIT) who undergo cardiopulmonary bypass (CPB) with heparin.
Design: Systematic review and meta-analysis.
Setting: N/A.
Participants: Adults having cardiac surgery with a history of HIT who received preoperative or intraoperative TPE or intravenous cangrelor as an adjunct to CPB with heparin.
Interventions: None MEASUREMENTS AND MAIN RESULTS: A systematic review was performed using MEDLINE, PubMed, and Google Scholar. The primary outcome was avoidance of thromboembolism (venous or arterial) during or after CPB. Proportional meta-analysis with a random effects model was used to calculate a weighted-pooled proportion/efficacy for the study's primary outcome. Fifty-seven patients in 17 reports received TPE as an adjunctive treatment to prevent HIT-related thrombosis related to heparinization during CPB and 3 (5.3%) experienced thrombosis. Proportional meta-analysis suggested a weighted-pooled freedom from perioperative thromboembolism rate of 91.0% (95% CI 82.6%-96.9%). Fifteen patients in 6 reports received intravenous cangrelor as an adjunctive treatment to prevent HIT-related thrombosis related to heparinization during CPB and 2 (13.3%) experienced thrombosis. Proportional meta-analysis suggested a weighted-pooled freedom from perioperative thromboembolism rate of 83.0% (95% CI 61.2%- 97.6%).
Conclusions: TPE and cangrelor are feasible strategies to prevent thromboembolism in adults with HIT who require CPB with heparin. Given the relatively small number of cases in the published literature and a high likelihood for publication and detection biases, prudence remains warranted when using these strategies.
期刊介绍:
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.