活化凝血酶原复合物浓缩物在小儿心脏病患者中的应用,我们的早期经验。

IF 1.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS World Journal for Pediatric and Congenital Heart Surgery Pub Date : 2023-07-01 Epub Date: 2023-06-04 DOI:10.1177/21501351231174828
Elena Ashikhmina Swan, Nathan J Brinkman, Brian D Lahr, Michael E Nemergut, Joseph A Dearani, Elizabeth H Stephens
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引用次数: 0

摘要

背景:小儿心脏手术与凝血异常、出血和几乎无处不在的输血有关。随着患者血液管理的普及,人们正试图通过使用凝血酶原复合物浓缩物(PCCs)来减少大量输血。有关凝血酶原复合物浓缩物在成人心脏手术中的安全性和有效性的研究已经非常广泛,但有关儿童心脏手术的报道却寥寥无几。我们进行了一项观察性研究,重点关注标签外使用活化的 PCC 八因子抑制剂旁路活性(FEIBA)作为心肺旁路术(CPB)后止血方案的辅助治疗后的输血需求:我们回顾了2018年5月至2022年3月期间接受CPB心脏手术的体重≤15公斤儿童的病历。我们进行了倾向评分(PS)分析,以确定接受和未接受 FEIBA 的配对患者:在符合纳入标准的 210 名患者中,44 名患者接受了 FEIBA。基于倾向评分的分析确定了 40 对基线特征相似的配对患者。CPB 后的输血量(包括所有异体血制品和原位胺后输注的抢救性洗涤红细胞)与主要结果无统计学差异。具体来说,FEIBA 患者的输血量为 28 (22-34) mL/kg,对照组为 22 (11-49) mL/kg,P = 0.989。抵达重症监护室后,FEIBA 组患者的国际标准化比率平均比对照组低 8%(P = .009),血红蛋白平均比对照组高 1.08 g/dL(P = .050)。这两项差异在 POD 1 时仍不明显:在这项探索性研究中,我们发现尽管使用了 FEIBA,但 CPB 后的输血需求没有变化。
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Activated Prothrombin Complex Concentrate in Pediatric Cardiac Patients, Our Early Experience.

Background: Pediatric cardiac surgery is associated with abnormal coagulation, bleeding, and nearly ubiquitous transfusions. With the popularization of patient blood management, attempts are being made to decrease liberal transfusions by administering prothrombin complex concentrates (PCCs). The safety and efficacy of PCCs in adult cardiac surgery has been studied extensively, but only few reports address this in children. We performed an observational study focused on transfusion requirements after off-label use of activated PCC Factor Eight Inhibitor Bypassing Activity (FEIBA) as an adjunct to post-cardiopulmonary bypass (CPB) hemostatic protocol.

Methods: We reviewed the medical records of children ≤15 kg undergoing cardiac operations with CPB between May 2018 and March 2022. A propensity score (PS) analysis was performed to identify matched pairs of patients who did and did not receive FEIBA.

Results: Out of 210 patients who met the inclusion criteria, 44 patients received FEIBA. Propensity score-based analysis identified 40 matched pairs of patients with similar baseline characteristics. There was no statistically significant difference in the primary outcome-the volume of transfusion after CPB, which included all allogeneic blood products and salvaged washed red cells administered after protamine. Specifically, FEIBA patients were transfused 28 (22-34) mL/kg and controls were transfused 22 (11-49) mL/kg, P = .989. Upon arrival to ICU, the FEIBA group averaged an 8% lower international normalized ratio, compared with the controls (P = .009) and a 1.08 g/dL higher hemoglobin (P = .050). Neither difference remained significant on POD 1.

Conclusions: In this exploratory study, we found no change in transfusion requirements after CPB despite FEIBA administration.

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