Systematic monitoring of hemostatic management in hemophilia A patients with inhibitor in the perioperative period using rotational thromboelastometry
Systematic monitoring of hemostatic management in hemophilia A patients with inhibitor in the perioperative period using rotational thromboelastometry
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DOI：
10.1111/jth.12987
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发表时间：
2015-07-01
影响因子：
10.4
通讯作者：
Shima, M.
中科院分区：
文献类型：
--
作者：
Furukawa, S.;Nogami, K.;Shima, M.
背景对旁路治疗中存在抑制物的血友病A（HA）患者的管理仍然具有挑战性。特别是，治疗的监测受到有限的可靠性和缺乏标准化的限制，目前可用的方法来评估各种止血剂的生理作用。对这些患者的准确监测在手术情况下尤其重要。最近开发的综合凝血试验，包括旋转血栓弹性测定法（ROTEM），在这些情况下可能是有用的。我们试图建立一个系统的监测协议，使用ROTEM方法和结果比较重组凝血因子VIIa（rFVIIa）和活化凝血酶原复合物（aPCC）使用三步程序（尖峰，术前和围手术期）在8例接受择期手术的HA抑制剂患者中确定，并评估个体化治疗。在用rFVIIa治疗后的每个阶段，ROTEM参数表现出与接近正常水平相似的改善。存在aPCC的结果显示尖峰数据显著改善，尽管这似乎与术前和围手术期评估中的结果不同。来自穗和术前结果的信息提供了一个有用的指导，为建立一个有效剂量的治疗材料，并促进良好的止血控制手术期间和术后在所有cases.ConclusionThe研究结果表明，这种系统的分析，使用ROTEM可以提供一个有前途的策略，在HA患者的旁路治疗与抑制剂。
BackgroundThe management of hemophilia A (HA) patients with inhibitors on bypassing therapy remains challenging. In particular, the monitoring of treatment is restricted by the limited reliability and lack of standardization of currently available methods to evaluate the physiological effects of various hemostatic agents. Accurate monitoring of these patients is particularly important in surgical situations. The recently developed comprehensive coagulation assays, including rotational thromboelastometry (ROTEM), may be useful in these circumstances.ObjectiveWe have attempted to establish a systematic monitoring protocol using ROTEM (NATEM triggered by CaCl2) to evaluate the choice and effectiveness of different bypassing agents in the perioperative period.Methods and ResultsThe hemostatic effects of recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrates (aPCC) were determined using a three-step procedure (spike, preoperative and perioperative) in eight patients with HA inhibitor admitted for elective surgery and assessed for individually tailored therapy. The ROTEM parameters demonstrated similar improvement to approximately normal levels at each stage after treatment with rFVIIa. Results in the presence of aPCC showed a marked improvement in the spike data, although this appeared to be different from those in the preoperative and perioperative assessments. The information derived from the spike and preoperative findings provided a useful guide for establishing an effective dose of therapeutic material, and facilitated good hemostatic control during and after surgery in all cases.ConclusionThe findings suggest that this systematic analysis using ROTEM could provide a promising strategy for the use of bypassing therapy in HA patients with inhibitor.