Unfractionated Heparin Activity Measured by Anti-Factor Xa Levels Is Associated With the Need for Extracorporeal Membrane Oxygenation Circuit/Membrane Oxygenator Change: A Retrospective Pediatric Study
Unfractionated Heparin Activity Measured by Anti-Factor Xa Levels Is Associated With the Need for Extracorporeal Membrane Oxygenation Circuit/Membrane Oxygenator Change: A Retrospective Pediatric Study
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DOI：
10.1097/pcc.0000000000000101
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发表时间：
2014-05-01
影响因子：
4.1
通讯作者：
Fiser, Richard
中科院分区：
文献类型：
--
作者：
Irby, Katherine;Swearingen, Christopher;Fiser, Richard
目的：研究抗Xa因子水平是否与儿科患者血栓形成后需要更换回路/膜式氧合器相关。设计和设置：回顾性单机构研究。患者：回顾性记录审查了2009年至2011年期间接受体外膜肺氧合支持的62例儿科患者。干预措施：收集了标准人口统计学特征、体外膜肺氧合适应症、体外膜肺氧合持续时间、活化凝血时间测量值、抗Xa因子测量值和肝素输注速率的数据。使用广义线性模型将抗Xa因子浓度与血栓形成后整个回路/膜式氧合器的更换需求相关联。测量和主要结果：62例患者符合研究入选标准。62例患者中有45例无需更换回路。在62例患者中，17例因血栓形成需要更换回路/膜式氧合器。体外膜肺氧合支持期间每日抗Xa因子测量值的多变量分析估计平均抗Xa因子浓度为0.20 IU/mL（95% CI，0.16，0.24），显著高于估计浓度0.13 IU/mL（95% CI，0.12，0.14）（p = 0.001）。抗Xa因子水平降低0.01 IU/mL，需要更换回路/膜式氧合器的几率增加5%（比值比= 1.105; 95% CI，1.00，1.10; p = 0.044）。根据观察到的抗Xa因子浓度，与非完整循环组相比，完整循环组需要更换循环/膜式氧合器的比值增加了41%（比值比= 1.41; 95% CI，1.01，1.96; p = 0.044）。平均每日活化凝血时间测量值（p = 0.192）在两组之间没有差异，但平均每日肝素输注速率（p < 0.001）在两组之间有显著差异。结论：较高的抗Xa因子浓度与儿科患者在体外膜式氧合支持期间未因血栓形成而更换回路/膜式氧合器相关。有或没有回路/膜式氧合器变化的组之间的活化凝血时间测量值没有显著差异。这是第一项将抗Xa因子浓度与体外膜肺氧合支持期间儿科患者血栓形成的临床相关指标联系起来的研究。进一步的前瞻性研究是必要的。
Objective: Investigate whether anti-Factor Xa levels are associated with the need for change of circuit/membrane oxygenator secondary to thrombus formation in pediatric patients. Design and Settings: Retrospective single institution study. Patients: Retrospective record review of 62 pediatric patients supported with extracorporeal membrane oxygenation from 2009 to 2011. Interventions: Data on standard demographic characteristics, indications for extracorporeal membrane oxygenation, duration of extracorporeal membrane oxygenation, activated clotting time measurements, anti-Factor Xa measurements, and heparin infusion rate were collected. Generalized linear models were used to associate anti-Factor Xa concentrations and need for change of either entire circuit/membrane oxygenator secondary to thrombus formation. Measurements and Main Results: Sixty-two patients met study inclusion criteria. No-circuit change was required in 45 of 62 patients. Of 62 patients, 17 required change of circuit/membrane oxygenator due to thrombus formation. Multivariate analysis of daily anti-Factor Xa measurements throughout duration of extracorporeal membrane oxygenation support estimated a mean anti-Factor Xa concentration of 0.20 IU/mL (95% CI, 0.16, 0.24) in no-complete-circuit group that was significantly higher than the estimated concentration of 0.13 IU/mL (95% CI, 0.12, 0.14) in complete-circuit group (p = 0.001). A 0.01 IU/mL decrease in anti-Factor Xa increased odds of need for circuit/membrane oxygenator change by 5% (odds ratio = 1.105; 95% CI, 1.00, 1.10; p = 0.044). Based on the observed anti-Factor Xa concentrations, complete-circuit group had 41% increased odds for requiring circuit/membrane oxygenator change compared with no-complete-circuit group (odds ratio = 1.41; 95% CI, 1.01, 1.96; p = 0.044). Mean daily activated clotting time measurement (p = 0.192) was not different between groups, but mean daily heparin infusion rate (p < 0.001) was significantly different between the two groups. Conclusions: Higher anti-Factor Xa concentrations were associated with freedom from circuit/membrane oxygenator change due to thrombus formation in pediatric patients during extracorporeal membrane oxygenation support. Activated clotting time measurements did not differ significantly between groups with or without circuit/membrane oxygenator change. This is the first study to link anti-Factor Xa concentrations with a clinically relevant measure of thrombosis in pediatric patients during extracorporeal membrane oxygenation support. Further prospective study is warranted.