Anticoagulation Monitoring during Pediatric Extracorporeal Membrane Oxygenation
Anticoagulation Monitoring during Pediatric Extracorporeal Membrane Oxygenation
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DOI：
10.1097/mat.0b013e318279854a
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发表时间：
2013-01-01
期刊：
影响因子：
4.2
通讯作者：
Strouse, John J.
中科院分区：
文献类型：
--
作者：
Bembea, Melania M.;Schwartz, Jamie M.;Strouse, John J.
体外膜肺氧合 (ECMO) 期间监测抗凝作用的最佳方法尚不清楚。我们在三级儿科重症监护室进行了一项前瞻性观察研究。分别在 ECMO 6、12 和每 24 小时采集的血液样本中测量抗 Xa 因子、抗凝血酶 (AT) 和 VIII 因子活性 (FVIII)。我们招募了 34 名儿童，他们从 2008 年 4 月到 2010 年 9 月接受了 35 次 ECMO 运行。与婴儿/儿童相比，新生儿的活化凝血时间 (ACT) 和肝素剂量较高，而抗因子 Xa 水平较低。抗因子 Xa 中位数为 0.4 IU/ml，AT 中位数为 60%，FVIII 中位数为 67%。在 ECMO 上，肝素输注率、抗因子 Xa 和抗凝血酶 (AT) 逐日增加，FVIII 稳定，ACT 逐日下降。 ACT 与抗因子 Xa 的一致性较差 (42%)。即使在调整肝素剂量后，AT 仍与 ACT 呈负相关 (r = -0.33)，并且与抗因子 Xa 呈正相关 (r = 0.57)。这项研究强调了年龄差异以及 ECMO 期间凝血监测测定的天数变化。 ACT 与抗因子 Xa 相关性较差，而 AT 改变了 ACT 与肝素剂量之间的关系，表明在 ECMO 抗凝管理时应谨慎解释结果。需要进行更多研究来确定最佳的 ECMO 抗凝监测。 ASAIO 杂志 2013 年；59:63-68。
The best method of monitoring anticoagulation during extracorporeal membrane oxygenation (ECMO) is unknown. We conducted a prospective observational study in a tertiary pediatric intensive care unit. Antifactor Xa, antithrombin (AT), and factor VIII activity (FVIII) were measured in blood samples collected at 6, 12, and every 24 hours, respectively, of ECMO. We enrolled 34 children who underwent 35 ECMO runs from April 2008 to September 2010. Activated clotting time (ACT) and heparin doses were higher, whereas antifactor Xa levels were lower in neonates compared to infants/children. Median antifactor Xa was 0.4 IU/ml, median AT was 60%, and median FVIII was 67%. Heparin infusion rate, antifactor Xa, and antithrombin (AT) increased, FVIII was stable, and ACT decreased with each day on ECMO. ACT had poor agreement with antifactor Xa (42%). AT was inversely correlated with ACT (r = -0.33), even after adjusting for heparin dose, and positively correlated with antifactor Xa (r = 0.57). This study emphasizes the age differences as well as the variability over days of coagulation monitoring assays during ECMO. ACT is poorly correlated with antifactor Xa and AT modifies the relationship between ACT and the heparin dose, indicating that results should be interpreted with caution when managing anticoagulation on ECMO. Additional studies are warranted to determine optimal ECMO anticoagulation monitoring. ASAIO Journal 2013;59:63-68.