Activated Clotting Times Demonstrate Weak Correlation With Heparin Dosing in Adult Extracorporeal Membrane Oxygenation
Activated Clotting Times Demonstrate Weak Correlation With Heparin Dosing in Adult Extracorporeal Membrane Oxygenation
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DOI：
10.1097/mjt.0000000000001113
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发表时间：
2022-07-01
影响因子：
4.2
通讯作者：
Connors, Jean M.
中科院分区：
文献类型：
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作者：
Hohlfelder, Benjamin;Kelly, Daniel;Connors, Jean M.
背景：体外膜肺氧合（ECMO）抗凝管理的最佳监测策略仍然存在临床争议。体外生命支持组织抗凝指南建议可能需要进行多种抗凝测定，但没有指定首选的管理策略。研究问题：在成人 ECMO 患者中，哪些抗凝检测与普通肝素 (UFH) 剂量需求的相关性最高？研究设计：我们对 2013 年 2 月至 2015 年 7 月期间插管至 ECMO 的成年患者进行了回顾性图表审查。措施和结果：主要结果是活化凝血时间 (ACT)、活化部分凝血活酶时间 (aPTT) 以及抗 Xa 和 UFH 剂量之间的相关性。次要结果包括抗凝测定之间的相关性。通过对静脉动脉和静脉 ECMO 患者进行亚组分析，计算整个队列的相关性。结果：48 名患者纳入分析，其中 26 名患者最初插管至静脉动脉 ECMO，22 名患者最初插管至静脉-静脉 ECMO。 ECMO 治疗的中位持续时间为 7 天。平均 UFH 需求量为 1149 单位/小时或 15.3 单位/公斤/小时。 UFH 总剂量与抗 Xa 水平最相关 (r = 0.467)，而基于体重的肝素剂量与 aPTT 最相关 (0.405)。对于抗凝检测之间的相关性，与 ACT 相比，抗 Xa 和 aPTT 彼此之间的相关性更高 (r = 0.633)。结论：在需要 ECMO 的成年患者中，抗 Xa 抗体和 aPTT 监测与 UFH 剂量的相关性比 ACT 更密切。
Background: The optimal monitoring strategy for anticoagulation management in extracorporeal membrane oxygenation (ECMO) remains a clinical controversy. The Extracorporeal Life Support Organization Anticoagulation Guidelines suggest that multiple anticoagulation assays may be needed but do not specify a preferred management strategy. Study Question: In adult ECMO patients, which anticoagulation assays demonstrate the highest correlation with unfractionated heparin (UFH) dose requirements? Study Design: We performed a retrospective chart review of adult patients cannulated to ECMO between February 2013 and July 2015. Measures and Outcomes: The primary outcome was the correlation between activated clotting time (ACT), activated partial thromboplastin time (aPTT), and anti-Xa and UFH dose. Secondary outcomes included correlations between anticoagulation assays. Correlations were calculated for the entire cohort, with subgroup analysis of venoarterial and venovenous ECMO patients. Results: Forty-eight patients were included in the analysis, 26 initially cannulated to venoarterial ECMO and 22 to veno-venous ECMO. The median duration of ECMO therapy was 7 days. Mean UFH requirements were 1149 units/h or 15.3 units/kg/h. Total UFH dose was most correlated with anti-Xa levels (r = 0.467), whereas weight-based heparin dose was most correlated with aPTT (0.405). For correlations between anticoagulation assays, anti-Xa and aPTT were more highly correlated with each other (r = 0.633) compared with ACT. Conclusions: In adult patients requiring ECMO, anti-Xa and aPTT monitoring were correlated more closely with UFH dosing than ACT.