Single-center experience of extracorporeal membrane oxygenation mainly anticoagulated with nafamostat mesilate
Single-center experience of extracorporeal membrane oxygenation mainly anticoagulated with nafamostat mesilate
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DOI：
10.21037/jtd.2019.06.30
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发表时间：
2019-07-01
影响因子：
2.5
通讯作者：
Kang, Min-Woong
中科院分区：
文献类型：
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作者：
Han, Woosik;Bok, Jin San;Kang, Min-Woong
背景：出血仍然是体外膜肺氧合（ECMO）的主要问题。最近，几项研究提出甲磺酸萘莫司他（NM）作为肝素的替代抗凝剂，因为减少出血并发症和可比的血栓栓塞发作。本研究的目的是评估ECMO抗凝主要与NM.Methods的临床结局：这是一个回顾性观察病例系列的患者谁是放置在ECMO 2011年1月至2017年12月在忠南国立大学医院。主要结果是出血和血栓栓塞epission.Results：在研究期间，共91 ECMO运行87例患者被确定。有54次静脉-静脉运行和37次静脉-动脉运行。87例患者中，47例（54.0%）患者成功脱机，29例（33.3%）存活出院。大多数运行使用NM（n=68，74.7%）抗凝，其次是肝素（n=22，24.2%）和阿加曲班（n=1，1.1%）。ECMO支持的平均持续时间为11.3 ± 11.1天。出血的总体发生率为46.2%（n=42）; 26次运行使用NM抗凝（26/68，38.2%），16次使用肝素抗凝（16/22，72.7%）（P=0.005）。血栓栓塞事件的总体发生率为12.1%（n=11）。在NM组中，需要任何类型干预的高钾血症发生率为17.6%（n=12）。结论：在这项单中心研究中，NM似乎与ECMO期间较少的出血并发症相关，而不会增加血栓栓塞事件的发生率。
Background: Bleeding remains the chief concern during extracorporeal membrane oxygenation (ECMO). Recently, several studies proposed nafamostat mesilate (NM) as an alternative anticoagulant to heparin due to reduced bleeding complications and comparable thromboembolic episodes. The aim of this study was to evaluate the clinical outcomes of ECMO anticoagulated mainly with NM.Methods: This was a retrospective observational case series of patients who were placed on ECMO between January 2011 and December 2017 at Chungnam National University Hospital. The main outcomes were bleeding and thromboembolic episodes.Results: During the study period, a total of 91 ECMO runs on 87 patients were identified. There were 54 veno-venous runs and 37 veno-arterial runs. Among the 87 patients, 47 (54.0%) patients were successfully weaned and 29 (33.3%) survived to discharge. Most of the runs were anticoagulated with NM (n=68, 74.7%), followed by heparin (n=22, 24.2%) and argatroban (n=1, 1.1%). The mean duration of ECMO support was 11.3 +/- 11.1 days. The overall incidence of bleeding was 46.2% (n=42); 26 runs were anticoagulated with NM (26/68, 38.2%) and 16 with heparin (16/22, 72.7%) (P=0.005). The overall incidence of thromboembolic episodes was 12.1% (n=11). In the NM group, the incidence of hyperkalemia requiring any type of intervention was 17.6% (n=12).Conclusions: In this single center study, NM appears to be associated with fewer bleeding complications during ECMO without increasing the incidence of thromboembolic episodes.