Thromboelastometry, Thromboelastography, and Conventional Tests to Assess Anticoagulation During Extracorporeal Support: A Prospective Observational Study
Thromboelastometry, Thromboelastography, and Conventional Tests to Assess Anticoagulation During Extracorporeal Support: A Prospective Observational Study
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DOI：
10.1097/mat.0000000000001196
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发表时间：
2021-02-01
期刊：
影响因子：
4.2
通讯作者：
Foti, Giuseppe
中科院分区：
文献类型：
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作者：
Giani, Marco;Russotto, Vincenzo;Foti, Giuseppe
体外膜肺氧合 (ECMO) 患者的最佳抗凝监测对于避免出血和血栓栓塞并发症至关重要。除了传统的凝血试验外，人们对粘弹性止血试验（VHA）的使用越来越感兴趣，特别是血栓弹力图（TEG）。在这种情况下缺乏使用旋转血栓弹力测定法 (ROTEM) 的证据。该研究的目的是通过将 ROTEM 与 TEG 和传统凝血测定进行比较，评估 ROTEM 作为 ECMO 期间止血评估的工具。我们对使用普通肝素 (UFH) 抗凝的 ECMO 支持的成年患者进行了一项前瞻性、观察性、单中心研究。分析了 TEG 的高岭土反应时间（R，分钟）和 ROTEM 的 INTEM 凝血时间（CT，秒），并与传统凝血测试进行比较。在研究期间，我们纳入了 25 名接受 ECMO 支持的患者（14 名 V-A 和 11 名 V-V）； 84 个数据点可用于分析。中位 UFH 输注率为 15 [11-18] IU/min/kg。活化部分凝血活酶时间 (aPTT) 比率、高岭土 TEG R 时间和 INTEM CT 的中位值分别为 1.44 [1.21-1.7]、22 [13-40] 分钟和 201 [183-225] 秒。 INTEM CT (ROTEM) 显示与标准凝血测试具有中等相关性（aPTT 和活化凝血时间 (ACT) 的 R-2 分别 = 0.34 和 0.3，p < 0.001）。 INTEM CT 和高岭土 R 时间之间没有发现显着相关性 (R-2 = 0.01)。需要进一步研究来确定 ECMO 期间 ROTEM 的适当抗凝目标。
Optimal anticoagulation monitoring in patients with extracorporeal membrane oxygenation (ECMO) is fundamental to avoid hemorrhagic and thromboembolic complications. Besides conventional coagulation tests, there is growing interest in the use of viscoelastic hemostatic assays (VHA), in particular of tromboelastography (TEG). Evidence on the use of rotational thromboelastometry (ROTEM) is lacking in this setting. The aim of the study was to evaluate ROTEM as a tool for assessing hemostasis during ECMO, by comparing it to TEG and conventional coagulation assays. We conducted a prospective, observational, single-center study on adult patients on ECMO support anticoagulated with unfractioned heparin (UFH). Kaolin reaction time (R, min) for TEG and INTEM clotting time (CT, sec) for ROTEM were analyzed and compared with conventional coagulation tests. In the study period, we included 25 patients on ECMO support (14 V-A and 11 V-V); 84 data points were available for the analysis. Median UFH infusion rate was 15 [11-18] IU/min/kg. Median values for activated partial thromboplastin time (aPTT) ratio, Kaolin TEG R time, and INTEM CT were 1.44 [1.21-1.7], 22 [13-40] min, and 201 [183-225] sec, respectively. INTEM CT (ROTEM) showed a moderate correlation with standard coagulation tests (R-2 = 0.34 and 0.3 for aPTT and activated clotting time (ACT), respectively, p < 0.001). No significant correlation was found between INTEM CT and Kaolin R time (R-2 = 0.01). Further studies are needed to identify an appropriate anticoagulation target for ROTEM during ECMO.