Venoarterial-Extracorporeal Membrane Oxygenation Without Routine Systemic Anticoagulation Decreases Adverse Events
Venoarterial-Extracorporeal Membrane Oxygenation Without Routine Systemic Anticoagulation Decreases Adverse Events
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DOI：
10.1016/j.athoracsur.2019.08.040
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发表时间：
2020-05-01
影响因子：
4.6
通讯作者：
Prasad, Sunil
中科院分区：
文献类型：
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作者：
Wood, Katherine L.;Ayers, Brian;Prasad, Sunil
背景资料。尽管证据有限，但全身抗凝是目前接受静脉-动脉-体外膜氧合(VA-ECMO)支持的患者的标准护理。我们假设使用VA-ECMO的患者不进行抗凝治疗会减少并发症。我们回顾了在我们机构接受VA-ECMO支持的成年患者。根据抗凝策略对患者进行分层。主要结果是出血和血栓并发症的复合。次要结果包括血液制品的使用、肝素引起的血小板减少症(HIT)的发生率、住院时间和住院死亡率。从2011年5月到2018年1月，有203名符合条件的患者接受VA-ECMO支持，35%(75名患者)没有抗凝。非抗凝组的总体并发症发生率显著降低(57%比76%；P=0.007)，包括出血并发症减少(53%比63%；P=.178)，而血栓形成的风险却没有增加(13%比21%；P=.147)。抗凝组需要输注更多的压缩红细胞(12.8比1.09；P=0.002)和血小板(3.0比1.3；P=0.009)，而且HIT发生率更高(8%比0%；P=0.015)。总体死亡率无差异(72%比62%；P=.165)。接受VA-ECMO支持的患者缺乏常规的全身抗凝与较高的死亡率、泵衰竭或血栓并发症无关。患者对输血产品的要求较低，没有HIT的发生率。接受VA-ECMO支持但没有其他抗凝指征的患者，在VA-ECMO过程中可以在没有全身抗凝的情况下进行治疗。(C)2020年，由胸外科医生学会提供。
Background. Despite limited evidence, systemic anticoagulation is the current standard of care for patients supported on venoarterial-extracorporeal membrane oxygenation (VA-ECMO). We hypothesized that not anticoagulating patients on VA-ECMO would decrease complications.Methods. We retrospectively reviewed adult patients supported on VA-ECMO at our institution. Patients were stratified based on anticoagulation strategy. The primary outcome was a composite of hemorrhagic and thrombotic complications. Secondary outcomes included blood product use, incidence of heparin-induced thrombocytopenia (HIT), hospital length of stay, and in-hospital mortality.Results. From May 2011 through January 2018, there were 203 eligible patients supported on VA-ECMO, 35% (75 patients) were not anticoagulated. Overall complication rates were significantly lower for the no anticoagulation group (57% versus 76%; P = .007) including a trend toward fewer hemorrhagic complications (53% versus 63%; P = .178) without increased risk of thrombosis (13% versus 21%; P = .147). The anticoagulated group required more transfusions of packed red blood cells (12.8 versus 1.09; P = .002) and platelets (3.0 versus 1.3; P = .009) and showed a higher incidence of HIT (8% versus 0%; P = .015). No difference was found in overall mortality (72% versus 62%; P = .165).Conclusions. The absence of routine systemic anticoagulation for patients supported on VA-ECMO is not associated with higher mortality, pump failure, or thrombotic complications. Patients had a lower requirement for blood product transfusions, and there was no incidence of HIT. Patients supported on VA-ECMO without other indications for anticoagulation can be treated without systemic anticoagulation during their VA-ECMO course. (C) 2020 by The Society of Thoracic Surgeons.