Predictors of Thromboembolic Events in Patients with Ventricular Assist Device.
Predictors of Thromboembolic Events in Patients with Ventricular Assist Device.
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使用心室辅助装置的患者血栓栓塞事件的预测因素。
DOI：
10.1097/mat.0000000000000284
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Limdi,NitaA
中科院分区：
文献类型：
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作者：
Boehme,AmeliaK;Pamboukian,SalpyV;George,JamesF;Dillon,Chrisly;Levitan,EmilyB;Griffin,Russell;Beasley,TMark;McGwinJr,Gerald;Kirklin,JamesK;Limdi,NitaA
脑室辅助装置患者(VAD)患血栓栓塞症的风险增加。溶血的生物标志物，如乳酸脱氢酶(LDH)和控制不佳的国际标准化比率(INR)已被确定为血栓栓塞症的预测因子。这项研究纳入了2006-2012年间接受持续血流VAD治疗的19岁及以上患者(N=115)。我们评估了不同时间点乳酸脱氢酶升高(≥600IU/L)与血栓栓塞症的关系。在51.3人年的随访中，共有23例首次血栓栓塞症事件发生。植入VAD当天LDH升高的患者发生血栓栓塞症的风险增加(危险比[HR]：4.72，95%可信区间[CI]：1.44-15.4；p=0.01)。术后1个月内早期乳酸脱氢酶升高(HR：4.95，95%CI：1.69-14.4；P=0.003)和植入前估计肾小球滤过率(HR：4.74，95%CI：1.12-20.1；P=0.0346)的患者发生血栓栓塞症的风险增加，而抗凝控制良好的患者发生血栓栓塞症的风险降低(HR：0.3，95%CI：0.1-0.86；P=0.0247)。我们的研究首次强调了植入当天LDH升高与VAD术后血栓栓塞症之间的关系。这项研究详细说明了早期LDH升高增加血栓栓塞症的风险，以及将时间维持在治疗INR范围内的重要性。
Ventricular assist device patients (VAD) are at increased risk for thromboembolism. Biomarkers of hemolysis, such as lactate dehydrogenase (LDH) and poorly controlled international normalized ratio (INR) has been identified as predictors of thromboembolism. Patients aged 19 years and older who had a continuous flow VAD placed from 2006 to 2012 were included in this study (N= 115). We assessed the relationship of LDH elevation (≥ 600 IU/L) at different time points and thromboembolism. Over the 51.3 person-years of follow-up, a total of 23 first thromboembolic events occurred. Patients with elevated LDH on the day of VAD implantation had an increased risk for thromboembolism (hazard ratio [HR]: 4.72, 95% confidence interval [CI]: 1.44–15.4; p= 0.01). There was an increased risk of thromboembolism with early LDH elevation within the first month post-VAD (HR: 4.95, 95% CI: 1.69–14.4; p= 0.003) and estimated glomerular filtration rate< 30 before VAD implantation (HR: 4.74, 95% CI: 1.12–20.1; p= 0.0346), whereas there was a decreased risk with good anticoagulation control (HR: 0.30, 95% CI: 0.10–0.86; p= 0.0247). Our study is the first to highlight the association between LDH elevation on the day of implantation and post-VAD thromboembolism. This study details the increased risk of thromboembolism with early LDH elevation and the importance of maintaining time in therapeutic INR range.