Preventing thrombosis in a COVID-19 patient by combined therapy with nafamostat and heparin during extracorporeal membrane oxygenation.
Preventing thrombosis in a COVID-19 patient by combined therapy with nafamostat and heparin during extracorporeal membrane oxygenation.
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DOI：
10.1002/ams2.585
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发表时间：
2020-01
影响因子：
1.6
通讯作者：
Fujitani S
中科院分区：
文献类型：
--
作者：
Doi S;Akashi YJ;Takita M;Yoshida H;Morikawa D;Ishibashi Y;Higuma T;Fujitani S
本报告描述了一例COVID-19患者在体外膜肺氧合（ECMO）支持期间接受萘莫司他和肝素治疗，以预防回路血栓形成。联合应用萘莫司他和肝素可预防ECMO中的回路血栓形成。 在冠状病毒病（COVID-19）病例中，体外膜氧合（ECMO）中预防血栓形成可以挽救生命;然而，回路血栓形成是一种并发症。本报告描述了1例COVID-19患者在ECMO支持期间接受萘莫司他和肝素治疗以预防回路血栓形成。一名63岁的男性因COVID-19肺炎导致呼吸衰竭被转移到我院。为他提供静脉-静脉ECMO以维持氧合。在ECMO支持期间，尽管使用肝素进行了全身抗凝治疗，仍发生了闭塞性回路血栓形成。随后给予萘莫司他和肝素联合治疗。尽管联合治疗可以预防回路血栓形成，但由于高钾血症和血胸而改为肝素单药治疗。在气管切开术和氧合逐渐改善后，停止ECMO。他被转到另一家医院接受进一步康复治疗。萘莫司他和肝素联合治疗可预防ECMO期间的回路血栓形成。然而，在ECMO期间，这种联合治疗仍可能发生出血。
This report describes a COVID‐19 patient treated with nafamostat and heparin to prevent circuit thrombosis during extracorporeal membrane oxygenation (ECMO) support. Combination with nafamostat and heparin might prevent circuit thrombosis in ECMO. Preventing thrombosis in extracorporeal membrane oxygenation (ECMO) can be life‐saving in cases of coronavirus disease (COVID‐19); however, circuit thrombosis is a complication. This report describes a COVID‐19 patient treated with nafamostat and heparin to prevent circuit thrombosis during ECMO support. A 63‐year‐old man was transferred to our hospital with respiratory failure due to COVID‐19 pneumonia. He was provided venous‐venous ECMO to maintain oxygenation. During ECMO support, occlusive circuit thrombosis developed despite systemic anticoagulation therapy with heparin. He was subsequently given combination therapy with nafamostat and heparin. Although the combination therapy could prevent circuit thrombosis, it was converted to heparin monotherapy because of hyperkalemia and hemothorax. After tracheostomy and a gradual improvement in oxygenation, ECMO was discontinued. He was transferred to another hospital for further rehabilitation. Combination therapy with nafamostat and heparin can prevent circuit thrombosis during ECMO. However, bleeding can still develop with this combination therapy during ECMO.
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