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DOI：
10.1097/01.ccm.0000550888.78881.20
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发表时间：
2019
影响因子：
8.8
通讯作者：
Justin N. Tawil
中科院分区：
文献类型：
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作者：
T. Pang;Lisa Baumann Kruetziger;Joel T. Feih;N. Gaglianello;Bethanne Held Godgluck;David Joyce;Janelle J Juul;Joseph R. G. Rinka;Justin N. Tawil
方法：这项单中心回顾性队列分析评估了 2012 年至 2018 年入住重症监护室的 VAD 植入后接受肝素抗凝治疗的患者。主要结局是根据 INTERMACS 标准定义的大出血频率，或通过活化部分凝血活酶时间 (aPTT) 或抗 Xa 水平监测的患者血栓形成。使用 Pearson 相关性确定输注速率与测量的肝素参数之间的关系，并进行逻辑回归以确定与主要结局相关的危险因素。 结果：共有 53 名 VAD 后患者符合纳入条件；因信息不完整而排除8名患者，最终分析剩余45名患者。使用 aPTT 监测的患者 (n= 17) 与抗 Xa (n= 28) 水平相比，在大出血事件（41% vs. 50%，p= 0.57）、需要再次手术的大出血（12% vs. 21%，p= 0.69）和需要输血的大出血（47% vs. 43%，p= 0.78）方面没有统计学上的显着差异。输注速率和 aPTT 的 Pearson 相关系数 (r) 为 0.28，抗 Xa 药物的 Pearson 相关系数 (r) 为 0.33。 Logistic 回归表明，大出血与溶血有直接关系（OR 24.2；95% CI 1.94-302，p= 0.002），与血小板计数呈负相关，但不显着（OR 0.98；95% CI 0.96-1.00，p= 0.01）。两组均未发生血栓事件。结论：所使用的肝素监测参数之间大出血事件的发生率没有显着差异。溶血与大出血密切相关，而血小板可能具有保护作用。弱相关系数表明 aPTT 和抗 Xa 水平在评估抗凝状态时都不准确，应考虑个体化治疗目标。
Methods: This single-center, retrospective cohort analysis evaluated patients admitted to the intensive care unit post-VAD implantation being treated with heparin anticoagulation from 2012 to 2018. The primary outcome was the frequency of major bleeding, defined with INTERMACS criteria, or thrombosis in patients monitored by either activated partial thromboplastin time (aPTT) or anti-Xa levels. Pearson correlation was used to determine the relationship between infusion rate and measured heparin parameters, and logistic regression was performed to identify risk factors associated with the primary outcome.Results: A total of 53 post-VAD patients were eligible for inclusion; 8 patients were excluded for incomplete information, leaving 45 in the final analysis. There were no statistically significant differences between patients who were monitored using aPTT (n= 17) compared to anti-Xa (n= 28) levels in major bleeding events (41% vs. 50%, p= 0.57), major bleeding requiring reoperation (12% vs. 21%, p= 0.69), and major bleeding requiring transfusion (47% vs. 43%, p= 0.78). Pearson correlation coefficient (r) for infusion rate and aPTT was 0.28, and 0.33 for anti-Xa. Logistic regression demonstrated that major bleeding had a direct association with hemolysis (OR 24.2; 95% CI 1.94–302, p= 0.002) and an inverse, but nonsignificant, relationship with platelet count (OR 0.98; 95% CI 0.96–1.00, p= 0.01). No thrombotic events occurred in either group.Conclusions: No significant difference in the occurrence of major bleeding events was found between heparin monitoring parameters used. Hemolysis was strongly associated with major bleeding, while platelets may be protective. Weak correlation coefficients suggest that both aPTT and anti-Xa levels were inaccurate in assessing anticoagulation status and individualized therapeutic targets should be considered.