Filter clotting with continuous renal replacement therapy in COVID-19.
Filter clotting with continuous renal replacement therapy in COVID-19.
复制标题
DOI：
10.1007/s11239-020-02301-6
复制
发表时间：
2021-05
影响因子：
4
通讯作者：
Allegretti AS
中科院分区：
文献类型：
--
作者：
Endres P;Rosovsky R;Zhao S;Krinsky S;Percy S;Kamal O;Roberts RJ;Lopez N;Sise ME;Steele DJR;Lundquist AL;Rhee EP;Hibbert KA;Hardin CC;Mc Causland FR;Czarnecki PG;Mutter W;Tolkoff-Rubin N;Allegretti AS
冠状病毒病2019 （COVID-19）似乎与动脉和静脉血栓栓塞性疾病的增加有关。在持续肾替代治疗（CRRT）期间，这些推测的止血异常与滤过性凝血有关。我们的目的是表征COVID-19感染中CRRT过滤器凝血的负担，并描述一种使用抗Xa因子水平进行全身肝素给药的CRRT抗凝方案。连续接受CRRT的COVID-19患者的多中心研究主要结局为CRRT滤光片损失。65例患者进行了分析，其中17例使用抗Xa因子方案来指导全身肝素剂量。65名患者中有54名（83%）至少丢失了一个滤镜。第一过滤器的中位生存时间为6.5[2.5,33.5]小时。anti-Xa方案和标准护理抗凝组的第一过滤器和第二次过滤器损失没有差异，但方案组中丢失第三过滤器的患者较少（55%对93%），导致第三过滤器的中位生存时间更长（24[15.1,54.2]对17.3[9.5,35.1]小时，p = 0.04）。在COVID-19感染中，CRRT过滤器的损失率很高。在这一人群中，使用系统性未分级肝素，按抗Xa因子水平给药的抗凝方案是合理的抗凝方法。本文的在线版本（10.1007/s11239-020-02301-6）包含补充资料，仅供授权用户使用。
Coronavirus disease 2019 (COVID-19) appears to be associated with increased arterial and venous thromboembolic disease. These presumed abnormalities in hemostasis have been associated with filter clotting during continuous renal replacement therapy (CRRT). We aimed to characterize the burden of CRRT filter clotting in COVID-19 infection and to describe a CRRT anticoagulation protocol that used anti-factor Xa levels for systemic heparin dosing. Multi-center study of consecutive patients with COVID-19 receiving CRRT. Primary outcome was CRRT filter loss. Sixty-five patients were analyzed, including 17 using an anti-factor Xa protocol to guide systemic heparin dosing. Fifty-four out of 65 patients (83%) lost at least one filter. Median first filter survival time was 6.5 [2.5, 33.5] h. There was no difference in first or second filter loss between the anti-Xa protocol and standard of care anticoagulation groups, however fewer patients lost their third filter in the protocolized group (55% vs. 93%) resulting in a longer median third filter survival time (24 [15.1, 54.2] vs. 17.3 [9.5, 35.1] h, p = 0.04). The rate of CRRT filter loss is high in COVID-19 infection. An anticoagulation protocol using systemic unfractionated heparin, dosed by anti-factor Xa levels is reasonable approach to anticoagulation in this population. The online version of this article (10.1007/s11239-020-02301-6) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
168.9
作者：
Huang, Chaolin;Wang, Yeming;Cao, Bin
通讯作者：
Cao, Bin
影响因子：
38.9
作者：
Uchino, S;Fealy, N;Bellomo, R
通讯作者：
Bellomo, R
影响因子：
4.2
作者：
Zhang, Zhongheng;Ni, Hongying;Lu, Baolong
通讯作者：
Lu, Baolong
影响因子：
5
作者：
Lippi, Giuseppe;Plebani, Mario;Henry, Brandon Michael
通讯作者：
Henry, Brandon Michael
影响因子：
7.5
作者：
Klok, F. A.;Kruip, M. J. H. A.;Endeman, H.
通讯作者：
Endeman, H.