Camporota Luigi, Corno Eleonora, Menaldo Eleonora, Smith John, Lei Katie, Beale Richard, Wyncoll Duncan
Adult Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, 1st Floor East Wing, Lambeth Palace Road, London SE1 7EH, UK.
Crit Care. 2008;12(6):R163. doi: 10.1186/cc7163. Epub 2008 Dec 18.
Drotrecogin alfa (activated) (DrotAA) is licensed in the United States and the European Union for the treatment of severe sepsis with multiple organ failure. Patients with severe sepsis on renal replacement therapy (RRT), who typically receive additional anticoagulation to prevent circuit clotting, may be at higher risk of bleeding when DrotAA is administered in addition to standard anticoagulation. However, the effects of DrotAA on filter duration in the absence of additional anticoagulation have not been established. The aim of this study was to analyse the filter survival time (FST), and to quantify the requirement of packed red cells (PRC) and blood products during DrotAA infusion.
This was a single-centre, retrospective observational study conducted in an adult intensive care unit (ICU). Thirty-five patients with severe sepsis who had received both RRT and DrotAA were identified, and all relevant clinical and laboratory data were retrieved from the departmental electronic patient record. We compared haemofilter parameters, requirement of blood products and haemodynamic data recorded during RRT and the infusion of DrotAA with those recorded on RRT with standard anticoagulation after the DrotAA infusion had been completed (post-DrotAA).
The proportion of filter changes due to filter clotting was similar during DrotAA infusion and with conventional anticoagulation post-DrotAA infusion. There was no difference in the FST and filter parameters during DrotAA in the presence or absence of additional anticoagulation with heparin or epoprostenol. A similar proportion of patients required red cell transfusion, although a greater proportion of patients received platelet and fresh frozen plasma during DrotAA infusion compared with the post-DrotAA period with no difference between medical and surgical patients.
Additional anticoagulation during DrotAA infusion does not appear to improve FST. The use of DrotAA in patients with severe sepsis requiring RRT is safe and is not associated with an increased need for PRC transfusion or major bleeding events.
重组人活化蛋白C（Drotrecogin alfa (activated)，DrotAA）在美国和欧盟被批准用于治疗伴有多器官功能衰竭的严重脓毒症。接受肾脏替代治疗（RRT）的严重脓毒症患者通常需要额外抗凝以防止体外循环凝血，在标准抗凝基础上加用DrotAA时，出血风险可能更高。然而，在未进行额外抗凝的情况下，DrotAA对滤器使用时长的影响尚未明确。本研究旨在分析滤器存活时间（FST），并量化DrotAA输注期间浓缩红细胞（PRC）和血液制品的需求量。
这是一项在成人重症监护病房（ICU）进行的单中心回顾性观察研究。确定35例接受了RRT和DrotAA的严重脓毒症患者，并从科室电子病历中检索所有相关临床和实验室数据。我们将RRT期间和DrotAA输注期间记录的血液滤过器参数、血液制品需求量和血流动力学数据与DrotAA输注完成后（DrotAA后）采用标准抗凝进行RRT时记录的数据进行比较。
DrotAA输注期间因滤器凝血导致的滤器更换比例与DrotAA输注后采用传统抗凝时相似。在使用或不使用肝素或依前列醇进行额外抗凝的情况下，DrotAA输注期间的FST和滤器参数无差异。需要红细胞输血的患者比例相似，尽管与DrotAA后时期相比，DrotAA输注期间接受血小板和新鲜冰冻血浆的患者比例更高，内科和外科患者之间无差异。
DrotAA输注期间额外抗凝似乎并未改善FST。在需要RRT的严重脓毒症患者中使用DrotAA是安全的，且与PRC输血需求增加或大出血事件无关。
