急性缺血性血栓切除术抗凝治疗的审计
Audit of anticoagulation after embolectomy for acute ischaemia.
作者信息
Robinson T, Hunter I, Wathes R, Keeling D, Hands L
机构信息
Department of Vascular Surgery, Oxford Radcliffe NHS Trust, Oxford, UK.
出版信息
Ann R Coll Surg Engl. 2009 Sep;91(6):470-2. doi: 10.1308/003588409X432329. Epub 2009 Jun 25.
INTRODUCTION
Intravenous unfractionated heparin (UFH) is routinely used in patients after arterial embolectomy. Achieving and maintaining therapeutic levels requires a co-ordinated approach which may be difficult for busy junior doctors and laboratories. There is no current evidence regarding the use of subcutaneous low molecular weight heparin (LMWH) as an alternative.
PATIENTS AND METHODS
The study retrospectively examined all patients who had undergone any form of embolectomy during 2006 and 2007 by review of their medical records, an electronic laboratory database, and the patients' drug charts.
RESULTS
Overall, 45 patients were studied. A total of 389 activated partial thromboplastin time (APTT) tests were performed of which 146 (37.6%) were in the therapeutic range (50-90 s), 40.4% were < 50 s and 22.1% were > 90 s. Five patients (11.1%) had further surgical procedures. Significant bleeding occurred in two patients.
CONCLUSIONS
The results indicate that many patients are not appropriately anticoagulated. Whilst a new UFH protocol is being developed by our hospital trust, the authors believe the use of LMWH could provide a more effective and user-friendly alternative to UFH.
引言
动脉取栓术后患者通常使用静脉普通肝素（UFH）。要达到并维持治疗水平需要一种协调的方法，而这对于忙碌的低年资医生和实验室来说可能很困难。目前尚无关于使用皮下低分子量肝素（LMWH）作为替代药物的证据。
患者与方法
本研究通过查阅病历、电子实验室数据库和患者用药记录，回顾性研究了2006年至2007年期间接受任何形式取栓术的所有患者。
结果
总共研究了45例患者。共进行了389次活化部分凝血活酶时间（APTT）检测，其中146次（37.6%）处于治疗范围（50 - 90秒），40.4%低于50秒，22.1%高于90秒。5例患者（11.1%）接受了进一步的外科手术。2例患者发生了严重出血。
结论
结果表明，许多患者未得到适当的抗凝治疗。虽然我们医院信托机构正在制定新的普通肝素方案，但作者认为使用低分子量肝素可以为普通肝素提供一种更有效且更便于使用的替代方案。
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