体外膜肺氧合期间使用阿加曲班治疗肝素诱导的血小板减少症的剂量调整与监测：需谨慎对待
The dosing and monitoring of argatroban for heparin-induced thrombocytopenia during extracorporeal membrane oxygenation: a word of caution.
作者信息
Phillips M R, Khoury A I, Ashton R F, Cairns B A, Charles A G
机构信息
Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
出版信息
Anaesth Intensive Care. 2014 Jan;42(1):97-8. doi: 10.1177/0310057X1404200117.
Abstract
Heparin-induced thrombocytopenia is a serious complication of heparin use. Treatment includes discontinuation of heparin and initiation of alternative anticoagulation therapy. In extracorporeal membrane oxygenation anticoagulation is mandatory, and direct thrombin inhibitors (DTIs) have been approved in these cases. However, the use and monitoring of DTIs in extracorporeal membrane oxygenation patients is not well described. DTI use is also complicated by the imprecision of available monitoring tests and currently recommended dosing has been shown to result in a supratherapeutic anticoagulative state. This case report describes the successful use of the DTI argatroban as an alternative anticoagulant in a patient with heparin-induced thrombocytopenia requiring extracorporeal membrane oxygenation support.
摘要
肝素诱导的血小板减少症是使用肝素的一种严重并发症。治疗包括停用肝素并开始替代抗凝治疗。在体外膜肺氧合中，抗凝是必需的，直接凝血酶抑制剂（DTIs）已被批准用于这些情况。然而，关于DTIs在体外膜肺氧合患者中的使用和监测尚无详细描述。DTIs的使用还因现有监测测试的不精确性而变得复杂，目前推荐的剂量已被证明会导致抗凝状态超治疗范围。本病例报告描述了在一名需要体外膜肺氧合支持的肝素诱导的血小板减少症患者中成功使用DTI阿加曲班作为替代抗凝剂的情况。
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