MacLaren Graeme, Monagle Paul
Crit Care. 2014 Nov 21;18(6):636. doi: 10.1186/s13054-014-0636-4.
A heparin-like effect was recently described in infants, children, and adults receiving bivalirudin while supported on extracorporeal membrane oxygenation following cardiopulmonary bypass. This is most likely due to endogenous release of glycosaminoglycans from vascular endothelium and mast cells and is associated with longer duration of extracorporeal membrane oxygenation and an increased incidence of sepsis. Further investigation into this effect should include patients without recent cardiopulmonary bypass, exclude the presence of covalent antithrombin-heparin complexes, and employ a variety of different heparinases for thromboelastography. The phenomenon may partially explain the heterogeneity of anticoagulation requirements in patients on extracorporeal life support.
最近有报道称，在接受体外膜肺氧合（ECMO）支持的婴儿、儿童和成人中，在体外循环后使用比伐卢定会出现类似肝素的效应。这很可能是由于血管内皮细胞和肥大细胞内源性释放糖胺聚糖所致，并且与体外膜肺氧合时间延长和脓毒症发生率增加有关。对此效应的进一步研究应纳入近期未接受体外循环的患者，排除共价抗凝血酶-肝素复合物的存在，并在血栓弹力图检测中使用多种不同的肝素酶。该现象可能部分解释了接受体外生命支持的患者抗凝需求的异质性。
