Wong Trisha E, Nguyen Thuan, Shah Samir S, Brogan Thomas V, Witmer Char M
1Division of Hematology/Oncology, Departments of Pediatrics and Pathology, Oregon Health and Science University, Portland, OR.2Department of Public Health & Preventive Medicine, Biostatistics & Design Program, Oregon Health and Science University, Portland, OR.3Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.4Division of Critical Care, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA.5Division of Hematology, Department of Pediatrics, The Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Pediatr Crit Care Med. 2016 Dec;17(12):1170-1178. doi: 10.1097/PCC.0000000000000955.
To describe antithrombin concentrate use and to compare thrombotic and hemorrhagic outcomes throughout the hospital stay in pediatric subjects who received extracorporeal membrane oxygenation in a Pediatric Health Information System-participating children's hospital.
Retrospective, multi-center, cohort study.
Forty-three free-standing children's hospitals participating in Pediatric Health Information System.
Children older than or equal to 18 years of age who underwent extracorporeal membrane oxygenation between 2003 and 2012.
Subjects were classified as receiving antithrombin if they received at least one dose of antithrombin while on extracorporeal membrane oxygenation.
International Classification of Diseases, Ninth Revision, Clinical Modification codes codes were used to identify hemorrhagic and thrombotic complications during their hospitalization. Pediatric Health Information System data were analyzed to determine hospital-length of stay and in-hospital mortality. A total of 1,931 of 8,601 eligible subjects (21.5%) received at least one dose of antithrombin during their extracorporeal membrane oxygenation course. Antithrombin use during extracorporeal membrane oxygenation increased from 2.4% to 51.9% (p < 0.001) over the 10-year study period. Subjects who received antithrombin while on extracorporeal membrane oxygenation were younger (p = 0.02), had more chronic conditions (p < 0.001), and longer hospital stays (p < 0.001). On multivariate analysis, antithrombin use was associated with thrombotic events (odds ratio, 1.55; 95% CI, 1.36-1.77; p < 0.001), hemorrhagic events (odds ratio, 1.27; 95% CI, 1.14-1.42; p < 0.001), and longer hospital length of stays (slope coefficient, 1.05 d; 95% CI, 1.04-1.06; p < 0.001). No difference was observed in mortality (odds ratio, 0.99; 95% CI, 0.89-1.11; p = 0.90).
In this multicenter retrospective cohort study, subjects who received antithrombin during extracorporeal membrane oxygenation had a higher number of thrombotic and hemorrhagic events throughout the hospitalization and longer length of stays without an associated difference in mortality. While limitations exist with this analysis and results should be interpreted with caution, the fact remains that over half of pediatric patients on extracorporeal membrane oxygenation are currently receiving antithrombin without clear benefit, with extra cost, and potential harms, there needs to be strong consideration for a clinical trial.
描述抗凝血酶浓缩剂的使用情况，并比较在参与儿科健康信息系统的儿童医院接受体外膜肺氧合治疗的儿科患者住院期间的血栓形成和出血结局。
回顾性、多中心队列研究。
43家参与儿科健康信息系统的独立儿童医院。
2003年至2012年间接受体外膜肺氧合治疗的18岁及以上儿童。
如果受试者在接受体外膜肺氧合治疗期间至少接受一剂抗凝血酶，则被分类为接受抗凝血酶治疗。
使用国际疾病分类第九版临床修订本编码来识别住院期间的出血和血栓形成并发症。分析儿科健康信息系统数据以确定住院时间和院内死亡率。在8601名符合条件的受试者中，共有1931名（21.5%）在体外膜肺氧合治疗过程中至少接受一剂抗凝血酶。在10年的研究期间，体外膜肺氧合治疗期间抗凝血酶的使用从2.4%增加到51.9%（p<0.001）。在体外膜肺氧合治疗期间接受抗凝血酶的受试者更年轻（p=0.02），慢性病更多（p<0.001），住院时间更长（p<0.001）。多因素分析显示，使用抗凝血酶与血栓形成事件（比值比，1.55；95%可信区间，1.36-1.77；p<0.001）、出血事件（比值比，1.27；95%可信区间，1.14-1.42；p<0.001）和更长的住院时间（斜率系数，1.05天；95%可信区间，1.04-1.06；p<0.001）相关。死亡率无差异（比值比，0.99；95%可信区间，0.89-1.11；p=0.90）。
在这项多中心回顾性队列研究中，在体外膜肺氧合治疗期间接受抗凝血酶的受试者在住院期间发生血栓形成和出血事件的数量更多，住院时间更长，且死亡率无差异。虽然该分析存在局限性，结果应谨慎解释，但事实仍然是，超过一半接受体外膜肺氧合治疗的儿科患者目前在接受抗凝血酶治疗，却没有明显益处，还增加了成本和潜在危害，因此需要认真考虑进行一项临床试验。
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