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在接受治疗剂量未分级肝素的危重症患者中,活化部分凝血活酶时间与抗 Xa 活性之间的一致性。

Agreement between activated partial thromboplastin time and anti-Xa activity in critically ill patients receiving therapeutic unfractionated heparin.

机构信息

Service of Intensive Care and Burn Unit, Lausanne University Hospital (CHUV) and Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland.

Division of Haematology and Central Haematology Laboratory, Lausanne University Hospital (CHUV) and Faculty of Biology & Medicine, University of Lausanne, Lausanne, Switzerland.

出版信息

Thromb Res. 2019 Mar;175:53-58. doi: 10.1016/j.thromres.2019.01.002. Epub 2019 Jan 7.

Abstract

BACKGROUND

No study supports the use of either aPTT or anti-Xa activity for heparin monitoring in critical care patients. There are no strong data on the agreement between aPTT and anti-Xa. The aims of this study were to: 1. Analyse the agreement between aPTT and anti-Xa in a large population of critically ill patients under unfractionated heparin therapy (UFH), 2. Identify clinical and biological factors associated to agreement or disagreement, and 3. Analyse the impact of anti-Xa availability on the use of aPTT and UFH therapy.

METHODS

Retrospective study in a 35 beds mixed-ICU population between 2006 and 2016 in a University teaching hospital.

INCLUSION CRITERIA

delivery of a UFH dose >15,000 U/24 h during at least one day with one anti-Xa determination.

DATA

demographic variables, aPTT, anti-Xa, laboratory variables, presence of extracorporeal devices (ECD). Pairs of simultaneously dosed aPTT and anti-Xa [aPTT:anti-Xa] were analysed on the basis of their agreement within the sub-therapeutic, therapeutic (aPTT 50-80″, anti-Xa 0.3-0.7 U/ml) or supra-therapeutic ranges.

RESULTS

2283 patient admissions (2085 patients) were analysed. 35,595 [aPTT:anti-Xa] pairs were found. The overall [aPTT:anti-Xa] agreement was 59.6% and lowest (54.3%) in presence of ECD compared to non-ECD patients (61.6%; p < 0.001). Sixteen demographic and biological variables were analysed and were not predictive of [aPTT:anti-Xa] agreement. No significant difference in administered UFH dose was observed after anti-Xa introduction.

CONCLUSION

In this large cohort, the [aPTT:anti-Xa] agreement is <60% and significantly lower in patients with ECD. None of the variables identified as potentially affecting the agreement were predictive. Availability of anti-Xa had neither effect on aPTT use nor on UFH-dose. These results call for a prospective study to determine the optimal UFH-therapy monitoring tool.

摘要

背景

目前尚无研究支持在重症监护患者中使用 APTT 或抗 Xa 活性来监测肝素。关于 APTT 和抗 Xa 的一致性,目前也没有强有力的数据。本研究的目的是:1. 分析在接受未分级肝素(UFH)治疗的大量危重症患者中 APTT 和抗 Xa 之间的一致性;2. 确定与一致性或不一致性相关的临床和生物学因素;3. 分析抗 Xa 可用性对 APTT 和 UFH 治疗的影响。

方法

这是一项在 2006 年至 2016 年期间在一所大学教学医院的 35 张混合 ICU 人群中进行的回顾性研究。

纳入标准

在至少一天内给予 UFH 剂量>15,000 U/24 h,并进行一次抗 Xa 测定。

数据

人口统计学变量、APTT、抗 Xa、实验室变量、是否存在体外设备(ECD)。根据亚治疗(APTT 50-80",抗 Xa 0.3-0.7 U/ml)或治疗范围(APTT 50-80",抗 Xa 0.3-0.7 U/ml)内的一致性,分析同时给药的 APTT 和抗 Xa 的配对[aPTT:anti-Xa]。

结果

分析了 2283 例患者入院(2085 例患者)。共发现 35,595 对[aPTT:anti-Xa]。总体[aPTT:anti-Xa]一致性为 59.6%,在存在 ECD 的患者中最低(54.3%),而非 ECD 患者的一致性为 61.6%(p < 0.001)。分析了 16 个人口统计学和生物学变量,但它们都不能预测[aPTT:anti-Xa]的一致性。引入抗 Xa 后,观察到给予的 UFH 剂量无显著差异。

结论

在本大样本中,[aPTT:anti-Xa]的一致性<60%,在有 ECD 的患者中明显更低。未发现有任何被认为可能影响一致性的变量具有预测性。抗 Xa 的可用性既没有影响 APTT 的使用,也没有影响 UFH 剂量。这些结果呼吁进行一项前瞻性研究,以确定最佳的 UFH 治疗监测工具。

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