Oshita Jumpei, Sakamoto Shigeyuki, Matsushige Toshinori, Okazaki Takahito, Ishii Daizo, Kawano Reo, Kurisu Kaoru
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Clin Neurol Neurosurg. 2019 Sep;184:105422. doi: 10.1016/j.clineuro.2019.105422. Epub 2019 Jul 23.
The aim of this study was to investigate the relationship between the activated clotting time (ACT) and heparin loading based on body weight (BW), and factors other than BW that may contribute to the ACT after heparin loading to establish a more accurate regimen for achieving ACT targets during endovascular neurointerventions.
Japanese patients who underwent endovascular coiling of unruptured intracranial aneurysms or carotid artery stenting in our institution between January 2014 and November 2017 were enrolled. The ACT was measured before (pre-ACT) and 3 min after heparinization (post-ACT). The correlation between ACT and heparin loading based on BW and factors that may contribute to the ACT after heparin loading were analyzed retrospectively.
A total of 199 cases (109 males, age: 66 ± 12 years) were analyzed. There were positive correlations between the heparin loading per kg of BW and post-ACT, post-ACT - pre-ACT (ΔACT) (Spearman's r = 0.2946, 0.2633, P: <0.0001, 0.0002, respectively). Heparin loading per kg of BW, gender, hematocrit (Ht), estimate glomerular filtration rate (eGFR) were significant confounding factors to ΔACT. The calculated predicted ΔACT based on these significant factors was found to be highly correlated with ΔACT compared with the heparin loading per kg of BW. (Spearman's r = 0.5820, P = <0.0001).
Initial BW-based heparin loading is a simple way in endovascular neurointerventions. ACT after heparin loading based on BW has individual differences greatly, it is possible to estimate more accurately the heparin loading for acquiring the optimal ACT considering not only BW but also gender, Ht and eGFR.
本研究旨在探讨活化凝血时间（ACT）与基于体重（BW）的肝素负荷量之间的关系，以及肝素负荷后可能影响ACT的除体重之外的其他因素，以建立一种更准确的方案，在血管内神经介入治疗期间实现ACT目标。
纳入2014年1月至2017年11月在我院接受未破裂颅内动脉瘤血管内栓塞或颈动脉支架置入术的日本患者。在肝素化前（ACT前）和肝素化后3分钟（ACT后）测量ACT。回顾性分析ACT与基于体重的肝素负荷量以及肝素负荷后可能影响ACT的因素之间的相关性。
共分析199例患者（109例男性，年龄：66±12岁）。每千克体重的肝素负荷量与ACT后、ACT后-ACT前（ΔACT）呈正相关（Spearman相关系数r分别为0.2946、0.2633，P值均<0.0001、0.0002）。每千克体重的肝素负荷量、性别、血细胞比容（Ht）、估计肾小球滤过率（eGFR）是ΔACT的显著混杂因素。与每千克体重的肝素负荷量相比，基于这些显著因素计算出的预测ΔACT与ΔACT高度相关（Spearman相关系数r = 0.5820，P = <0.0001）。
在血管内神经介入治疗中，基于初始体重的肝素负荷是一种简单的方法。基于体重的肝素负荷后ACT个体差异很大，考虑到体重、性别、Ht和eGFR，有可能更准确地估计肝素负荷量以获得最佳ACT。
