Department of Emergency Medicine, Medical University of Vienna, Austria.
Department of Clinical Pharmacology, Medical University of Vienna, Austria.
Thromb Haemost. 2021 Apr;121(4):477-483. doi: 10.1055/s-0040-1719029. Epub 2020 Nov 13.
Coagulation abnormalities after successful resuscitation from cardiac arrest may be associated with unfavorable neurologic outcome. We investigated a potential association of activated partial thromboplastin time (aPTT) with neurologic outcome in adult cardiac arrest survivors. Therefore, we included all adults ≥18 years of age who suffered a nontraumatic cardiac arrest and had achieved return of spontaneous circulation between January 2013 and December 2018. Patients receiving anticoagulants or thrombolytic therapy and those subjected to extracorporeal membrane oxygenation support were excluded. Routine blood sampling was performed on admission as soon as a vascular access was available. The primary outcome was 30-day neurologic function, assessed by the Cerebral Performance Category scale (3-5 = unfavorable neurologic function). Multivariable regression was used to assess associations between normal (≤41 seconds) and prolonged (>41 seconds) aPTT on admission (exposure) and the primary outcome. Results are given as odds ratio (OR) with 95% confidence intervals (95% CIs). Out of 1,591 cardiac arrest patients treated between 2013 and 2018, 360 patients (32% female; median age: 60 years [interquartile range: 48-70]) were eligible for analysis. A total of 263 patients (73%) had unfavorable neurologic function at day 30. aPTT prolongation >41 seconds was associated with a 190% increase in crude OR of unfavorable neurologic function (crude OR: 2.89; 95% CI: 1.78-4.68, < 0.001) and with more than double the odds after adjustment for traditional risk factors (adjusted OR: 2.01; 95% CI: 1.13-3.60, = 0.018). In conclusion, aPTT prolongation on admission is associated with unfavorable neurologic outcome after successful resuscitation from cardiac arrest.
心脏骤停复苏成功后出现的凝血异常可能与不良神经结局相关。我们研究了激活部分凝血活酶时间（aPTT）与成年心脏骤停幸存者神经结局的潜在关联。因此，我们纳入了所有年龄≥18 岁、发生非外伤性心脏骤停并于 2013 年 1 月至 2018 年 12 月期间恢复自主循环的患者。排除接受抗凝或溶栓治疗以及接受体外膜肺氧合支持的患者。一旦获得血管通路，患者入院时即进行常规血液采样。主要结局是 30 天神经功能，采用脑功能分类量表（3-5=不良神经功能）评估。多变量回归用于评估入院时（暴露）正常（≤41 秒）和延长（>41 秒）aPTT 与主要结局之间的关联。结果以比值比（OR）及其 95%置信区间（95%CI）表示。在 2013 年至 2018 年期间接受治疗的 1591 例心脏骤停患者中，有 360 例（32%为女性；中位年龄：60 岁[四分位间距：48-70]）符合分析条件。共有 263 例（73%）患者在 30 天时神经功能不良。aPTT 延长>41 秒与不良神经功能的粗 OR 增加 190%相关（粗 OR：2.89；95%CI：1.78-4.68，<0.001），并且在调整传统危险因素后，OR 增加一倍以上（调整 OR：2.01；95%CI：1.13-3.60，=0.018）。总之，心脏骤停复苏成功后，入院时 aPTT 延长与不良神经结局相关。
