From the Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
Division of Pediatric Surgery, Department of Surgery, NewYork-Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
ASAIO J. 2021 Jan 1;67(1):91-95. doi: 10.1097/MAT.0000000000001195.
Hemorrhagic and thrombotic complications are a significant source of morbidity and mortality for pediatric patients on extracorporeal membrane oxygenation (ECMO). Optimal anticoagulation therapies and monitoring strategies remain unknown. In 2013, our institution changed the anticoagulation monitoring protocol from activated clotting time (ACT) to antifactor Xa (anti-Xa) levels. We conducted a retrospective review of patients who received anticoagulation management directed by ACT results (n = 96) or anti-Xa levels (n = 72) between January 2010 and March 2016. Hemorrhagic complications occurred in 25% of the ACT group and 39% of the anti-Xa group (p = 0.054). Thrombotic complications were observed in 12.5% of the ACT group and 14% of the anti-Xa group (p = 0.8). There was a greater incidence of extracorporeal cardiopulmonary resuscitations (E-CPR; 36% vs. 15%; p = 0.005) in the anti-Xa group as compared with the ACT group. Secondary analysis showed no difference in transfusion requirements for red blood cells (ml/kg; p = 0.32) or platelets (ml/kg; p = 0.32). There was no difference in average heparin infusion rates (unit/kg/hr) per cannulation (p = 0.17) between the groups. Management of anticoagulation based on anti-Xa levels appears to be as effective as management based on ACT results.
出血和血栓并发症是体外膜肺氧合 (ECMO) 儿科患者发病率和死亡率的重要原因。最佳的抗凝治疗和监测策略仍不清楚。2013 年，我们机构将抗凝监测方案从激活凝血时间 (ACT) 改为抗因子 Xa (anti-Xa) 水平。我们对 2010 年 1 月至 2016 年 3 月期间接受 ACT 结果（n = 96）或 anti-Xa 水平（n = 72）指导的抗凝管理的患者进行了回顾性分析。ACT 组出血并发症发生率为 25%，anti-Xa 组为 39%（p = 0.054）。ACT 组血栓并发症发生率为 12.5%，anti-Xa 组为 14%（p = 0.8）。与 ACT 组相比，anti-Xa 组行体外心肺复苏术（E-CPR；36% vs. 15%；p = 0.005）的发生率更高。二次分析显示，两组间红细胞（ml/kg；p = 0.32）或血小板（ml/kg；p = 0.32）的输血需求无差异。两组间每根导管的肝素平均输注率（单位/kg/hr）无差异（p = 0.17）。基于 anti-Xa 水平的抗凝管理似乎与基于 ACT 结果的管理同样有效。
