Rali Aniket S, Salem Ahmed M, Gebre Melat, Garies Taylor M, Taduru Siva, Bracey Arthur W
Division of Cardiovascular Medicine, Vanderbilt University Medical Centre Nashville, Tennessee, US.
Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine Houston, Texas, US.
Card Fail Rev. 2021 Feb 19;7:e01. doi: 10.15420/cfr.2020.22. eCollection 2020 Mar.
The initiation and management of anticoagulation is a fundamental practice for a wide variety of indications in cardiovascular critical care, including the management of patients with acute MI, stroke prevention in patients with AF or mechanical valves, as well as the prevention of device thrombosis and thromboembolic events with the use of mechanical circulatory support and ventricular assist devices. The frequent use of antiplatelet and anticoagulation therapy, in addition to the presence of concomitant conditions that may lead to a propensity to bleed, such as renal and liver dysfunction, present unique challenges. The use of viscoelastic haemostatic assays provides an additional tool allowing clinicians to strike a delicate balance of attaining adequate anticoagulation while minimising the risk of bleeding complications. In this review, the authors discuss the role that viscoelastic haemostatic assay plays in cardiac populations (including cardiac surgery, heart transplantation, extracorporeal membrane oxygenation, acute coronary syndrome and left ventricular assist devices), and identify areas in need of further study.
抗凝治疗的启动与管理是心血管危重症多种适应证的基本实践，包括急性心肌梗死患者的管理、房颤或机械瓣膜患者的卒中预防，以及使用机械循环支持和心室辅助装置时预防装置血栓形成和血栓栓塞事件。除了存在可能导致出血倾向的合并症（如肾和肝功能不全）外，抗血小板和抗凝治疗的频繁使用也带来了独特的挑战。黏弹性止血检测的应用提供了一种额外的工具，使临床医生能够在实现充分抗凝的同时，微妙地平衡并尽量降低出血并发症的风险。在本综述中，作者讨论了黏弹性止血检测在心脏人群（包括心脏手术、心脏移植、体外膜肺氧合、急性冠脉综合征和左心室辅助装置）中所起的作用，并确定了需要进一步研究的领域。
