University of California, Davis Medical Center, Sacramento, California.
ASAIO J. 2021 Apr 1;67(4):411-415. doi: 10.1097/MAT.0000000000001246.
The preferred assay for measuring and adjusting unfractionated heparin (UFH) infusion to achieve optimal outcomes during extracorporeal membrane oxygenation (ECMO) is not well established. This retrospective cohort study explored safety and efficacy outcome differences between anti-factor Xa (anti-Xa) and activated partial thromboplastin time (aPTT) for UFH in adult venoarterial ECMO. Forty-one patients were included and analyzed. The UFH rate at first goal and time to goal were both higher in the aPTT versus anti-Xa cohort but did not achieve statistical significance (12.14 vs. 9.58 unit/kg/hour (p = 0.29), 20.22 vs. 12.05 hours (p = 0.11)). The aPTT cohort was in target goals 35.0% of the time versus 47.7% in the anti-Xa cohort (p = 0.13), above goal 41.0% vs. 17.3% (p = 0.02), and below-goal 24.0% versus 35.0% of the time (p = 0.34). Minimum heparin rates in the aPTT cohort were 6.28 vs. 3.33 unit/kg/hour in the anti-Xa cohort (p = 0.07), and the maximum UFH rate was 18.77 unit/kg/hour vs. 15.48 unit/kg/hour (p = 0.10). Our findings suggest that aPTT monitoring may result in a delay to target attainment, higher UFH rates, and overall exposure.
在体外膜肺氧合 (ECMO) 期间，为达到最佳效果而调整未分级肝素 (UFH) 输注的首选检测方法尚未得到很好的建立。本回顾性队列研究探讨了在成人静脉-动脉 ECMO 中，抗因子 Xa (anti-Xa) 和激活部分凝血活酶时间 (aPTT) 监测 UFH 的安全性和疗效结果差异。共纳入并分析了 41 例患者。在 aPTT 组与 anti-Xa 组中，达到第一个目标的 UFH 率和达到目标的时间均更高，但未达到统计学意义（12.14 与 9.58 单位/kg/小时（p = 0.29），20.22 与 12.05 小时（p = 0.11））。aPTT 组目标范围内的时间为 35.0%，anti-Xa 组为 47.7%（p = 0.13），高于目标的时间为 41.0%与 17.3%（p = 0.02），低于目标的时间为 24.0%与 35.0%（p = 0.34）。aPTT 组的最低肝素率为 6.28 单位/kg/小时，anti-Xa 组为 3.33 单位/kg/小时（p = 0.07），最大 UFH 率为 18.77 单位/kg/小时与 15.48 单位/kg/小时（p = 0.10）。我们的研究结果表明，aPTT 监测可能导致达到目标的时间延迟、更高的 UFH 率和整体暴露。
