Belcher Carrigan, Kataria Vivek, Ryman Klayton M, Wang Xuan, Moon Joon Yong, Modrykamien Ariel, Mora Adan
Baylor University Medical Center, Dallas, TX, USA.
Baylor Scott & White Health, Dallas, TX, USA.
Hosp Pharm. 2022 Aug;57(4):504-509. doi: 10.1177/00185787211061383. Epub 2021 Dec 3.
To evaluate unfractionated heparin (UFH) dosing guided by antifactor Xa levels during targeted temperature management (TTM) post-cardiac arrest.
Single-center, retrospective, observational study between January 1, 2014 and September 1, 2020. Patients initiated on TTM post-cardiac arrest and UFH were evaluated for inclusion. Patients included were ≥18 years of age and received weight-based UFH for ≥6 hours with 2 antifactor Xa levels drawn at target temperature. Excluded patients had no available temperature readings, received extracorporeal membrane oxygenation (ECMO) or factor Xa inhibitor (within 72 hours), or had hypertriglyceridemia or hyperbilirubinemia. The primary endpoint was to evaluate the proportion of patients that achieved a therapeutic antifactor Xa level between 0.3 and 0.7 IU/mL at steady state during TTM. Secondary endpoints included average UFH dose and average time to therapeutic antifactor Xa level at steady state; percent of first and total antifactor Xa levels subtherapeutic, therapeutic, and supratherapeutic during TTM.
A total of 73 patients met inclusion criteria. Of these, 21 patients achieved steady-state therapeutic antifactor Xa levels during TTM. The average time and dose to steady-state therapeutic antifactor Xa levels were 8.1 ± 4.5 hours and 9.9 ± 3.2 units/kg/hour. Overall, 61.7% of first and 47.4% of all antifactor Xa levels were supratherapeutic during TTM. Three (4.1%) patients experienced a major bleeding event.
Guideline recommended UFH dosing, 12 or 18 units/kg/hour, during TTM resulted in more supratherapeutic antifactor Xa levels. Reduction of UFH infusion dose to 10 units/kg/hour may be required during TTM to maintain therapeutic antifactor Xa levels.
评估心脏骤停后目标温度管理（TTM）期间，根据抗Xa因子水平指导普通肝素（UFH）的给药情况。
2014年1月1日至2020年9月1日期间的单中心回顾性观察研究。对心脏骤停后开始TTM并使用UFH的患者进行纳入评估。纳入患者年龄≥18岁，接受基于体重的UFH治疗≥6小时，在目标温度下进行了2次抗Xa因子水平检测。排除的患者没有可用的体温读数，接受了体外膜肺氧合（ECMO）或Xa因子抑制剂（72小时内），或患有高甘油三酯血症或高胆红素血症。主要终点是评估在TTM期间达到稳态时抗Xa因子水平在0.3至0.7 IU/mL之间的患者比例。次要终点包括稳态时UFH的平均剂量和达到治疗性抗Xa因子水平的平均时间；TTM期间首次和所有抗Xa因子水平低于治疗水平、治疗水平和高于治疗水平的百分比。
共有73例患者符合纳入标准。其中，21例患者在TTM期间达到了稳态治疗性抗Xa因子水平。达到稳态治疗性抗Xa因子水平的平均时间和剂量分别为8.1±4.5小时和9.9±3.2单位/千克/小时。总体而言，在TTM期间，61.7%的首次抗Xa因子水平和47.4%的所有抗Xa因子水平高于治疗水平。3例（4.1%）患者发生了大出血事件。
在TTM期间，指南推荐的UFH给药剂量12或18单位/千克/小时导致更多高于治疗水平的抗Xa因子水平。在TTM期间可能需要将UFH输注剂量降至10单位/千克/小时，以维持治疗性抗Xa因子水平。
