Department of Anesthesiology and Intensive Care Medicine, University Hospital, Tübingen, Germany.
Medical Faculty of Tuebingen, Institute for Clinical and Experimental Transfusion Medicine, Tübingen, Germany.
Eur J Clin Invest. 2023 Jun;53(6):e13963. doi: 10.1111/eci.13963. Epub 2023 Feb 14.
In severe acute respiratory distress syndrome (ARDS), venovenous extracorporeal membrane oxygenation (vvECMO) can be a lifesaver. However, anticoagulation therapy is mandatory because the nonendothelial extracorporeal surface increases the risk of thromboembolic problems. Heparin is still the most common anticoagulant, but argatroban could be an alternative. This work investigates whether argatroban offers a therapeutic advantage over heparin during vvECMO.
We performed a retrospective cohort study of patients who underwent vvECMO for severe ARDS and received heparin or argatroban as anticoagulation therapy. Demographic variables, intensive care unit (ICU) treatment and outcome parameters were evaluated. The primary outcome parameter was the operating time of the membrane oxygenator normalized to the duration of vvECMO treatment. Secondary outcome parameters were transfusion requirements normalized to the duration of vvECMO therapy.
Fifty seven patients from January 2019 to February 2021 underwent vvECMO and were included in this study. Thirty three patients received heparin and 24 patients argatroban as anticoagulatory therapy. The groups did not differ in demographics, ICU scoring systems, or comorbidities. Platelet counts and partial prothrombin time did not differ between the two groups during the first 6 days of vvECMO. The argatroban group had lower requirements for red blood cells, platelets and fresh frozen plasma. The mean runtime of the individual membrane oxygenator increased from 12.3 days (heparin group) to 16.6 days in the argatroban group.
Our findings suggest that argatroban can be considered as anticoagulant during vvECMO.
在严重急性呼吸窘迫综合征（ARDS）中，静脉-静脉体外膜肺氧合（vvECMO）可以救命。然而，抗凝治疗是强制性的，因为非内皮细胞的体外表面增加了血栓栓塞问题的风险。肝素仍然是最常用的抗凝剂，但阿加曲班可能是一种替代方法。这项工作研究了在 vvECMO 期间，阿加曲班是否比肝素具有治疗优势。
我们对因严重 ARDS 接受 vvECMO 并接受肝素或阿加曲班作为抗凝治疗的患者进行了回顾性队列研究。评估了人口统计学变量、重症监护病房（ICU）治疗和预后参数。主要预后参数是膜氧合器的运行时间与 vvECMO 治疗时间的归一化。次要预后参数是输注需求与 vvECMO 治疗时间的归一化。
2019 年 1 月至 2021 年 2 月期间，57 名患者接受 vvECMO 治疗并纳入本研究。33 名患者接受肝素治疗，24 名患者接受阿加曲班抗凝治疗。两组在人口统计学、ICU 评分系统或合并症方面没有差异。在 vvECMO 的前 6 天，两组的血小板计数和部分凝血酶原时间没有差异。阿加曲班组的红细胞、血小板和新鲜冷冻血浆的需求较低。单个膜氧合器的平均运行时间从肝素组的 12.3 天增加到阿加曲班组的 16.6 天。
我们的研究结果表明，阿加曲班可以在 vvECMO 期间被考虑作为抗凝剂。
