Rychlíčková Jitka, Šrámek Vladimír, Suk Pavel
International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Masaryk University, St. Anne's University Hospital Brno, Brno, Czechia.
Front Med (Lausanne). 2023 Feb 23;10:1112770. doi: 10.3389/fmed.2023.1112770. eCollection 2023.
Heparin-induced thrombocytopenia is a life-threatening immune-mediated complication of unfractionated heparin therapy. Fondaparinux is a therapeutic alternative, but it has limited evidence for its use in patients on extracorporeal membrane oxygenation (ECMO). We present a series of three adult patients with COVID-19 on ECMO who were diagnosed with heparin-induced thrombocytopenia after 7-12 days of unfractionated heparin treatment and were switched to fondaparinux. Fondaparinux was initiated with an intravenous loading dose of 5 mg, followed by a dose of 2.5 mg subcutaneously every 8-12 h. Dosage was adjusted according to daily measured anti-Xa concentration with a target range of 0.4-0.7 mg/L. The total duration of treatment with fondaparinux and ECMO ranged from 13 to 26 days. One major bleeding episode unrelated to fondaparinux therapy was observed, and the transfusions requirement was also low in all patients. The ECMO circuit was changed once in each patient. This series provides a deep insight into the use of fondaparinux over an extended period of time in patients on ECMO. Based on the presented data, fondaparinux can be considered a reasonable and affordable anticoagulant in patients without a high risk of bleeding.
肝素诱导的血小板减少症是普通肝素治疗的一种危及生命的免疫介导并发症。磺达肝癸钠是一种治疗选择，但在体外膜肺氧合（ECMO）患者中使用的证据有限。我们报告了3例接受ECMO治疗的成人COVID-19患者，他们在接受普通肝素治疗7至12天后被诊断为肝素诱导的血小板减少症，并改用磺达肝癸钠。磺达肝癸钠开始静脉注射负荷剂量5mg，随后每8至12小时皮下注射2.5mg。根据每日测定的抗Xa浓度调整剂量，目标范围为0.4至0.7mg/L。磺达肝癸钠和ECMO的总治疗时间为13至26天。观察到1例与磺达肝癸钠治疗无关的严重出血事件，所有患者的输血需求也较低。每位患者的ECMO回路均更换了一次。本系列深入探讨了磺达肝癸钠在接受ECMO治疗的患者中长期使用的情况。根据所提供的数据，对于没有高出血风险的患者，磺达肝癸钠可被视为一种合理且经济实惠的抗凝剂。
