接受体外膜肺氧合的患者狼疮抗凝物的流行率和影响。
Prevalence and Impact of Lupus Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation.
机构信息
Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria.
Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
出版信息
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231207062. doi: 10.1177/10760296231207062.
BACKGROUND
Monitoring of blood coagulation is essential in ECMO patients. We investigated the prevalence of lupus anticoagulant (LA) and its association with coagulation testing and hemostaseologic complications in patients treated with ECMO.
METHODS
This is a retrospective analysis including adult patients who received ECMO at a medical intensive care unit at the Medical University of Vienna. The primary outcome was the prevalence of LA. Secondary outcomes included conditions associated with LA positivity, rates of bleeding and thromboembolic events, as well as the proportions of aPTT and antiXa measurements within the target range.
RESULTS
Between 2013 and 2021 193 patients received ECMO, in 62 (32%) of whom LA diagnostics were performed. Twenty-two (35%) patients tested positive. LA positive patients had more frequently received VV ECMO (77.3% vs 34.3%; p = 0.002), were more frequently diagnosed with viral respiratory infections (SARS-CoV2: 45.5% vs 20%; p = 0.041, influenza virus: 22.7% vs 0%; p = 0.003), had a longer ECMO treatment duration (25 vs 10 days; p = 0.011) and a longer ICU stay (48 vs 25 days; p = 0.022), but similar rates of bleeding and thromboembolic events.
背景
在 ECMO 患者中，监测凝血至关重要。我们调查了狼疮抗凝剂 (LA) 的流行情况及其与 ECMO 治疗患者的凝血检测和止血并发症的关系。
方法
这是一项回顾性分析，纳入了在维也纳医科大学重症监护病房接受 ECMO 治疗的成年患者。主要结局是 LA 的患病率。次要结局包括与 LA 阳性相关的情况、出血和血栓栓塞事件的发生率，以及 aPTT 和抗 Xa 测量值在目标范围内的比例。
结果
2013 年至 2021 年间，193 名患者接受了 ECMO，其中 62 名（32%）进行了 LA 诊断。22 名（35%）患者检测呈阳性。LA 阳性患者更频繁地接受了 VV ECMO（77.3% vs 34.3%；p = 0.002），更频繁地被诊断为病毒呼吸道感染（SARS-CoV2：45.5% vs 20%；p = 0.041，流感病毒：22.7% vs 0%；p = 0.003），ECMO 治疗时间更长（25 天 vs 10 天；p = 0.011）和 ICU 住院时间更长（48 天 vs 25 天；p = 0.022），但出血和血栓栓塞事件的发生率相似。
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