Department of Pharmacy, NYU Langone Hospital, Brooklyn, NY, USA. Electronic address: https://www.twitter.com/olivia_nuti.
Department of Pharmacy, NYU Langone Health, New York, NY, USA. Electronic address: https://www.twitter.com/ColombianpharmD.
Heart Lung Circ. 2024 Jul;33(7):975-982. doi: 10.1016/j.hlc.2024.01.032. Epub 2024 Apr 4.
Evidence supporting anticoagulation with unfractionated heparin (UFH) in patients with an intra-aortic balloon pump (IABP) to prevent limb ischaemia remains limited, while bleeding risks remain high. Monitoring heparin in this setting with anti-factor Xa (anti-Xa) is not previously described.
The study objective is to describe the incidence of thromboembolic and bleeding events with the use of UFH in patients with an IABP utilising monitoring with both anti-Xa and activated partial thromboplastin time (aPTT).
This is a retrospective study of adults who received an IABP and UFH for ≥24 hours. Electronic medical records were reviewed for pertinent data. The primary outcome was the incidence of limb ischaemia during IABP. Secondary outcomes included myocardial infarction, thrombus on IABP, or stroke. Exploratory outcomes included any venous thromboembolism and bleeding events.
Of 159 patients, 88% received an IABP for cardiogenic shock and median duration of IABP support was 118 hours (interquartile range, 67-196). Limb ischaemia occurred in four of 159 patients (2.5%). Strokes occurred in 3.8% of the cohort, and bleeding events occurred in 33%. Despite anticoagulation use in all patients, 11% experienced a venous thromboembolism, with most identified upon asymptomatic screening with concern for heparin-induced thrombocytopenia. We found no differences in outcomes that occurred with a hybrid anti-Xa and aPTT versus aPTT monitoring alone.
We observed a high rate of thrombotic and bleeding complications with the use of UFH in patients with an IABP. Use of anti-Xa versus aPTT for monitoring was not associated with complications. These data suggest safer anticoagulation strategies are needed in this setting.
支持在主动脉内球囊泵（IABP）置入患者中使用未分级肝素（UFH）预防肢体缺血的证据仍然有限，而出血风险仍然很高。在此情况下使用抗因子 Xa（anti-Xa）监测肝素尚未有相关报道。
本研究旨在描述使用 IABP 时，UFH 治疗超过 24 小时的患者中，应用抗-Xa 和活化部分凝血活酶时间（aPTT）监测时发生血栓栓塞和出血事件的发生率。
这是一项回顾性研究，纳入了接受 IABP 和 UFH 治疗超过 24 小时的成年患者。回顾电子病历以获取相关数据。主要结局为 IABP 期间发生肢体缺血的发生率。次要结局包括心肌梗死、IABP 血栓或中风。探索性结局包括任何静脉血栓栓塞和出血事件。
在 159 例患者中，88%的患者因心源性休克而接受 IABP，IABP 支持的中位时间为 118 小时（四分位距，67-196）。159 例患者中有 4 例（2.5%）发生肢体缺血。该队列中有 3.8%的患者发生中风，33%的患者发生出血事件。尽管所有患者均接受抗凝治疗，但仍有 11%的患者发生静脉血栓栓塞，其中大多数是在无症状筛查时发现的，原因是担心肝素诱导的血小板减少症。我们发现，与单独使用 aPTT 监测相比，使用混合 anti-Xa 和 aPTT 监测时，结局并无差异。
我们观察到在 IABP 置入患者中使用 UFH 时，血栓形成和出血并发症的发生率很高。与 aPTT 监测相比，使用 anti-Xa 监测并未增加并发症。这些数据表明，在此情况下需要更安全的抗凝策略。
