Yılmaz Rabia, Arslan Murat, Özel Bilgi Deniz, Çukurova Zafer
University of Health Sciences Türkiye, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Anaesthesiology and Reanimation Critical Care, İstanbul, Türkiye.
Turk J Anaesthesiol Reanim. 2025 Jul 24;53(4):170-176. doi: 10.4274/TJAR.2025.241745. Epub 2025 May 14.
Due to a lack of high-quality data to guide anticoagulation therapy in extracorporeal membrane oxygenation (ECMO) patients, there is significant variation in practice among centers. We aimed to investigate the safety, anticoagulation efficacy, and cost-effectiveness of using bivaluridine as a primary anticoagulant without unfractionated heparin (UFH) in ECMO patients.
The study population included patients undergoing Veno-Venous ECMO for acute respiratory distress syndrome. A total of 56 patients were evaluated, 25 were on UFH and 31 were on bivalirudin.
There was no significant difference between the time to reach the target activated partial thromboplastin time (aPTT) interval [6 (3.5-11) UFH, 9 (4-19) bivalirudin, P=0.287]. There was no significant difference between the percentage of time spent in the target aPTT interval (61.48±14.72 UFH, 62.65±11.99 bivaluridine, =0.745). The median amount of erythrocyte suspension replacement (12.04±8.01; 7.9±4.71; =0.028) and the median amount of fresh frozen plasma replacement [4 (2-6); 1 (0-4); =0.001] were higher in the UFH group than in the bivaluridine group. The cost was lower in the UFH group compared to the bivalirudin group [$38.1 (13.5-48.7); $463.7 (194.3-819.8); < 0.001].
The use of bivaluridine as a primary anticoagulant does not lead to any decrease in anticoagulant efficacy.
由于缺乏高质量数据来指导体外膜肺氧合（ECMO）患者的抗凝治疗，各中心在实际操作上存在显著差异。我们旨在研究在ECMO患者中使用比伐卢定作为主要抗凝剂而不使用普通肝素（UFH）的安全性、抗凝效果和成本效益。
研究人群包括因急性呼吸窘迫综合征接受静脉-静脉ECMO治疗的患者。共评估了56例患者，25例使用UFH，31例使用比伐卢定。
达到目标活化部分凝血活酶时间（aPTT）间隔的时间无显著差异[UFH组为6（3.5 - 11），比伐卢定组为9（4 - 19），P = 0.287]。在目标aPTT间隔内花费的时间百分比无显著差异（UFH组为61.48±14.72，比伐卢定组为62.65±11.99，P = 0.745）。UFH组红细胞悬液置换的中位数（12.04±8.01；7.9±4.71；P = 0.028）和新鲜冰冻血浆置换的中位数[4（2 - 6）；1（0 - 4）；P = 0.001]高于比伐卢定组。UFH组的成本低于比伐卢定组[$38.1（13.5 - 48.7）；$463.7（194.3 - 819.8）；P < 0.001]。
使用比伐卢定作为主要抗凝剂不会导致抗凝效果降低。
