PDF(Pubmed)
Abstract：
In unfractionated heparin (UFH) monitoring during extracorporeal circulation, the traditional measures of activated clotting time (ACT) or activated partial thromboplastin time (APTT) may diverge, confounding anticoagulant adjustments. We aimed to explore the factors explaining this discrepancy in children and young adults. This retrospective observational study, conducted at an urban regional tertiary hospital, included consecutive pediatric patients who received UFH during extracorporeal circulation (continuous kidney replacement therapy or extracorporeal membrane oxygenation) between April 2017 and March 2021. After patients whose ACT and APTT were not measured simultaneously or who were also taking other anticoagulants were excluded, we analyzed 94 samples from 23 patients. To explain the discrepancy between ACT and APTT, regression equations were created using a generalized linear model (family = gamma, link = logarithmic) with ACT as the response variable. Other explanatory variables included age, platelet count, and antithrombin. Compared to APTT alone as an explanatory variable, the Akaike information criterion and pseudo-coefficient of determination improved from 855 to 625 and from 0.01 to 0.42, respectively, when these explanatory variables were used. In conclusion, we identified several factors that may explain some of the discrepancy between ACT and APTT in the routinely measured tests. Evaluation of these factors may aid in appropriate adjustments in anticoagulation therapy.
摘要：
在体外循环期间的普通肝素（UFH）监测中，激活凝血时间（ACT）或激活部分凝血活酶时间（APTT）的传统测量可能会有所不同，混杂抗凝剂调整。我们旨在探讨解释儿童和年轻人这种差异的因素。这项回顾性观察研究，在城市地区三级医院进行，纳入了2017年4月至2021年3月期间在体外循环(连续肾脏替代疗法或体外膜氧合)期间接受UFH的连续儿科患者.排除未同时检测ACT和APTT或同时服用其他抗凝剂的患者后，我们分析了23例患者的94份样本.为了解释ACT和APTT之间的差异，回归方程是使用广义线性模型(家庭=伽马，link=对数)，ACT作为响应变量。其他解释变量包括年龄，血小板计数,和抗凝血酶.与单独作为解释变量的APTT相比，Akaike信息准则和伪确定系数分别从855提高到625和从0.01提高到0.42，当使用这些解释变量时。总之,我们确定了一些因素,这些因素可以解释常规测量测试中ACT和APTT之间的一些差异.评估这些因素可能有助于抗凝治疗的适当调整。
