Abstract：
Background: Antithrombin (AT) replacement is occasionally utilized in the setting of extracorporeal membrane oxygenation (ECMO)-associated heparin resistance. Although past studies emphasized the high costs and limited clinical benefit of AT supplementation, guidance on strategies to prevent unnecessary use remain lacking.Methods: In this retrospective study, we evaluated the cost, efficacy, and safety outcomes three years pre- and post-implementation of an AT restriction protocol in adult ECMO patients. The primary endpoint was the cost spent on anticoagulation and AT normalized to ECMO duration. Secondary endpoints included thromboembolic and bleeding outcomes.Results: 175 patients were included for analysis (pre-restriction protocol n = 87; post-restriction protocol n = 88). Implementation of the restriction resulted in complete elimination of AT use and significantly reduced the primary cost endpoint from $1009.20 to $42.99 per ECMO day (p < .001). There was no significant change in occurrence of new Venous Thromboembolism (VTE) (p = .099). Those in the pre-implementation group had significantly higher rates of transfusions (p < .001) and ISTH major bleeding (p < .001). Outcomes remained significant after exclusion of patients with coronavirus infections.Conclusion: Results of this study exemplify how AT restriction can be successfully implemented to decrease anticoagulation-associated costs without jeopardizing the risk of bleeding and thrombosis in ECMO patients.
摘要：
背景：抗凝血酶（AT）替代偶尔用于体外膜氧合（ECMO）相关的肝素抵抗。尽管过去的研究强调补充AT的高成本和有限的临床益处，仍然缺乏关于防止不必要使用的策略的指导。方法：在这项回顾性研究中，我们评估了成本，功效,以及在成年ECMO患者中实施AT限制方案前和后三年的安全性结果。主要终点是在抗凝和AT上花费的成本与ECMO持续时间的标准化。次要终点包括血栓栓塞和出血结果。结果：175例患者被纳入分析（限制前方案n=87；限制后方案n=88）。实施该限制导致完全消除AT使用，并将主要成本终点从$1009.20降低到$42.99/ECMO日（p<.001）。新的静脉血栓栓塞（VTE）的发生没有显着变化（p=0.099）。实施前组的输血率（p<.001）和ISTH大出血率（p<.001）明显更高。在排除冠状病毒感染患者后，结果仍然很重要。结论：这项研究的结果说明了如何在不危及ECMO患者出血和血栓形成风险的情况下成功实施AT限制以降低抗凝相关费用。
