Abstract：
OBJECTIVE: To evaluate the impact of inflammation on anticoagulation monitoring for patients supported with extracorporeal membrane oxygenation (ECMO).
METHODS: Prospective single-center cohort study.
METHODS: University-affiliated tertiary care academic medical center.
METHODS: Adult venovenous and venoarterial ECMO patients anticoagulated with heparin/ MEASUREMENTS AND MAIN RESULTS: C-Reactive protein (CRP) was used as a surrogate for overall inflammation. The relationship between CRP and the partial thromboplastin time (PTT, seconds) was evaluated using a CRP-insensitive PTT assay (PTT-CRP) in addition to measurement using a routine PTT assay. Data from 30 patients anticoagulated with heparin over 371 ECMO days was included. CRP levels (mg/dL) were significantly elevated (median, 17.2; interquartile range [IQR], 9.2-26.1) and 93% of patients had a CRP of ≥5. The median PTT (median 58.9; IQR, 46.9-73.3) was prolonged by 11.3 seconds compared with simultaneously measured PTT-CRP (median, 47.6; IQR, 40.1-55.5; p < 0.001). The difference between PTT and PTT-CRP generally increased with CRP elevation from 2.7 for a CRP of <5.0 to 13.0 for a CRP between 5 and 10, 17.7 for a CRP between 10 and 15, and 15.1 for a CRP of >15 (p < 0.001). In a subgroup of patients, heparin was transitioned to argatroban, and a similar effect was observed (median PTT, 62.1 seconds [IQR, 53.0-78.5 seconds] vs median PTT-CRP, 47.6 seconds [IQR, 41.3-57.7 seconds]; p < 0.001).
CONCLUSIONS: Elevations in CRP are common during ECMO and can falsely prolong PTT measured by commonly used assays. The discrepancy due to CRP-interference is important clinically given narrow PTT targets and may contribute to hematological complications.
METHODS: Prospective single-center cohort study.
METHODS: University-affiliated tertiary care academic medical center.
METHODS: Adult venovenous and venoarterial ECMO patients anticoagulated with heparin/ MEASUREMENTS AND MAIN RESULTS: C-Reactive protein (CRP) was used as a surrogate for overall inflammation. The relationship between CRP and the partial thromboplastin time (PTT, seconds) was evaluated using a CRP-insensitive PTT assay (PTT-CRP) in addition to measurement using a routine PTT assay. Data from 30 patients anticoagulated with heparin over 371 ECMO days was included. CRP levels (mg/dL) were significantly elevated (median, 17.2; interquartile range [IQR], 9.2-26.1) and 93% of patients had a CRP of ≥5. The median PTT (median 58.9; IQR, 46.9-73.3) was prolonged by 11.3 seconds compared with simultaneously measured PTT-CRP (median, 47.6; IQR, 40.1-55.5; p < 0.001). The difference between PTT and PTT-CRP generally increased with CRP elevation from 2.7 for a CRP of <5.0 to 13.0 for a CRP between 5 and 10, 17.7 for a CRP between 10 and 15, and 15.1 for a CRP of >15 (p < 0.001). In a subgroup of patients, heparin was transitioned to argatroban, and a similar effect was observed (median PTT, 62.1 seconds [IQR, 53.0-78.5 seconds] vs median PTT-CRP, 47.6 seconds [IQR, 41.3-57.7 seconds]; p < 0.001).
CONCLUSIONS: Elevations in CRP are common during ECMO and can falsely prolong PTT measured by commonly used assays. The discrepancy due to CRP-interference is important clinically given narrow PTT targets and may contribute to hematological complications.
摘要：
目的：评估炎症对体外膜氧合（ECMO）患者抗凝监测的影响。
方法：前瞻性单中心队列研究。
方法：大学附属三级护理学术医学中心。
方法：成人静脉和静脉动脉ECMO患者抗凝肝素/测量和主要结果：C-反应蛋白（CRP）被用作整体炎症的替代品。CRP与部分凝血活酶时间（PTT，秒），除了使用常规PTT测定进行测量外，还使用CRP不敏感的PTT测定（PTT-CRP）进行评估。纳入了30例肝素抗凝超过371个ECMO天的患者的数据。CRP水平（mg/dL）显着升高（中位数，17.2；四分位数间距[IQR]，9.2-26.1)，93%的患者CRP≥5。PTT中位数(中位数58.9；IQR，46.9-73.3）与同时测量的PTT-CRP（中位数，47.6；IQR，40.1-55.5；p<0.001）。PTT和PTT-CRP之间的差异通常随着CRP升高而增加，从<5.0的CRP升高为2.7到5和10之间的CRP升高为13.0，10和15之间的CRP升高为17.7，而>15的CRP升高为15.1（p<0.001）。在一组患者中，肝素被转移到阿加曲班，并观察到类似的效果(中位PTT，62.1秒[IQR，53.0-78.5秒]与中位PTT-CRP，47.6秒[IQR，41.3-57.7秒]；p<0.001）。
结论：CRP升高在ECMO期间是常见的，并且可以错误地延长通过常用测定法测量的PTT。由于CRP干扰引起的差异在临床上对狭窄的PTT目标很重要，并且可能导致血液学并发症。
方法：前瞻性单中心队列研究。
方法：大学附属三级护理学术医学中心。
方法：成人静脉和静脉动脉ECMO患者抗凝肝素/测量和主要结果：C-反应蛋白（CRP）被用作整体炎症的替代品。CRP与部分凝血活酶时间（PTT，秒），除了使用常规PTT测定进行测量外，还使用CRP不敏感的PTT测定（PTT-CRP）进行评估。纳入了30例肝素抗凝超过371个ECMO天的患者的数据。CRP水平（mg/dL）显着升高（中位数，17.2；四分位数间距[IQR]，9.2-26.1)，93%的患者CRP≥5。PTT中位数(中位数58.9；IQR，46.9-73.3）与同时测量的PTT-CRP（中位数，47.6；IQR，40.1-55.5；p<0.001）。PTT和PTT-CRP之间的差异通常随着CRP升高而增加，从<5.0的CRP升高为2.7到5和10之间的CRP升高为13.0，10和15之间的CRP升高为17.7，而>15的CRP升高为15.1（p<0.001）。在一组患者中，肝素被转移到阿加曲班，并观察到类似的效果(中位PTT，62.1秒[IQR，53.0-78.5秒]与中位PTT-CRP，47.6秒[IQR，41.3-57.7秒]；p<0.001）。
结论：CRP升高在ECMO期间是常见的，并且可以错误地延长通过常用测定法测量的PTT。由于CRP干扰引起的差异在临床上对狭窄的PTT目标很重要，并且可能导致血液学并发症。
