背景:与活化部分凝血活酶时间(aPTT)相比,血栓弹力图(TEG)提供了更动态的止血评估。然而,TEG在体外膜氧合(ECMO)期间监测比伐卢定的临床应用尚不清楚.本研究的目的是评估比伐卢定抗凝的成年ECMO患者中aPTT和TEG之间的相关性。
方法:这是一个多中心,回顾性,进行了为期2年的队列研究。包括需要ECMO和比伐卢定治疗的成人患者,其中≥1个相应的标准TEG和aPTT血浆样本彼此抽取≤4小时。主要终点是确定标准TEG反应(R)时间与比伐卢定aPTT血清浓度之间的相关系数。
结果:共纳入104例患者,包括848例同时进行的TEGR时间和aPTT实验室评估。在研究人群中证明了TEG-R时间和aPTT之间的中度相关性(r=0.41;p<0.001)。总的来说,502(59.2%)对TEGR时间和aPTT值的并发评估显示它们是否属于次级,supra-,或根据机构对比伐卢定的分类进行治疗。“治疗性”aPTT中的42.2%(n=271/642)不一致的TEGR时间在亚治疗和超治疗类别之间几乎相等。
结论:在危重患者ECMO过程中,TEGR时间与aPTT与比伐卢定之间存在中度相关性。需要进一步的研究来解决最佳测试,以指导ECMO患者抗凝剂量的临床决策。
Thromboelastography (TEG) offers a more dynamic assessment of hemostasis over activated partial thromboplastin time (aPTT). However, the clinical utility of TEG in monitoring bivalirudin during extracorporeal membrane oxygenation (ECMO) remains unknown. The purpose of this study was to evaluate the correlation between aPTT and TEG in adult ECMO patients anticoagulated with bivalirudin.
Multicenter, retrospective, cohort study conducted over a 2-year period.
Two academic university medical centers (Banner University Medical Center) in Phoenix and Tucson, AZ.
Adult patients requiring ECMO and bivalirudin therapy with ≥1 corresponding standard TEG and aPTT plasma samples drawn ≤4 h of each other were included. The primary endpoint was to determine the correlation coefficient between the standard TEG reaction (R) time and bivalirudin aPTT serum concentrations.
A total of 104 patients consisting of 848 concurrent laboratory assessments of R time and aPTT were included. A moderate correlation between TEG R time and aPTT was demonstrated in the study population (r = 0.41; p < 0.001). Overall, 502 (59.2%) concurrent assessments of TEG R time and aPTT values showed agreement on whether they were sub-, supra-, or therapeutic according to the institution\'s classification for bivalirudin. The 42.2% (n = 271/642) discordant TEG R times among \"therapeutic\" aPTT were almost equally distributed between subtherapeutic and supratherapeutic categories.
Moderate correlation was found between TEG R time and aPTT associated with bivalirudin during ECMO in critically ill adults. Further research is warranted to address the optimal test to guide clinical decision-making for anticoagulation dosing in ECMO patients.