比伐卢定
医学
肝素
加药
部分凝血活酶时间
体外
体外膜肺氧合
凝血时间激活
抗凝剂
肾脏替代疗法
麻醉
直接凝血酶抑制剂
重症监护医学
外科
阿加曲班
内科学
心脏病学
华法林
血小板
心房颤动
达比加群
心肌梗塞
经皮冠状动脉介入治疗
作者
Elizabeth Walker,A. Joshua Roberts,Erin L Louie,William E. Dager
出处
期刊:Asaio Journal
[Ovid Technologies (Wolters Kluwer)]
日期:2019-02-01
卷期号:65 (2): 134-138
被引量:25
标识
DOI:10.1097/mat.0000000000000780
摘要
Systemic anticoagulation with unfractionated heparin is standard of care for patients receiving extracorporeal life support (ECLS); however, an alternative anticoagulant may be necessary when challenges with heparin therapy arise. Evidence for alternative anticoagulation in ECLS patients is limited. This retrospective analysis evaluated the dosing and outcomes associated with bivalirudin use in 14 adult ECLS patients. Indications for bivalirudin included heparin-induced thrombocytopenia, heparin resistance, or persistent clotting or bleeding while on heparin. The median initial bivalirudin dose to achieve target activated partial thromboplastin time was 0.15 mg/kg/h (range 0.04–0.26 mg/kg/h). Dosing requirements increased by 75–125% when renal replacement was included. Median time on bivalirudin was 5.2 days (range 0.9–28 days). Five patients (36%) required a circuit change while on bivalirudin because of clotting or failing oxygenation, and four (28.6%) had bleeding significant enough to require either reduction in activated partial thromboplastin time goals or temporary holding of anticoagulation. Bivalirudin appears to be a potential option for adult patients on ECLS who are unable to receive or fail heparin therapy; however, the wide variation in dosing suggests the need for careful management.
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