阿加曲班抗凝在儿童VA-ECMO中的应用效果分析

Analysis of the application efficacy of argatroban anticoagulation in pediatric VA-ECMO

目的分析阿加曲班在儿童静脉-动脉体外膜肺氧合(VA-ECMO)中的抗凝剂量和效果。方法回顾性分析2021年10月至2023年1月广西壮族自治区人民医院儿童重症监护室(PICU)收治的5例接受VA-ECMO治疗儿童的阿加曲班抗凝情况。结果5例VA-ECMO儿童存活出院3例,死亡2例,均无阿加曲班直接相关的大出血或血栓事件,均在使用肝素后更换为阿加曲班抗凝,可达成活化部分凝血酶原时间(APTT)抗凝目标,但存在APTT和激活全血凝固时间(ACT)分离现象。阿加曲班维持剂量较低,且随着体重下降有减少趋势。更换阿加曲班抗凝后血小板水平有所上升,ECMO氧合器寿命有所延长,但血制品用量未见减少。结论阿加曲班可用于抗凝血酶Ⅲ(AT3)低下和肝素抗凝不佳的儿童VA-ECMO抗凝,起始剂量宜小,并根据体重和凝血指标进行个体化调整。

Objective To analyze the anticoagulant dosage and efficacy of argatroban in pediatric veno-arterial extracorporeal membrane oxygenation(VA-ECMO).Methods A retrospective analysis was conducted on five cases of pediatric VA-ECMO patients who were admitted to the Pediatric Intensive Care Unit(PICU)of the People′s Hospital of Guangxi Zhuang Autonomous Region from October 2021 to January 2023,and the use of argatroban as an anticoagulant was focused on the patients.Results Among the five cases of pediatric patients undergoing VA-ECMO,three cases survived at discharge from the hospital and two cases died,and there were no major bleeding or thrombotic events directly associated with argatroban.Argatroban was administered after initial heparin use and the activated partial thromboplastin time(APTT)goal were achieved.However,there was a dissociation between APTT and activated clotting time of whole blood(ACT).The maintenance dosage of argatroban was relatively low and tended to decrease with weight loss.Platelet levels increased after switching to argatroban anticoagulation,resulting in the extended lifespan of ECMO oxygenator,but no reduction in blood product usage was observed.Conclusion Argatroban can be used for anticoagulation in pediatric VA-ECMO cases with low levels of antithrombinⅢ(AT3)and inadequate anticoagulation with heparin.The initial dosage of argatroban should be conservative and individualized adjustments should be made according to the patients′weight and coagulation parameters.