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首页> 外文期刊>Artificial Organs >Efficacy and safety of anticoagulation with heparin versus heparin plus epoprostenol in patients undergoing extracorporeal liver support with prometheus.
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Efficacy and safety of anticoagulation with heparin versus heparin plus epoprostenol in patients undergoing extracorporeal liver support with prometheus.

机译：肝素与肝素加依普舒坦醇抗凝治疗接受普罗米修斯体外肝支持的患者的疗效和安全性。

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Anticoagulation for extracorporeal liver support is delicate due to underlying coagulation disorders in patients with liver failure and to the associated elevated bleeding risk. To date, there has been no detailed report on anticoagulation issues in patients treated with Prometheus, a device based on the principle of fractionated plasma separation and adsorption. We studied 17 patients from two centers treated with Prometheus, comparing standard anticoagulation with heparin (15 treatments) and a combination of heparin and the synthetic prostacyclin epoprostenol (22 treatments). Standard coagulation tests, proteins C and S, and thrombin-antithrombin (TAT) complex were determined, and adverse events were recorded. All but two treatments could be completed as scheduled, although filter exchange due to filter clotting was required in 24% of the treatments. Three out of 17 patients developed severe bleeding complications within 24 h of treatment. There were no overt thrombotic events. Addition of epoprostenol neither reduced coagulation-related adverse events nor improved standard coagulation parameters. Protein C, but not protein S, showed a significant reduction (23 +/- 18%) after Prometheus treatments, but levels rebounded to baseline within 18 h. TAT levels--a measure for activation of coagulation--were only altered by Prometheus in patients where TAT was already elevated before treatment. In conclusion, anticoagulation of Prometheus with heparin is feasible but still associated with a relatively high frequency of filter clotting and a considerable risk of severe bleeding in this high-risk patient population. As addition of epoprostenol did not prove beneficial, other strategies, such as regional anticoagulation with citrate, should be further evaluated.
机译：由于肝功能衰竭患者潜在的凝血功能障碍以及相关的出血风险增加，因此体外肝支持的抗凝作用微妙。迄今为止，还没有关于使用普罗米修斯治疗的患者的抗凝问题的详细报告，普罗米修斯是基于血浆分离和吸附分离原理的装置。我们研究了来自两个接受普罗米修斯治疗的中心的17例患者，比较了标准抗凝治疗和肝素治疗（15种治疗方法）以及肝素和人工合成前列环素Epoprostenol的组合治疗（22种治疗方法）。确定了标准凝血试验，蛋白C和S以及凝血酶-抗凝血酶（TAT）复合物，并记录了不良事件。除了两次处理外，所有处理都可以按计划完成，尽管在24％的处理中由于过滤器凝结而需要更换过滤器。 17名患者中有3名在治疗24小时内出现严重的出血并发症。没有明显的血栓事件。依泊麦醇的添加既不能减少与凝血有关的不良事件，也不能改善标准凝血参数。普罗米修斯治疗后，蛋白C（而非蛋白S）显示出显着降低（23 +/- 18％），但水平在18小时内反弹至基线。 TAT水平-一种凝血激活的指标-仅在治疗前TAT已升高的患者中被Prometheus改变。总之，用肝素对普罗米修斯进行抗凝是可行的，但在该高危患者人群中，滤器凝结的频率相对较高，并且存在严重出血的风险。由于证明添加依普西汀醇没有益处，因此应进一步评估其他策略，例如柠檬酸的局部抗凝治疗。

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