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首页> 外文期刊>Artificial Organs >Primary anticoagulation with bivalirudin for patients with implantable ventricular assist devices
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Primary anticoagulation with bivalirudin for patients with implantable ventricular assist devices

机译：比伐卢定对植入式心室辅助设备的患者进行原发性抗凝治疗

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Bivalirudin is a direct thrombin inhibitor that is increasingly used in patients undergoing mechanical circulatory support as it presents many advantages compared with unfractionated heparin. The aim of this study was to describe our experience with bivalirudin as primary anticoagulant in patients undergoing ventricular assist device (VAD) implantation. An observational study was performed on 12 consecutive patients undergoing VAD implantation at our institution. Patients received a continuous infusion of bivalirudin, with a starting dose of 0.025mg/kg/h; the target activated partial thromboplastin time (aPTT) was between 45 and 60s. Patients never received heparin during hospitalization nor had a prior diagnosis of heparin-induced thrombocytopenia (HIT). All patients received a continuous flow pump except one. Preoperative platelets count was 134000±64000 platelets/mm3. Mean bivalirudin dose was 0.040±0.026mg/kg/h over the course of therapy (5-12 days). Lowest platelets count during treatment was 73000±23000 platelets/mm3. No thromboembolic complications occurred. Two episodes of minor bleeding from chest tubes that subsided after reduction or temporary suspension of bivalirudin infusion were observed. Intensive care unit stay was 8 (7-17) days, and hospital stay was 25 (21-33) days. Bivalirudin is a valuable option for anticoagulation in patients with a VAD and can be easily monitored with aPTT. The use of a bivalirudin-based anticoagulation strategy in the early postoperative period may overcome many limitations of heparin and, above all, the risk of HIT, which is higher in patients undergoing VAD implantation. Bivalirudin should no longer be regarded as a second-line therapy for anticoagulation in patients with VAD. [Correction added on 6 December 2013, after first online publication: The dose of bivalirudin in the Abstract to 0.025 mg/kg/h].
机译：比伐卢定是一种直接的凝血酶抑制剂，由于与普通肝素相比具有许多优势，因此越来越多地用于接受机械循环支持的患者。这项研究的目的是描述我们将比伐卢定用作心室辅助装置（VAD）植入患者的主要抗凝剂的经验。在我们机构对连续12例接受VAD植入的患者进行了观察性研究。患者接受比伐卢定的连续输注，起始剂量为0.025mg / kg / h;目标激活的部分凝血活酶时间（aPTT）在45至60s之间。患者在住院期间从未接受过肝素治疗，也没有事先诊断过肝素诱导的血小板减少症（HIT）。除一个患者外，所有患者均接受连续流泵。术前血小板计数为134000±64000血小板/ mm3。在治疗过程中（5-12天），比伐卢定的平均剂量为0.040±0.026mg / kg / h。治疗期间最低的血小板计数为73000±23000血小板/ mm3。没有发生血栓栓塞并发症。观察到有两次发作的比伐卢定输注减少或暂时停止后，胸管轻微出血消失。重症监护病房住院时间为8（7-17）天，住院时间为25（21-33）天。比伐卢定是VAD患者抗凝的重要选择，可通过aPTT轻松监测。术后早期使用基于比伐卢定的抗凝策略可以克服肝素的许多局限性，最重要的是，HIT的风险在接受VAD植入的患者中更高。比伐卢定不应再被视为VAD患者抗凝的二线治疗。 [2013年12月6日首次在线发布后更正：摘要中比伐卢定的剂量为0.025 mg / kg / h]。

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