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Argatroban in extracorporeal membrane oxygenation.

机译：阿加曲班在体外膜氧合。

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The objective of this study was to assess the required dose and anticoagulatory effect of argatroban (Mitsubishi, Pharma Deutschland GmbH, Dusseldorf, Germany), a direct thrombin inhibitor approved for anticoagulation in patients with heparin-induced thrombocytopenia (HIT) undergoing extracorporeal membrane oxygenation (ECMO). Nine consecutive patients undergoing ECMO for severe acute respiratory distress syndrome (ARDS) and presenting with suspected HIT were treated with a continuous argatroban infusion. Coagulation variables were measured and dose adjustments of argatroban were performed to target for an activated partial thromboplastin time (aPTT) of 50 to 60 s. The first patient received argatroban 2 microg/kg/min as recommended by the manufacturer. This resulted in excessive anticoagulation and severe bleeding. The consecutive eight patients received a 10-fold lower dose (0.2 microg/kg/min). This dose sufficiently increased aPTT time from 46 +/- 6 s to 65 +/- 14 s (P < 0.001) and thrombin time from 18 +/- 8 s to 45 +/- 11 s (P = 0.001). The maintenance dose averaged 0.15 microg/kg/min. Duration of argatroban infusion for ECMO averaged 4 +/- 1 days and no oxygenator or extracorporeal system clotting was observed. In three of nine patients (33%), HIT was confirmed. Argatroban is a feasible and effective anticoagulant for patients with suspected HIT undergoing ECMO. However, a dose 10-fold lower than that recommended by the manufacturer is sufficient to achieve appropriate anticoagulation in critically ill patients undergoing ECMO.
机译：这项研究的目的是评估Argatroban（Mitsubishi，Pharma Deutschland GmbH，Dusseldorf，Germany）的所需剂量和抗凝作用，argatroban是一种直接凝血酶抑制剂，已被批准用于接受肝素诱导的血小板减少症（HIT）进行体外膜氧合的患者进行抗凝治疗（ ECMO）。连续9例因严重急性呼吸窘迫综合征（ARDS）接受ECMO并出现疑似HIT的患者接受连续阿加曲班输注治疗。测量凝血变量，并进行阿加曲班剂量调整，以使活化的部分凝血活酶时间（aPTT）为50至60 s。根据制造商的建议，第一例患者接受了2 microg / kg / min的argatroban。这导致过度的抗凝和严重的出血。连续的八名患者接受了低十倍的剂量（0.2微克/千克/分钟）。该剂量足以将aPTT时间从46 +/- 6 s增加到65 +/- 14 s（P <0.001），并将凝血酶时间从18 +/- 8 s增加到45 +/- 11 s（P = 0.001）。维持剂量平均为0.15微克/千克/分钟。 ECMO的Argatroban输注时间平均为4 +/- 1天，未观察到充氧器或体外系统凝结。 9名患者中有3名（33％）确诊为HIT。对于怀疑患有HIT的ECMO患者，Argatroban是一种可行且有效的抗凝剂。但是，比制造商建议的剂量低10倍的剂量足以在接受ECMO的重症患者中实现适当的抗凝治疗。

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