Fresh frozen plasma: A solution to heparin resistance during extracorporeal membrane oxygenation (ECMO)

IF 0.3 Q4 CRITICAL CARE MEDICINE
Fayaz Mohammed Khazi , Ashraf Mahmoud Elhoufi , Tarek Ahmed AbdelAziz , Nayyer R Siddiqui , Bassil Al-Zamkan , Suresh Babu Robert , Pradeep Kumar Pillai , Obaid Aljassim
{"title":"Fresh frozen plasma: A solution to heparin resistance during extracorporeal membrane oxygenation (ECMO)","authors":"Fayaz Mohammed Khazi ,&nbsp;Ashraf Mahmoud Elhoufi ,&nbsp;Tarek Ahmed AbdelAziz ,&nbsp;Nayyer R Siddiqui ,&nbsp;Bassil Al-Zamkan ,&nbsp;Suresh Babu Robert ,&nbsp;Pradeep Kumar Pillai ,&nbsp;Obaid Aljassim","doi":"10.1016/j.ejccm.2018.12.020","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>The management of Heparin resistance in patients undergoing ECMO is still uncertain. We sought to assess the efficacy and safety of Fresh frozen plasma to optimize the anticoagulation in these patients.</p></div><div><h3>Methods</h3><p>We studied 42 adults undergoing VA-ECMO. Heparin infusion was increased incrementally to achieve target ACT in HG group and plasma administered in FFPG group in heparin resistance (HR) patients. Statistical comparison was performed between these two groups and results compared with non-heparin resistance (Non-HR) patients.</p></div><div><h3>Results</h3><p>Overall 36% survived and 64% suffered bleeding complications. There was no difference in age (p = 0.118) or average ECMO duration (p = 0.393). The heparin requirement was significantly less in FFPG (p = 0.008) and average ACT difference of 159.2 (20.3) was highly significant (p &lt; 0.001). Clinically the survival was higher in FFPG (50% vs 10%) without statistical difference (p = 0.07) probably due to small sample size. Twenty HR compared to 22 Non-HR patients. The survival rate (41% vs 30%) was not statistically significant (p = 0.340). However, more bleeding 80% vs 50% recorded in HR (p = 0.043) even though heparin doses between them was not different.</p></div><div><h3>Conclusions</h3><p>The heparin requirement was high in patients treated with heparin alone. Fresh frozen plasma effectively increased ACT to therapeutic target in HR patients. There was no difference in the heparin dose, significantly higher bleeding complications were recorded in HR patients. Clinically, survival was better in Non-heparin resistance and plasma treated patients that was not found to be statistically significant.</p></div>","PeriodicalId":31233,"journal":{"name":"Egyptian Journal of Critical Care Medicine","volume":null,"pages":null},"PeriodicalIF":0.3000,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ejccm.2018.12.020","citationCount":"2","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Egyptian Journal of Critical Care Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2090730318300574","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 2

Abstract

Objective

The management of Heparin resistance in patients undergoing ECMO is still uncertain. We sought to assess the efficacy and safety of Fresh frozen plasma to optimize the anticoagulation in these patients.

Methods

We studied 42 adults undergoing VA-ECMO. Heparin infusion was increased incrementally to achieve target ACT in HG group and plasma administered in FFPG group in heparin resistance (HR) patients. Statistical comparison was performed between these two groups and results compared with non-heparin resistance (Non-HR) patients.

Results

Overall 36% survived and 64% suffered bleeding complications. There was no difference in age (p = 0.118) or average ECMO duration (p = 0.393). The heparin requirement was significantly less in FFPG (p = 0.008) and average ACT difference of 159.2 (20.3) was highly significant (p < 0.001). Clinically the survival was higher in FFPG (50% vs 10%) without statistical difference (p = 0.07) probably due to small sample size. Twenty HR compared to 22 Non-HR patients. The survival rate (41% vs 30%) was not statistically significant (p = 0.340). However, more bleeding 80% vs 50% recorded in HR (p = 0.043) even though heparin doses between them was not different.

Conclusions

The heparin requirement was high in patients treated with heparin alone. Fresh frozen plasma effectively increased ACT to therapeutic target in HR patients. There was no difference in the heparin dose, significantly higher bleeding complications were recorded in HR patients. Clinically, survival was better in Non-heparin resistance and plasma treated patients that was not found to be statistically significant.

新鲜冷冻血浆:体外膜氧合(ECMO)过程中肝素耐药性的解决方案
目的ECMO患者肝素耐药的处理尚不明确。我们试图评估新鲜冷冻血浆的有效性和安全性,以优化这些患者的抗凝治疗。方法对42例成人进行VA-ECMO。在肝素耐药(HR)患者中,HG组逐渐增加肝素输注以达到目标ACT, FFPG组血浆给药。对两组进行统计学比较,并与非肝素耐药(Non-HR)患者进行比较。结果总生存率为36%,出血并发症发生率为64%。年龄(p = 0.118)和平均ECMO持续时间(p = 0.393)无差异。FFPG组肝素需要量显著减少(p = 0.008),ACT平均差值159.2(20.3)极显著(p < 0.001)。临床上FFPG组生存率较高(50% vs 10%),但无统计学差异(p = 0.07),可能是样本量小所致。20例HR患者与22例非HR患者相比。生存率(41% vs 30%)差异无统计学意义(p = 0.340)。然而,即使肝素剂量在HR组之间没有差异,出血量80% vs 50% (p = 0.043)。结论单用肝素治疗的患者肝素需要量较高。新鲜冷冻血浆可有效提高HR患者的ACT达到治疗目标。肝素剂量差异无统计学意义,HR患者出血并发症发生率明显增高。临床上,非肝素耐药和血浆治疗患者的生存率更高,但无统计学意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
5
审稿时长
42 weeks
期刊介绍: The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信