Impact of inflammation and steroids on anti-coagulation in children supported on a ventricular assist device

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-04-06 DOI:10.1007/s10047-024-01442-2

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引用次数: 0

Abstract

Critically ill pediatric patients supported on ventricular assist devices (VADs) are increasingly being anticoagulated on bivalirudin, but with difficulty monitoring anticoagulation. Activated partial thromboplastin time (aPTT) has recently been shown to poorly correlate with bivalirudin plasma concentrations, while dTT had excellent correlation. However, aPTT is the more common monitoring test and dTT testing is rarely used. In addition, effects of frequent clinical VAD scenarios (such as inflammation) on the accuracy of aPTT and dTT testing remains uncertain. We reviewed the effects of clinical scenarios (infection/inflammation, chylothorax, and steroids administration) on anticoagulation monitoring in 10 pediatric VAD patients less than 3 years at Cincinnati Children's Hospital Medical Center from 10/27/2020 to 5/6/2022 using bivalirudin for anticoagulation. There were 16 inflammation/infection, 3 chylothorax, and 6 steroids events. Correlation between dTT and aPTT was significantly lower after infection/inflammation, with dTT increasing prior to inflammation/infection while aPTT remained unchanged. In addition, steroids are administered to VAD patients to reduce inflammation and thus additionally stabilize anticoagulation. However, this anticoagulation stabilization effect was reflected more accurately by dTT compared to aPTT. In children requiring VAD support utilizing bivalirudin anticoagulation, inflammation/infection is a common occurrence resulting in anticoagulation changes that may be more accurately reflected by dTT as opposed to aPTT.

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炎症和类固醇对使用心室辅助装置的儿童抗凝血功能的影响

摘要使用心室辅助装置（VAD）的重症儿科患者越来越多地使用比伐卢定进行抗凝，但却很难监测抗凝情况。最近的研究表明，活化部分凝血活酶时间（aPTT）与双伐卢定血浆浓度的相关性很差，而 dTT 的相关性则很好。然而，活化部分凝血活酶时间（PTT）是更常用的监测检测方法，而 dTT 检测则很少使用。此外，频繁出现的临床 VAD 情景（如炎症）对 aPTT 和 dTT 检测准确性的影响仍不确定。我们回顾了 2020 年 10 月 27 日至 2022 年 6 月 5 日期间辛辛那提儿童医院医疗中心使用比伐卢定进行抗凝治疗的 10 名 3 岁以下儿科 VAD 患者的临床情况（感染/炎症、乳糜胸和类固醇用药）对抗凝血监测的影响。共发生 16 起炎症/感染、3 起乳糜胸和 6 起类固醇事件。感染/发炎后 dTT 和 aPTT 之间的相关性明显降低，发炎/感染前 dTT 增高，而 aPTT 保持不变。此外，VAD 患者服用类固醇可减轻炎症，从而进一步稳定抗凝。然而，与 aPTT 相比，dTT 能更准确地反映这种抗凝稳定作用。在需要使用双醋鲁定抗凝法进行 VAD 支持的儿童中，炎症/感染是一种常见现象，会导致抗凝变化，而 dTT 与 aPTT 相比，可能更能准确地反映出这种变化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.