平行抗xa和APTT之间的差异与Impella™支持的心源性休克患者的死亡率有关。

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2025-03-06 DOI:10.1016/j.jtha.2025.02.028

Charlotte J Van Edom, Francesca Fiorelli, Tim Balthazar, Maria Monteagudo-Vela, Thomas Vanassche, Vasileios F Panoulas, Christophe Vandenbriele

{"title":"平行抗xa和APTT之间的差异与Impella™支持的心源性休克患者的死亡率有关。","authors":"Charlotte J Van Edom, Francesca Fiorelli, Tim Balthazar, Maria Monteagudo-Vela, Thomas Vanassche, Vasileios F Panoulas, Christophe Vandenbriele","doi":"10.1016/j.jtha.2025.02.028","DOIUrl":null,"url":null,"abstract":"Background: Managing unfractionated heparin (UFH) during percutaneous mechanical circulatory support for cardiogenic shock (CS) is challenging due to potential discrepancies between coagulation tests.Objectives: To study the causes and consequences of discrepancies between anti-Xa and activated partial thromboplastin time (APTT) for UFH monitoring during microaxial flow pump support (Impella) for CS.Methods: We assessed patients in CS supported with Impella in 2 tertiary care centers over 62 months. UFH was titrated based on anti-Xa levels with parallel APTT measurements. In-range anti-Xa levels were considered between 0.20 and 0.30 IU/mL or 0.31 and 0.50IU/mL, and the corresponding APTT values were 40 to 55 seconds and 56 to 80 seconds, respectively. Pearson correlation was calculated between anti-Xa and APTT. Samples with in-range anti-Xa but prolonged APTT were analyzed for abnormalities in international normalized ratio (INR; ≥1.5) and/or fibrinogen (<1.5g/L). Mortality during Impella support was then compared in those with and without additional coagulation abnormalities (chi-squared test).Results: Correlation between anti-Xa and APTT was weak (r = 0.50, P < .001, N = 2447). When anti-Xa was in range (N = 1914 samples), 24% had short, 52% had in-range, and 24% had prolonged APTT. Of the 57 patients with prolonged APTT, 28 had abnormal same-day INR and/or fibrinogen, whereas 29 had normal fibrinogen and INR. Mortality was higher in patients with abnormal INR and/or fibrinogen than in those with normal fibrinogen and INR (32% vs 10%; P = .043).Conclusion: Anti-Xa/APTT discrepancies are frequent during percutaneous mechanical circulatory support for CS, highlighting the importance of a multiple testing strategy. Outcomes of patients with prolonged APTT were related to the presence of abnormal INR and/or fibrinogen, suggesting a serious concomitant underlying disease.","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.5000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Discrepancy between parallel anti-Xa and activated partial thromboplastin time is related to mortality in patients with Impella-supported cardiogenic shock.\",\"authors\":\"Charlotte J Van Edom, Francesca Fiorelli, Tim Balthazar, Maria Monteagudo-Vela, Thomas Vanassche, Vasileios F Panoulas, Christophe Vandenbriele\",\"doi\":\"10.1016/j.jtha.2025.02.028\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Managing unfractionated heparin (UFH) during percutaneous mechanical circulatory support for cardiogenic shock (CS) is challenging due to potential discrepancies between coagulation tests.Objectives: To study the causes and consequences of discrepancies between anti-Xa and activated partial thromboplastin time (APTT) for UFH monitoring during microaxial flow pump support (Impella) for CS.Methods: We assessed patients in CS supported with Impella in 2 tertiary care centers over 62 months. UFH was titrated based on anti-Xa levels with parallel APTT measurements. In-range anti-Xa levels were considered between 0.20 and 0.30 IU/mL or 0.31 and 0.50IU/mL, and the corresponding APTT values were 40 to 55 seconds and 56 to 80 seconds, respectively. Pearson correlation was calculated between anti-Xa and APTT. Samples with in-range anti-Xa but prolonged APTT were analyzed for abnormalities in international normalized ratio (INR; ≥1.5) and/or fibrinogen (<1.5g/L). Mortality during Impella support was then compared in those with and without additional coagulation abnormalities (chi-squared test).Results: Correlation between anti-Xa and APTT was weak (r = 0.50, P < .001, N = 2447). When anti-Xa was in range (N = 1914 samples), 24% had short, 52% had in-range, and 24% had prolonged APTT. Of the 57 patients with prolonged APTT, 28 had abnormal same-day INR and/or fibrinogen, whereas 29 had normal fibrinogen and INR. Mortality was higher in patients with abnormal INR and/or fibrinogen than in those with normal fibrinogen and INR (32% vs 10%; P = .043).Conclusion: Anti-Xa/APTT discrepancies are frequent during percutaneous mechanical circulatory support for CS, highlighting the importance of a multiple testing strategy. Outcomes of patients with prolonged APTT were related to the presence of abnormal INR and/or fibrinogen, suggesting a serious concomitant underlying disease.\",\"PeriodicalId\":17326,\"journal\":{\"name\":\"Journal of Thrombosis and Haemostasis\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.5000,\"publicationDate\":\"2025-03-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Thrombosis and Haemostasis\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jtha.2025.02.028\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thrombosis and Haemostasis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jtha.2025.02.028","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景：在经皮机械循环支持（PMCS）治疗心源性休克（CS）期间管理未分离肝素（UFH）是具有挑战性的，因为凝血试验之间存在潜在的差异。目的：研究微轴流泵支持（Impella™）治疗CS期间uhf监测中抗xa和活化部分凝血活素时间（APTT）差异的原因和后果。患者/方法：我们评估了在两个三级医疗中心接受Impella™支持的CS患者超过62个月。通过平行APTT测量，根据抗xa水平对UFH进行滴定。范围内抗xa水平被认为在0.20-0.30IU/mL或0.31-0.50IU/mL之间，相应的APTT水平分别为40-55s和56-80s。计算抗xa与APTT之间的Pearson相关性。结果：抗xa和APTT之间的相关性很弱（r=0.50, p）。结论：抗xa /APTT差异在CS的pMCS期间很常见，强调了多重检测策略的重要性。延长APTT患者的预后与异常INR和/或纤维蛋白原的存在有关，提示有严重的伴有基础疾病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Discrepancy between parallel anti-Xa and activated partial thromboplastin time is related to mortality in patients with Impella-supported cardiogenic shock.

Background: Managing unfractionated heparin (UFH) during percutaneous mechanical circulatory support for cardiogenic shock (CS) is challenging due to potential discrepancies between coagulation tests.

Objectives: To study the causes and consequences of discrepancies between anti-Xa and activated partial thromboplastin time (APTT) for UFH monitoring during microaxial flow pump support (Impella) for CS.

Methods: We assessed patients in CS supported with Impella in 2 tertiary care centers over 62 months. UFH was titrated based on anti-Xa levels with parallel APTT measurements. In-range anti-Xa levels were considered between 0.20 and 0.30 IU/mL or 0.31 and 0.50IU/mL, and the corresponding APTT values were 40 to 55 seconds and 56 to 80 seconds, respectively. Pearson correlation was calculated between anti-Xa and APTT. Samples with in-range anti-Xa but prolonged APTT were analyzed for abnormalities in international normalized ratio (INR; ≥1.5) and/or fibrinogen (<1.5g/L). Mortality during Impella support was then compared in those with and without additional coagulation abnormalities (chi-squared test).

Results: Correlation between anti-Xa and APTT was weak (r = 0.50, P < .001, N = 2447). When anti-Xa was in range (N = 1914 samples), 24% had short, 52% had in-range, and 24% had prolonged APTT. Of the 57 patients with prolonged APTT, 28 had abnormal same-day INR and/or fibrinogen, whereas 29 had normal fibrinogen and INR. Mortality was higher in patients with abnormal INR and/or fibrinogen than in those with normal fibrinogen and INR (32% vs 10%; P = .043).

Conclusion: Anti-Xa/APTT discrepancies are frequent during percutaneous mechanical circulatory support for CS, highlighting the importance of a multiple testing strategy. Outcomes of patients with prolonged APTT were related to the presence of abnormal INR and/or fibrinogen, suggesting a serious concomitant underlying disease.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.