Efficacy and safety of argatroban in patients with acute respiratory distress syndrome and extracorporeal lung support
| Autor: | David Schwaiberger, Christian Pille, Steffen Weber-Carstens, Martina Gassner, Mario Menk, Bjoern Weiss, Anton Goldmann, Philipp Briem |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
ARDS
medicine.drug_class medicine.medical_treatment 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine 600 Technik Medizin angewandte Wissenschaften::610 Medizin und Gesundheit Extracorporeal Argatroban 03 medical and health sciences 0302 clinical medicine Severity of illness Extracorporeal membrane oxygenation Medicine medicine.diagnostic_test business.industry Research Anticoagulant lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 Heparin medicine.disease Anesthesia ECMO business Partial thromboplastin time medicine.drug |
| Zdroj: | Annals of Intensive Care Annals of Intensive Care, Vol 7, Iss 1, Pp 1-12 (2017) |
| Popis: | Background Extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (pECLA) requires effective anticoagulation. Knowledge on the use of argatroban in patients with acute respiratory distress syndrome (ARDS) undergoing ECMO or pECLA is limited. Therefore, this study assessed the feasibility, efficacy and safety of argatroban in critically ill ARDS patients undergoing extracorporeal lung support. Methods This retrospective analysis included ARDS patients on extracorporeal lung support who received argatroban between 2007 and 2014 in a single ARDS referral center. As controls, patients who received heparin were matched for age, sex, body mass index and severity of illness scores. Major and minor bleeding complications, thromboembolic events, administered number of erythrocyte concentrates, thrombocytes and fresh-frozen plasmas were assessed. The number of extracorporeal circuit systems and extracorporeal lung support cannulas needed due to clotting was recorded. Also assessed was the efficacy to reach the targeted activated partial thromboplastin time (aPTT) in the first consecutive 14 days of therapy, and the controllability of aPTT values is within a therapeutic range of 50–75 s. Fisher’s exact test, Mann–Whitney U tests, Friedman tests and multivariate nonparametric analyses for longitudinal data (MANOVA; Brunner’s analysis) were applied where appropriate. Results Of the 535 patients who met the inclusion criteria, 39 receiving argatroban and 39 matched patients receiving heparin (controls) were included. Baseline characteristics were similar between the two groups, including severity of illness and organ failure scores. There were no significant differences in major and minor bleeding complications. Rates of thromboembolic events were generally low and were similar between the two groups, as were the rates of transfusions required and device-associated complications. The controllability of both argatroban and heparin improved over time, with a significantly increasing probability to reach the targeted aPTT corridor over the first days (p |
| Databáze: | OpenAIRE |
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