Journal
AMERICAN JOURNAL OF THERAPEUTICS
Volume 29, Issue 4, Pages E385-E393Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MJT.0000000000001113
Keywords
extracorporeal membrane oxygenation; anticoagulant; assay; unfractionated heparin
Categories
Ask authors/readers for more resources
This study retrospectively analyzed the monitoring strategies for anticoagulation management in adult ECMO patients. The results showed that monitoring of anti-Xa and aPTT were more closely correlated with UFH dosing.
Background: The optimal monitoring strategy for anticoagulation management in extracorporeal membrane oxygenation (ECMO) remains a clinical controversy. The Extracorporeal Life Support Organization Anticoagulation Guidelines suggest that multiple anticoagulation assays may be needed but do not specify a preferred management strategy. Study Question: In adult ECMO patients, which anticoagulation assays demonstrate the highest correlation with unfractionated heparin (UFH) dose requirements? Study Design: We performed a retrospective chart review of adult patients cannulated to ECMO between February 2013 and July 2015. Measures and Outcomes: The primary outcome was the correlation between activated clotting time (ACT), activated partial thromboplastin time (aPTT), and anti-Xa and UFH dose. Secondary outcomes included correlations between anticoagulation assays. Correlations were calculated for the entire cohort, with subgroup analysis of venoarterial and venovenous ECMO patients. Results: Forty-eight patients were included in the analysis, 26 initially cannulated to venoarterial ECMO and 22 to veno-venous ECMO. The median duration of ECMO therapy was 7 days. Mean UFH requirements were 1149 units/h or 15.3 units/kg/h. Total UFH dose was most correlated with anti-Xa levels (r = 0.467), whereas weight-based heparin dose was most correlated with aPTT (0.405). For correlations between anticoagulation assays, anti-Xa and aPTT were more highly correlated with each other (r = 0.633) compared with ACT. Conclusions: In adult patients requiring ECMO, anti-Xa and aPTT monitoring were correlated more closely with UFH dosing than ACT.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available