Anticoagulation treatment during extracorporeal membrane oxygenation (ECMO) treatment is unavoidable. However, discontinuation of heparin infusion is necessary when challenges associated with the use of heparin, such as bleeding and thrombocytopenia, are encountered. The medical records of 94 adult (age ≥ 18 years) patients treated with ECMO from January 2011 to March 2015, at Chung-Ang University Hospital, Seoul, Korea, were reviewed. Among the 94 patients, 55 patients underwent ECMO treatment for three or more days. In 52.7% of these patients (n = 29, group A), heparin was stopped for three or more days because of thrombocytopenic events (< 50,000 cells/mm), higher than target range (> 230 seconds) activated clotting time (ACT), bleeding complications, or the need for other surgical procedures. In 43.6% of patients (n = 24, group B), heparin was continuously infused during the entire ECMO process. The mean length of ECMO support after the initiation of heparin discontinuation in patients in group A was 10.2 ± 14.7 days. There were no intracardiac, intravascular, or intracircuit thrombotic complications in group A. There was no difference in the ECMO weaning success rate between the two groups (41.4% in group A vs. 54.2% in group B, p = 0.353). Heparin discontinuation can be considered in a select group of patients with coagulation abnormalities or bleeding.
Background: Red cell distribution width (RDW) is a novel prognostic marker independently associated with adverse outcomes in acute decompensated heart failure (ADHF) patients. The aim of the present study was to assess whether the change in RDW after discharge had prognostic value in patients with ADHF.Methods and Results: RDW was measured in 261 patients admitted with ADHF, at admission and at discharge and 1 month after discharge. Cardiovascular (CV) events were defined as CV mortality and heart failure rehospitalization. Kaplan-Meier analysis showed that patients with positive RDW change between admission and 1 month after discharge (RDW∆1Mdis-adm; n=136) had a significantly higher number of CV events compared with patients with no positive RDW∆1Mdis-adm (n=125; 60.3% vs. 47.2%, log-rank: P=0.007). On Cox hazards analysis, a positive RDW∆1Mdis-adm was an independent predictor of CV events after adjusting for other CV risk factors (hazard ratio, 1.740; 95% confidence interval: 1.149-2.633, P=0.009). Conclusions:A novel relationship was noted between positive RDW∆1Mdis-adm and CV events in ADHF patients. Measurement of RDW at 1 month after ADHF assists in the prediction of adverse CV outcomes. Therefore, repeated measurement of RDW is a simple and inexpensive method that may facilitate assessment of CV risk stratification in patients with ADHF. Methods PatientsWe retrospectively investigated consecutive patients who visited the emergency department (ED) of Severance Cardiovascular Hospital, Seoul, Korea between January 2005 and June 2009 with clinical diagnosis (rale or generalized edema or pulmonary congestion) of ADHF and left ventricular ejection fraction (LVEF) <50%) measured on transthoracic echocardiography using Simpson's biplane rule within 24 h. Two-dimensional echocardiography and RDW measured at admission, at discharge and 1 month after discharge were available for 261 patients. Patients with known hematologic diseases such as hemolytic anemia, neoplastic metastases to bone marrow, pregnancy, severe arthritis, inflammatory bowel diseases and transfusion, iron replacement therapy, which can increase plasma RDW levels, and other extracellular fluid-increasing diseases (eg, hypothyroidism and liver cirrhosis) were excluded. Measurements of Blood Chemistry and RDWPatients had venous blood collected for measurement of routine blood chemistry and NT-proBNP at admission. The blood samples were tested with NT-proBNP, which was kept at 4°C, using an electrochemiluminescence immunoassay (Elecsys proBNP; Roche Diagnostics, Basel, Switzerland) within 1 h of ED visit. RDW was measured using the Coulter STK-S analyzer (Coulter, FL, USA) in the Severance Cardiovascular Hospital, laboratory. RDWadm was defined as RDW at admission; RDWdis as RDW at discharge; RDW1Mdis as RDW 1 month after discharge. The change in RDW between admission and discharge (RDW∆dis-adm) was calculated as RDWdisRDWadm, and that between admission and 1 month after discharge (RDW∆1Mdis-adm) as RDW1Mdis-RDWadm. The change in hemoglobin (Hb) bet...
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