A case of antithrombin replacement using recombinant human antithrombin in an adult patient supported with extracorporeal membrane oxygenation

Lavandosky, Gerald

doi:10.1002/ccr3.312

Cited by 5 publications

(3 citation statements)

References 10 publications

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“…72,73 On the other side, in an adult patient with V-V ECMO support for respiratory failure, the AT activity level was 47%, and the heparin dosage to reach an ACT 160-180 was 15 U/kg/h. 74 Moreover, in patients on ECMO, the definition of heparin resistance lacks consensus, but Northrop et al set it at 60 U/kg/h, so while 15 U/kg/h is a value that we can consider normal, the target ACT value in this study was lower.…”

Section: Effects On Anticoagulationmentioning

confidence: 69%

A narrative review of antithrombin use during veno-venous extracorporeal membrane oxygenation in adults: rationale, current use, effects on anticoagulation, and outcomes

et al. 2020

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Background: During extracorporeal membrane oxygenation, the large contact surface between the blood and the extracorporeal circuit causes a continuous activation of coagulation and inflammation. Unfractionated heparin, a glycosaminoglycan that must bind to antithrombin as a cofactor, is currently the standard anticoagulant adopted during extracorporeal membrane oxygenation. Antithrombin, beyond being a potent natural anticoagulant, acts in the cross-talk between coagulation and inflammatory system through anticoagulation and coagulation-independent effects. Objectives: In this review, we describe, in the adult setting of veno-venous extracorporeal membrane oxygenation, the pathophysiological rationale for antithrombin use, the current practice of administration, and the effects of antithrombin on anticoagulation, bleeding, and outcomes. Data sources: Studies on adults (18 years or older) on veno-venous extracorporeal membrane oxygenation published from 1995 to 2018 in order to evaluate the use of antithrombin. Results: In adults on veno-venous extracorporeal membrane oxygenation, antithrombin supplementation has a highly pathophysiological rationale since coagulation factor consumption, systemic inflammatory response syndrome, and endothelial activation are triggered by extracorporeal membrane oxygenation. Eleven articles are focused on the topic but among the authors there is no consensus on the threshold for supplementation (ranging from 70% to 80%) as well as on the dose (rarely standardized) and time of administration (bolus vs continuous infusion). Consistently, antithrombin is considered able to achieve better anticoagulation targets in or not in the presence of heparin resistance. The impact of antithrombin administration on bleeding still shows contrasting results. Conclusion: Antithrombin use in veno-venous extracorporeal membrane oxygenation should be investigated on the threshold for supplementation, dose, and time of administration.

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Section: Effects On Anticoagulationmentioning

confidence: 69%

A narrative review of antithrombin use during veno-venous extracorporeal membrane oxygenation in adults: rationale, current use, effects on anticoagulation, and outcomes

et al. 2020

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“…As plasma transfusions only marginally increase AT levels, some authors have evaluated the effect of AT concentrates. They have shown that AT concentrates can efficiently increase AT levels as they cause less hemodilution . This has mostly been evaluated in extracorporeal membrane oxygenation (ECMO), another clinical situation with a potential imbalance between pro‐ and anticoagulant factors, in which there is possibly some value in correcting low AT levels .…”

Section: Discussionmentioning

confidence: 99%

Effects of plasma transfusions on antithrombin levels after paediatric liver transplantation

Arni

Wildhaber²,

Mclin³

et al. 2018

Vox Sanguinis

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“…[101] Attention has focused on singlenucleotide polymorphisms (SNPs) of genes that encode two proteins: the cytochrome P450 2C9 enzyme and vitamin K epoxide reductase complex (VKORC1). [102] Studies suggest that CYP 2C9 influences warfarin metabolism and affects warfarin half-life, whereas VKORC1 plays a role in the pharmacodynamic response in expression of the enzymatic target of warfarin. For instance, patients who carry CYP 2C9*2 and CYP 2C9*3 alleles tend to require lower warfarin maintenance doses because of their slowed metabolism compared with patients who carry the "wild-type" allele.…”

Section: Current State Of Systemic Anticoagulation Usagementioning

confidence: 99%

Achieving Totally Local Anticoagulation on Blood Contacting Devices

Gbyli

Mercaldi

Sundaram

et al. 2017

Adv Materials Inter

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The recent years have witnessed an increased activity in biocompatibility research aimed at limiting biomaterial-induced blood coagulation. From 2008 to 2016, a total of $36,946,764.00 USD was awarded in grants to 213 research proposals and as large as 50.4% ($18,627,854.00) of that award monies were distributed to 101 proposals over the fiscal years of FY14 to FY16 alone. However, the complexity in blood responses to biomaterials, variability in blood function between individuals and animal species, and differences in medical device application and test setting all continue to pose difficulties in making a breakthrough in this field. This review focuses on the remaining challenges in the context of biomaterial surface interaction with blood, biomaterial properties and their influence on coagulation, old and new surface anticoagulation methods, main test systems (complement and platelet function) for evaluating those methods, limitations of modification techniques, and the current state of systemic anticoagulation usage as adjunctive therapy for controlling blood coagulation on biomaterials. Finally, we propose ingredients necessary for advancing the field towards achieving totally local surface anticoagulation on blood contacting devices including standardization of in vitro and in-vivo test methods. Some highlights of recent forwardlooking work and articles on local anticoagulation are also presented.

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A case of antithrombin replacement using recombinant human antithrombin in an adult patient supported with extracorporeal membrane oxygenation

Abstract: Key Clinical MessageIn the critically ill patient on extracorporeal life support, antithrombin production and activity can be decreased and may require replacement to therapeutic levels in order to maintain appropriate anticoagulation and prevent thrombosis.

Cited by 5 publications

References 10 publications

A narrative review of antithrombin use during veno-venous extracorporeal membrane oxygenation in adults: rationale, current use, effects on anticoagulation, and outcomes

A narrative review of antithrombin use during veno-venous extracorporeal membrane oxygenation in adults: rationale, current use, effects on anticoagulation, and outcomes

Effects of plasma transfusions on antithrombin levels after paediatric liver transplantation

Achieving Totally Local Anticoagulation on Blood Contacting Devices

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