Age-Based Difference in Activation Markers of Coagulation and Fibrinolysis in Extracorporeal Membrane Oxygenation

Hundalani, Shilpa G; Nguyen, Kim T.; Soundar, Esther; Kostousov, Vadim; Bomgaars, Lisa; Moïse, Alicia A.; Hui, Shiu‐Ki Rocky; Teruya, Jun

doi:10.1097/pcc.0000000000000107

Cited by 41 publications

(32 citation statements)

References 30 publications

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“…Some evidence suggests even if the heparin anti-FXa activity is within the target range, there is still significant activation of coagulation, detected by elevated markers such as thrombinantithrombin complex and prothrombin fragment 1.2 during ECMO. 36 This shows an additional limitation of anticoagulation by heparin.…”

Section: Coagulopathymentioning

confidence: 98%

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Thomas

Kostousov

Teruya

2017

Semin Thromb Hemost

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220

197

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Extracorporeal membrane oxygenation (ECMO) has been used for >40 years to support lung and heart failure; however, bleeding and thrombosis remain serious complications. The known etiologies of bleeding include heparin effect or overdose, coagulopathy, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis. Bleeding sites may include cannula insertion sites, recent surgical incisions, vascular access sites, lung, gastrointestinal tract, mouth, nose, thoracic cavity, abdominal cavity, and brain. Massive bleeding in the brain, the most feared bleeding complication, can be rapidly fatal because it occurs in a rigid closed space, is difficult to drain, and cannot be stopped with direct pressure to the bleeding site. Pulmonary hemorrhage may cause irreversible lung damage. Management should be swift and precise to prevent fatal bleeding. In contrast, etiologies of thrombosis include high fibrinogen and factor VIII levels, heparin resistance, and platelet activation. Achieving the optimal anticoagulation balance to prevent bleeding and thrombosis in ECMO patients is extremely complex. Experts in hemostasis should be a part of an institutional ECMO team and continuously available for immediate management.

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Section: Coagulopathymentioning

confidence: 98%

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Thomas

Kostousov

Teruya

2017

Semin Thromb Hemost

Self Cite

220

197

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“…23 Plasmin-antiplasmin complex (PAP) is a sensitive marker for fibrinolysis, and in ECMO patients younger than 30 days, PAP is significantly elevated on day 5 compared with day 1 of ECMO. 83…”

Section: Acquired Von Willebrand Syndromementioning

confidence: 99%

Hemostatic Management of Extracorporeal Circuits Including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation

Fang

Navaei

Hensch

et al. 2019

Semin Thromb Hemost

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Cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO) cause hemostatic derangements that can predispose patients to both bleeding and thrombotic complications. Often, patients present for urgent surgery while taking medications including antiplatelet agents, vitamin K antagonists, and direct oral anticoagulants, which must be recognized, monitored, and managed. During extracorporeal circulation, appropriate anticoagulation, most commonly with heparin, is required to maintain blood flow and avoid thrombotic complications. However, anticoagulation and other effects of extracorporeal circuits can also have an undesired consequence of bleeding. Extracorporeal circulation leads to coagulopathy that may require therapy with blood products such as platelets, cryoprecipitate, and plasma in case a patient bleeds. Platelet dysfunction related to exposure to a foreign circuit is a primary concern, as is the development of acquired von Willebrand syndrome, which frequently remains undetected on routine testing. Hemorrhagic complications in ECMO, such as intracranial hemorrhage, pulmonary hemorrhage, and hemithorax, can occur. Hemostatic agents including antifibrinolytics, desmopressin, fibrinogen concentrates, and other factor concentrates may be needed to achieve hemostasis in these often-challenging patients. Managing bleeding on extracorporeal support requires careful monitoring and a thoughtful approach.

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“…Bedside tests such as TEG or Rotem are increasingly being evaluated. Exposure to the foreign surface of the ECMO circuits only accentuates the existing coagulopathy with further consumption of clotting factors and platelets (78,79). Future biocompatible materials might limit the need for systemic anticoagulation or antiplatelet agents on ECMO limiting transfusion requirements and hemorrhagic or thrombotic events.…”

Section: Anticoagulation Is More Complex Than In Children/adolescentsmentioning

confidence: 99%

ECMO for Neonatal Sepsis in 2019

Butt

Chiletti

2020

Front. Pediatr.

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Sepsis and septic shock in newborns causes mortality and morbidity depending on the organism and primary site. ECMO provides cardiorespiratory support to allow adequate organ perfusion during the time for antibiotics and source control surgery (if needed) to occur. ECMO mode and cannulation site vary depending on support required and local preference. Earlier and more aggressive use of ECMO can improve survival.

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Age-Based Difference in Activation Markers of Coagulation and Fibrinolysis in Extracorporeal Membrane Oxygenation

Cited by 41 publications

References 30 publications

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Bleeding and Thrombotic Complications in the Use of Extracorporeal Membrane Oxygenation

Hemostatic Management of Extracorporeal Circuits Including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation

ECMO for Neonatal Sepsis in 2019

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