Evaluation of a pharmacy managed heparin protocol for extracorporeal membrane oxygenation patients

Fitousis, Kalliopi; Klasek, Robin; Mason, Phillip E.; Masud, Faisal

doi:10.1177/0267659116678057

Cited by 20 publications

(6 citation statements)

References 22 publications

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“…However, when viewing the large variety of tests used, it is not surprising that results are conflicting. While in some investigations a good correlation between both tests was found, a weak correlation was reported in some other investigations (19)(20)(21).…”

Section: Monitoring Of Anticoagulation With Ufhmentioning

confidence: 83%

Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation

Koster¹,

Ljajikj²,

Faraoni³

2019

Ann. Cardiothorac. Surg.

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Unfractionated heparin (UFH) is the anticoagulant of choice during extracorporeal membrane oxygenation (ECMO) support. Despite its favorable pharmacologic properties, management of heparin anticoagulation during ECMO remains a major challenge. To date, little is known about the optimal monitoring strategy or the heparin dose offering the best safety/efficacy profile. Therefore, it remains unclear if the heparin dose should be adapted to target a specific "clotting time" [e.g., activated clotting time (ACT) or activated partial thromboplastin time (aPTT)] or a heparin concentration, measured by coagulation factor anti-Xa assay. In addition, no study has compared the relevance of modern viscoelastic coagulation tests over the single value of a clotting time or heparin concentration value. Although guidelines for anticoagulation during ECMO support have been published, the absence of evidence limits the quality of the recommendations provided, which explains the major intra-and inter-institutional variability observed. Large prospective multicenter trials are urgently needed to investigate the optimal anticoagulation management strategy during ECMO support.

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Section: Monitoring Of Anticoagulation With Ufhmentioning

confidence: 83%

Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation

Koster¹,

Ljajikj²,

Faraoni³

2019

Ann. Cardiothorac. Surg.

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“…While there is no evidence on the ECLS anticoagulation strategies, the superior controllability and worldwide experience over decades lead unfractionated heparin as the anticoagulant of choice, frequently controlled by partial thromboplastin time or the activated clotting time measurements, thromboelastometry or factor Xa analysis. 35 , 36 , 37 …”

Section: Resultsmentioning

confidence: 99%

Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure –A clinical practice Guideline Level 3

et al. 2021

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Aims Worldwide applications of extracorporeal circulation for mechanical support in cardiac and circulatory failure, which are referred to as extracorporeal life support (ECLS) or veno‐arterial extracorporeal membrane oxygenation (va‐ECMO), have dramatically increased over the past decade. In spite of the expanding use and the immense medical as well as socio‐economic impact of this therapeutic approach, there has been a lack of interdisciplinary recommendations considering the best available evidence for ECLS treatment. Methods and Results In a multiprofessional, interdisciplinary scientific effort of all scientific societies involved in the treatment of patients with acute cardiac and circulatory failure, the first evidence‐ and expert consensus‐based guideline (level S3) on ECLS/ECMO therapy was developed in a structured approach under regulations of the AWMF (Association of the Scientific Medical Societies in Germany) and under use of GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. This article presents all recommendations created by the expert panel, addressing a multitude of aspects for ECLS initiation, continuation, weaning and aftercare as well as structural and personnel requirements. Conclusions This first evidence‐ and expert consensus‐based guideline (level S3) on ECLS/ECMO therapy should be used to apply the best available care nationwide. Beyond clinical practice advice, remaining important research aspects for future scientific efforts are formulated.

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“…[57][58][59][60][61][62][63] However, the anticoagulation goal and frequency of monitoring may vary according to the desired intensity of anticoagulation and center-specific protocols. 56,[64][65][66][67][68][69][70][71][72][73] Antithrombin III (ATIII) levels should also be monitored occasionally, with levels maintained >50%. In situations where UFH cannot be used, anticoagulation for ECMO has been achieved using direct thrombin inhibitors.…”

Section: Anti Coag Ul Ati Onmentioning

confidence: 99%

Continuous renal replacement therapy in patients treated with extracorporeal membrane oxygenation

Selewski

Wille

2021

Seminars in Dialysis

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Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy utilized for patients of all ages with severe life-threatening cardiopulmonary failure. 1 The indications for ECMO include reversible conditions with a high predicted mortality of ≥80%. Although ECMO was originally developed as a rescue therapy for neonates with respiratory failure, in recent years the number of adults placed on ECMO has surpassed the number of pediatric and neonatal patients combined. [1][2][3] Patients treated with ECMO represent the sickest patients encountered in critical care and are at highrisk of developing multiple organ dysfunction and associated sequelae, including acute kidney injury (AKI) and fluid overload (FO). Continuous renal replacement therapy (CRRT) is being increasinglyutilized in patients on ECMO to manage AKI, prevent and treat FO. This review will summarize our current understanding of the epidemiology and impact of AKI, indications and timing for CRRT, delivery of CRRT, and the outcomes associated with CRRT for patients on ECMO.

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Evaluation of a pharmacy managed heparin protocol for extracorporeal membrane oxygenation patients

Abstract: There was a similar rate of thrombotic and bleeding events between the two study groups. A pharmacy managed heparin protocol utilizing aPTT monitoring appears to be a safe and effective method of providing anticoagulation in adult ECMO patients.

Cited by 20 publications

References 22 publications

Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation

Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation

Use of extracorporeal circulation (ECLS/ECMO) for cardiac and circulatory failure –A clinical practice Guideline Level 3

Continuous renal replacement therapy in patients treated with extracorporeal membrane oxygenation

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