Low-dose heparin during extracorporeal membrane oxygenation treatment in adults

Yeo, Hye Ju; Kim, Do-Hyung; Jeon, Doosoo; Kim, Yun Seong; Cho, Woo Hyun

doi:10.1007/s00134-015-4015-7

Cited by 59 publications

(65 citation statements)

References 4 publications

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“…As a matter of fact, incidence of bleeding complications in our study was lower than reported in other case series [30]. This might be explained by the mechanism of action of PC.…”

Section: Key Findingscontrasting

confidence: 55%

Protein C zymogen in severe sepsis: a double-blinded, placebo-controlled, randomized study

et al. 2016

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“…As a matter of fact, incidence of bleeding complications in our study was lower than reported in other case series [30]. This might be explained by the mechanism of action of PC.…”

Section: Key Findingscontrasting

confidence: 55%

Protein C zymogen in severe sepsis: a double-blinded, placebo-controlled, randomized study

et al. 2016

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“…Because of this need for anticoagulation, ECMO introduces the risk of serious, sometimes fatal, bleeding complications [10-14]. While the development of biocompatible ECMO circuit components in the past decade have allowed for the use of lower levels of anticoagulation, clinically significant hemorrhagic complications still occur, albeit less frequently than in the past [9, 15-18]. …”

Section: Introductionmentioning

confidence: 99%

Thrombocytopenia and extracorporeal membrane oxygenation in adults with acute respiratory failure: a cohort study

et al. 2016

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Purpose The association between extracorporeal membrane oxygenation (ECMO) use and the development of thrombocytopenia is widely presumed yet weakly demonstrated. We hypothesized that longer duration of ECMO support would be independently associated with worsened thrombocytopenia. Methods We performed a single-center retrospective cohort study of 100 adults who received ECMO for acute respiratory failure. We used generalized estimating equations to test the association between days on ECMO and daily percentage of platelets compared to the first post-cannulation platelet count. We constructed a multivariable logistic regression model with backwards stepwise elimination to identify clinical predictors of severe thrombocytopenia (≤ 50,000/μL) while on ECMO. Results Days on ECMO was not associated with a decrease in platelet count in the unadjusted analysis (β: -0.85, 95% CI: -2.05 to 0.36), nor after controlling for days hospitalized prior to ECMO, APACHE II score, platelet transfusions, and potential thrombocytopenia-inducing medications (β: -0.85, 95% CI: -1.9 to 0.22). Twenty-two subjects (22%) developed severe thrombocytopenia. The APACHE II score and platelet count at the time of cannulation predicted the development of severe thrombocytopenia. The odds of developing severe thrombocytopenia increased 35% for every 5-point increase in APACHE II score (OR 1.35, 95% CI: 0.94 to 1.94), and increased 35% for every 25,000/μL platelets below a mean at cannulation of 188,000/μL (OR 1.35, 95% CI: 1.10 to 1.64). Conclusions Duration of ECMO is not associated with the development of thrombocytopenia. The severity of critical illness and platelet count at the time of cannulation predict the development of severe thrombocytopenia while receiving ECMO for respiratory failure. Future studies should validate these findings, especially in cohorts with more venoarterial ECMO patients, and should characterize the association between thrombocytopenia and bleeding events while on ECMO.

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“…An observational study of 61 patients treated with venovenous ECMO and subcutaneous prophylactic anticoagulation only reported no fatal thrombotic events, while incidence of clinically relevant bleeding and consumption of blood transfusions were lower in comparison to current data . Similar results were found in a patient population on unfractionated heparin with lower target ACT of 140‐160 seconds instead of the recommended 180‐220 seconds . Only few case descriptions report on the use of venovenous ECLS without anticoagulation.…”

Section: Discussionmentioning

confidence: 55%

“…22 Similar results were found in a patient population on unfractionated heparin with lower target ACT of 140-160 seconds instead of the recommended 180-220 seconds. 23 Only few case descriptions report on the use of venovenous ECLS without anticoagulation. In highly selected patients such as trauma victims with hemorrhagic tendency or ongoing bleed ing, heparin-free extracorporeal therapy seems to be a con siderable option for initial 24,25 or long-term 26 extracorporeal respiratory or circulatory support.…”

Section: Discussionmentioning

confidence: 99%

ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

et al. 2019

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Severe thrombocytopenia poses a high risk for bleeding thus representing a relative contraindication for anticoagulation and therefore extracorporeal membrane oxygenation (ECMO). We herein report on a series of immunocompromised patients with severe thrombocytopenia undergoing long‐term ECMO without systemic anticoagulation. We retrospectively identified seven adult patients with anticoagulation withdrawal for ≥3 days (range 5–317) during venovenous ECMO therapy due to thrombocytopenia < 50 G/L treated in a university‐affiliated hospital from January 2013 to April 2017. All ECMO systems used were heparin coated. Overall, 530 ECMO days were observed, 404 (76%) of them without systemic anticoagulation. Platelet count during ECMO treatment was 24 G/L (median, range 1‐138), ECMO duration was 35 days (5‐317), and ECMO was run without any anticoagulation for 20 days (5‐317). Altogether, five clotting events were seen leading to oxygenator exchanges. Bleeding was common including one fatal intracerebral hemorrhage. Altogether, 29 platelet concentrates per patient (7‐207) were administered, which correspond to 0.8 per day (0.6‐1.3). One patient survived ICU and hospital. In patients with thrombocytopenia, ECMO can be run without anticoagulation even for considerably long periods of time. Bleeding remains common, while clotting events seem to be rare. However, prognosis of this patient population undergoing ECMO support seems grim.

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Low-dose heparin during extracorporeal membrane oxygenation treatment in adults

Cited by 59 publications

References 4 publications

Protein C zymogen in severe sepsis: a double-blinded, placebo-controlled, randomized study

Protein C zymogen in severe sepsis: a double-blinded, placebo-controlled, randomized study

Thrombocytopenia and extracorporeal membrane oxygenation in adults with acute respiratory failure: a cohort study

ECMO without anticoagulation in patients with disease‐related severe thrombocytopenia: Feasible but futile?

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