Progressive increase in D-dimer levels during extracorporeal membrane oxygenation can predict membrane oxygenator failure in children given hematopoietic stem cell transplantation?

Nardo, Matteo Di; Merli, Pietro; Cecchetti, Corrado; Pasotti, Elisabetta; Bertaina, Alice; Locatelli, Franco

doi:10.1016/j.jcrc.2015.09.010

Cited by 9 publications

(15 citation statements)

References 3 publications

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“…In small retrospective studies, increase in d-dimer in particular has been shown to be an early predictor of membrane oxygenator failure. [73][74][75] In conclusion, the current data and practices developed through decades of experience suggest that anticoagulation should be used for most ECMO patients, although there are some clear differences between children and adults. Thrombosis and hemorrhagic management during ECMO should be tailored to the individual patient and condition being supported by ECMO.…”

Section: Hemorrhage and Thrombosismentioning

confidence: 95%

2021 ELSO Adult and Pediatric Anticoagulation Guidelines

et al. 2022

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Disclaimer: These guidelines for adult and pediatric anticoagulation for extracorporeal membrane oxygenation are intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing ECLS / ECMO and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgment, knowledge and expertise. These guidelines do not take the place of physicians’ and other health professionals’ judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but ELSO is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.

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Section: Hemorrhage and Thrombosismentioning

confidence: 95%

2021 ELSO Adult and Pediatric Anticoagulation Guidelines

et al. 2022

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“…A small number of papers have recently been published regarding the use of D-dimer to predict membrane dysfunction in patients on ECMO. [343536] Membrane failure is a common technical problem that necessitates changes to the ECMO circuit. Based on the literature, it appears well established in the ECMO community that D-dimer is a useful marker to help predict membrane oxygenator failure and plan the needed technical intervention to repair the problem.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the literature, it appears well established in the ECMO community that D-dimer is a useful marker to help predict membrane oxygenator failure and plan the needed technical intervention to repair the problem. [343536]…”

Section: Discussionmentioning

confidence: 99%

Order Indication Solicitation to Assess Clinical Laboratory Test Utilization: D-Dimer Order Patterns as an Illustrative Case

Rudolf

Baron

Dighe

2019

Journal of Pathology Informatics

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Background:A common challenge in the development of laboratory clinical decision support (CDS) and laboratory utilization management (UM) initiatives stems from the fact that many laboratory tests have multiple potential indications, limiting the ability to develop context-specific alerts. As a potential solution, we designed a CDS alert that asks the ordering clinician to provide the indication for testing, using D-dimer as an exemplar. Using data collected over a nearly 3-year period, we sought to determine whether the indication capture was a useful feature within the CDS alert and whether it provided actionable intelligence to guide the development of an UM strategy.Methods:We extracted results and ordering data for D-dimer testing performed in our laboratory over a 35-month period. We analyzed order patterns by clinical indication, hospital service, and length of hospitalization.Results:Our final data set included 13,971 result-order combinations and indeed provided actionable intelligence regarding test utilization patterns. For example, pulmonary embolism was the most common emergency department indication (86%), while disseminated intravascular coagulation was the most common inpatient indication (56%). D-dimer positivity rates increased with the duration of hospitalization and our data suggested limited utility for ordering this test in the setting of suspected venous thromboembolic disease in admitted patients. In addition, we found that D-dimer was ordered for unexpected indications including the assessment of stroke, dissection, and extracorporeal membrane oxygenation.Conclusions:Indication capture within a CDS alert and correlation with result data can provide insight into order patterns which can be used to develop future CDS strategies to guide appropriate test use by clinical indication.

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“…62,63 Bleeding is an important complication of ECMO that often limits its potential benefits; therefore, strict haemostatic balance should be achieved. 64,65 Generally, according to the ELSO criteria, 65,66 platelet counts should be maintained between 80 000/µL and 100 000/µL to reduce the risk of bleeding during ECMO; however, this target could be infeasible in patients receiving HCT because of their haematological status. 25 Therefore, clinical situations of refractory thrombocytopenia should be evaluated with extreme caution before considering ECMO (weak recommendation).…”

Section: Use Of Ecmo In Paediatric Long-term Survivors After Hctmentioning

confidence: 99%

“…The achievement of these goals is complex and requires a strict and individualised management of platelet count and all other clotting parameters (ie, activated clotting time, activated partial thromboplastin time, prothrombin time, anti-Factor Xa, fibrin ogen concentration, and d-dimer concentration). 64,65 Unfortunately, data in neonatal and paediatric patients receiving ECMO suggest that laboratory measurements of anticoagulation such as activated clotting time, activated partial thromboplastin time, and anti-Factor Xa levels are unable to predict the risk of bleeding or thrombosis during ECMO; further, they correlated poorly with each other and with the dose of anticoagulant used (eg, heparin). 110 Thus, many clinicians are adopting viscoelastic tests such as rotational thromboelastometry or thromboelastography to stratify the risk of bleeding.…”

Section: Reviewmentioning

confidence: 99%