2018
DOI: 10.1186/s13613-017-0352-8 View full text |Buy / Rent full text
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Abstract: BackgroundThere is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO is currently burdened by a high rate of hemostatic complications, possibly associated with inadequate monitoring of heparin anticoagulation. This study aims to assess the safety and feasibility of an anticoagulation protocol for patients undergoing ECMO based on thromboelastography (TEG) as opposed to an activated partial thromboplastin time (aPTT)-based protocol.MethodsWe performed a mu… Show more

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“…However, the bleeding rate is slightly higher than in a general ECMO cohort, reporting on a bleeding rate of approximately 11% [25]. All 4 patients with severe bleeding complications suffered from severe thrombocytopenia (< 10 G/l); 2 of them were treated with a continuous intravenous infusion of unfractionated heparin to maintain an aPTT of 50-70 s. The way of anti-coagulation in ECMO therapy is still a controversial field [26,27]. The way between providing enough anti-coagulation to prevent thrombotic events and avoiding bleeding events is a walk on the tightrope.…”
Section: Discussionmentioning
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“…However, the bleeding rate is slightly higher than in a general ECMO cohort, reporting on a bleeding rate of approximately 11% [25]. All 4 patients with severe bleeding complications suffered from severe thrombocytopenia (< 10 G/l); 2 of them were treated with a continuous intravenous infusion of unfractionated heparin to maintain an aPTT of 50-70 s. The way of anti-coagulation in ECMO therapy is still a controversial field [26,27]. The way between providing enough anti-coagulation to prevent thrombotic events and avoiding bleeding events is a walk on the tightrope.…”
Section: Discussionmentioning
“…To date, there are no large multicenter trials comparing viscoelastic tests with conventional coagulation measures and their ability to guide anticoagulation therapy. One small pilot RCT was performed indicating that it is feasible to conduct such a trial [46].…”
Section: Viscoelastic Testsmentioning
“…In addition, heparin dosing was lower in the TEG group compared to the aPTT group (12 IU/kg/ h vs. 16 IU/kg/h, respectively, p = 0.03) with no increase in thrombotic complications. While a larger trial is needed, the results are encouraging that a TEG-driven protocol is both safe and feasible in adult patients requiring V-V ECMO [46]. In a recent pediatric study, a retrospective chart review of patients requiring venovenous (VV) and venoarterial (VA) ECMO was performed within a singlecenter, tertiary care children's hospital.…”
Section: Viscoelastic Testsmentioning
“…Blood transfusion is to be expected due to blood loss and coagulopathy. Some centers use thromboelastography to guide what blood products (platelets, fresh frozen plasma, or cryoprecipitate) are necessary during ECMO management [11].…”
Section: Management Of Ecmomentioning