Venoarterial-Extracorporeal Membrane Oxygenation Without Routine Systemic Anticoagulation Decreases Adverse Events

Wood, Katherine; Ayers, Brian; Gošev, Igor; Kumar, Neil G.; Melvin, Amber L.; Barrus, Bryan; Prasad, Sunil

doi:10.1016/j.athoracsur.2019.08.040

Cited by 103 publications

(103 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 Given that any heparin administration increases the general risk of bleeding complications 4 it is obvious that many centers prefer low-dose heparin or even an anticoagulant-free management in order to reduce hemorrhagic events. [4][5][6][7] Classically, low-dose and subtherapeutic UFH anticoagulation is not monitored at all. 8 Previous studies, focusing on adjusted low-dose UFH prophylaxis, suggested that UFH monitoring may improve the outcome in critical ill patients.…”

Section: Introductionmentioning

confidence: 99%

Activated Clotting Time (ACT) for Monitoring of Low-Dose Heparin: Performance Characteristics in Healthy Adults and Critically Ill Patients

Wehner

Boehne

David

et al. 2020

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

Dose adjustment of unfractionated heparin (UFH) anticoagulation is an important factor to reduce hemorrhagic events. High doses of heparin can be monitored by Activated Clotting Time (ACT). Because of limited information about the monitoring of low-dose heparin we assessed monitoring by ACT, aPTT and anti-Xa. Blood samples from healthy volunteers (n = 54) were treated ex vivo with increasing UFH doses (0-0.4 IU/ml). Samples from ICU-patients (n = 60), were drawn during continuous UFH infusion. Simultaneous ACT measurements were performed using iSTAT and Hemochron. In UFH treated blood, iSTAT and Hemochron showed a significant change of ACT at ≥0.075 IU/ml and ≥0.1 IU/ml UFH, respectively. In ICU-patients no relationship between ACT and either UFH dose, aPTT and anti-Xa was observed. Hemochron was affected by antithrombin and platelet count. iSTAT was sensitive to CRP and hematocrit. A moderate correlation was identified between UFH dose and aPTT (R2 = 0.196) or anti-Xa (R2 = 0.162). In heparin-spiked blood, ACT is sensitive to heparin at levels of ≥0.1 IU/ml heparin. In ICU-patients, ACT did not correlate with UFH dose or other established methods. Both systems were differently influenced by certain parameters.

show abstract

Section: Introductionmentioning

confidence: 99%

Activated Clotting Time (ACT) for Monitoring of Low-Dose Heparin: Performance Characteristics in Healthy Adults and Critically Ill Patients

Wehner

Boehne

David

et al. 2020

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

show abstract

“…Some authors propose VA-ECMO without routine systemic anticoagulation to decrease hemorrhagic complications and other adverse events. 18 The most frequent complication in our patients was hemorrhage that manifested as severe postoperative bleeding, which needed surgical re-exploration. This finding is in accordance with previous reports that showed an incidence of this complication between 5% and 62%.…”

Section: Discussionmentioning

confidence: 77%

“…If necessary, to prevent and manage hemorrhagic complications, we run the pump without anticoagulation safely for a few days. Some authors propose VA‐ECMO without routine systemic anticoagulation to decrease hemorrhagic complications and other adverse events 18 . The most frequent complication in our patients was hemorrhage that manifested as severe postoperative bleeding, which needed surgical re‐exploration.…”

Section: Discussionmentioning

confidence: 90%

Preoperative extracorporeal membrane oxygenation for postinfarction ventricular septal defect: Case series of three patients with a literature review

et al. 2020

View full text Add to dashboard Cite

The mortality rate after the development of postinfarction ventricular septal defect (VSD) remains high, despite progress in pharmacologic therapy, invasive cardiology, and surgical techniques. We present three cases of preoperative venoarterial extracorporeal membrane oxygenation as a bridge to reparative surgical repair in patients with cardiogenic shock who would otherwise require emergent cardiac surgery with an associated risk. Two patients were discharged, whereas the third patient died due to pulmonary artery rupture after a right ventricular assist device implantation, despite the fact that he had a successful bridge to reparative surgery and VSD repair. Finally, a review of the current literature concerning the use of preoperative venoarterial extracorporeal membrane oxygenation as a bridge to reparative surgery is provided.

show abstract

“…Moreover, the need for systemic anticoagulation may be further diminished in the setting of superimposed coagulopathy. Recent cohorts demonstrate a lack of increase in thromboembolism rates and overall decreased bleeding-related complications in patients who are not anticoagulated while on ECMO ( 19 ). This strategy was initially described in the trauma literature ( 17 , 20 , 21 ).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Amniotic Fluid Embolism-Induced Cardiac Arrest in the First Trimester of Pregnancy: A Case Report

Creel-Bulos

Hassani

Stentz

et al. 2020

Critical Care Explorations

View full text Add to dashboard Cite

show abstract

Venoarterial-Extracorporeal Membrane Oxygenation Without Routine Systemic Anticoagulation Decreases Adverse Events

Cited by 103 publications

References 23 publications

Activated Clotting Time (ACT) for Monitoring of Low-Dose Heparin: Performance Characteristics in Healthy Adults and Critically Ill Patients

Activated Clotting Time (ACT) for Monitoring of Low-Dose Heparin: Performance Characteristics in Healthy Adults and Critically Ill Patients

Preoperative extracorporeal membrane oxygenation for postinfarction ventricular septal defect: Case series of three patients with a literature review

Extracorporeal Membrane Oxygenation for Amniotic Fluid Embolism-Induced Cardiac Arrest in the First Trimester of Pregnancy: A Case Report

Contact Info

Product

Resources

About