Bleeding, Thrombosis, and Transfusion With Two Heparin Anticoagulation Protocols in Venoarterial ECMO Patients
Journal of Cardiothoracic and Vascular Anesthesia
ACT; aPTT; bleeding; clotting; ECMO; shock; thrombosis
Objective: To compare the incidence of bleeding and thrombosis between adult venoarterial (VA) extracorporeal membrane oxygenation (ECMO) patients managed with an activated clotting time (ACT)-guided heparin anticoagulation protocol and activated partial thromboplastin time (aPTT) protocol. Design: Retrospective cohort study. Setting: Tertiary care, academic medical center. Participants: Consecutive adult VA ECMO patients during a 6-year period. Interventions: None. Measurements and Main Results: Demographic, medical, transfusion, and ECMO data were collected for all patients. Primary study outcomes were bleeding and thrombosis. Secondary outcomes were stroke and in-hospital mortality. One hundred twenty-one patients were included in the cohort. Fifty patients had ACT monitoring, and 71 had aPTT monitoring. There was no difference in the incidence of bleeding or thrombosis between the 2 groups (78.0% v 67.6% for bleeding [p = 0.21] and 16.0% v 19.7% for thrombosis [p = 1.0]). After adjusting for age and total ECMO days, patients managed with ACT received approximately 30% more red blood cell, fresh frozen plasma, and platelet transfusion (all p < 0.05). Conclusion: There is no apparent difference in the incidence rate of bleeding or thrombosis between VA ECMO patients managed with an ACT- or aPTT-guided heparin anticoagulation protocol. Patients managed with an ACT-guided protocol received more blood transfusion, which could reflect greater total bleeding. Future randomized controlled trials would help to elucidate optimal anticoagulation strategies for VA ECMO patients.
Mazzeffi, M., Tanaka, K., Roberts, A., Rector, R., Menaker, J., Kon, Z., Deatrick, K., Kaczorowski, D., Griffith, B., & Herr, D. (2019). Bleeding, Thrombosis, and Transfusion With Two Heparin Anticoagulation Protocols in Venoarterial ECMO Patients. Journal of Cardiothoracic and Vascular Anesthesia, 33 (5). http://dx.doi.org/10.1053/j.jvca.2018.07.045