PMID- 26673593
OWN - NLM
STAT- MEDLINE
DCOM- 20160211
LR  - 20190319
IS  - 0310-057X (Print)
IS  - 0310-057X (Linking)
VI  - 44
IP  - 1
DP  - 2016 Jan
TI  - Discordance between ROTEM(R) clotting time and conventional tests during 
      unfractionated heparin-based anticoagulation in intensive care patients on 
      extracorporeal membrane oxygenation.
PG  - 85-92
AB  - We hypothesised that ROTEM(R) (Basel, Switzerland) INTEM(R) (ROTEM, Basel, 
      Switzerland) clotting time (CT) would have good agreement with activated partial 
      thromboplastin time (aPTT) in determining whether a dose adjustment should be 
      made to the unfractionated heparin (UFH) infusion in patients on extracorporeal 
      membrane oxygenation. All patients treated with extracorporeal membrane 
      oxygenation over a five-year period were included for data analysis. 
      Retrospective analysis was performed of prospectively collected data points, 
      wherein aPTT, activated CT and ROTEM was performed simultaneously to monitor 
      UFH-based anticoagulation. Two hundred data points were available for analysis. 
      Turnaround time was shortest for activated CT followed by ROTEM and aPTT. Despite 
      achieving therapeutic aPTT targets, the majority (>50%) of INTEM CT results were 
      within normal limits. The aPTT and INTEM CT results correlated weakly (r=0.31, 
      95% confidence interval [0.17, 0.43]) and there was no agreement between the 
      directional changes of aPTT and INTEM CT results on successive days (x(2) =2.33, 
      P=0.17). Due to relative insensitivity, INTEM CT-guided UFH titration was 
      estimated to result in a 289% increase in incidence of up-titration, over 
      aPTT-guided titration. The INTEM CT results (r=0.36, 95% confidence interval 
      [0.23, 0.48]) correlated weakly with UFH infusion rates. The UFH infusion rate 
      only explained 13% variability in INTEM CT values. While haemorrhagic 
      complications were frequent, no major clotting complications were encountered. 
      Our results demonstrated that aPTT and INTEM CT do not provide equivalent 
      information to guide UFH infusion rate titration during extracorporeal membrane 
      oxygenation. Our study suggests caution regarding the use of ROTEM for guiding 
      UFH-based anticoagulation as it may lead to excessive UFH exposure.
FAU - Prakash, S
AU  - Prakash S
AD  - Department of Intensive Care, Flinders Medical Centre, Bedford Park, South 
      Australia.
FAU - Wiersema, U F
AU  - Wiersema UF
AD  - Department of Intensive Care, Flinders Medical Centre, Bedford Park, South 
      Australia.
FAU - Bihari, S
AU  - Bihari S
AD  - Department of Intensive Care, Flinders Medical Centre, Bedford Park, South 
      Australia.
FAU - Roxby, D
AU  - Roxby D
AD  - SA Pathology Transfusion Medicine, Flinders Medical Centre, Bedford Park, South 
      Australia.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Anaesth Intensive Care
JT  - Anaesthesia and intensive care
JID - 0342017
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*pharmacology
MH  - *Critical Care
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Heparin/*pharmacology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
MH  - *Whole Blood Coagulation Time
OTO - NOTNLM
OT  - extracorporeal membrane oxygenation
OT  - heparin
OT  - partial thromboplastin time
OT  - point-of-care systems
OT  - thromboelastometry
EDAT- 2015/12/18 06:00
MHDA- 2016/02/13 06:00
CRDT- 2015/12/18 06:00
PHST- 2015/12/18 06:00 [entrez]
PHST- 2015/12/18 06:00 [pubmed]
PHST- 2016/02/13 06:00 [medline]
AID - 20150234 [pii]
AID - 10.1177/0310057X1604400113 [doi]
PST - ppublish
SO  - Anaesth Intensive Care. 2016 Jan;44(1):85-92. doi: 10.1177/0310057X1604400113.