PMID- 28166602
OWN - NLM
STAT- MEDLINE
DCOM- 20170418
LR  - 20170418
IS  - 1098-9064 (Electronic)
IS  - 0094-6176 (Linking)
VI  - 43
IP  - 3
DP  - 2017 Apr
TI  - Managing the Precarious Hemostatic Balance during Extracorporeal Life Support: 
      Implications for Coagulation Laboratories.
PG  - 291-299
LID - 10.1055/s-0036-1593414 [doi]
AB  - For the past four decades, extracorporeal life support (ECLS) has been used to 
      treat critically ill adult and pediatric patients with cardiac and/or respiratory 
      failure unresponsive to medical management, and there are increasing numbers of 
      centers performing ECLS for numerous indications worldwide. Despite the progress 
      with advancing technology, hemorrhagic and thrombotic complications occur 
      frequently and are associated with worse outcomes, but the exact cause is often 
      elusive or multifactorial. As a result of the interaction between blood and a 
      nonendothelialized circuit, there is activation of coagulation, fibrinolysis, as 
      well as an increased inflammatory response; thus, anticoagulation of the patient 
      and circuit is necessary. While unfractionated heparin (UFH) remains the mainstay 
      anticoagulant used during ECLS, there is a paucity of published data to develop a 
      universal anticoagulation guideline and centers are forced to create 
      individualized protocols to guide anticoagulation management, frequently while 
      lacking expertise. From an international survey, centers often use a combination 
      of tests to guide management, which in turn can lead to discordant results and 
      confused management. Studies are urgently needed to investigate optimization of 
      current anticoagulation strategies with UFH, as well as use of alternative 
      anticoagulants and nonthrombogenic biomaterials.
CI  - Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
FAU - Winkler, Anne M
AU  - Winkler AM
AD  - Director of Medical Affairs, Instrumentation Laboratory, Bedford, Massachusetts.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170206
PL  - United States
TA  - Semin Thromb Hemost
JT  - Seminars in thrombosis and hemostasis
JID - 0431155
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Blood Coagulation/*drug effects
MH  - Blood Coagulation Tests/methods
MH  - Critical Illness/*therapy
MH  - Drug Monitoring/methods
MH  - Extracorporeal Membrane Oxygenation/adverse effects/*methods
MH  - Hemorrhage/etiology/prevention & control
MH  - Hemostasis/*drug effects
MH  - Humans
MH  - Thrombosis/etiology/prevention & control
EDAT- 2017/02/07 06:00
MHDA- 2017/04/19 06:00
CRDT- 2017/02/07 06:00
PHST- 2017/02/07 06:00 [pubmed]
PHST- 2017/04/19 06:00 [medline]
PHST- 2017/02/07 06:00 [entrez]
AID - 10.1055/s-0036-1593414 [doi]
PST - ppublish
SO  - Semin Thromb Hemost. 2017 Apr;43(3):291-299. doi: 10.1055/s-0036-1593414. Epub 
      2017 Feb 6.