PMID- 28237895
OWN - NLM
STAT- MEDLINE
DCOM- 20180102
LR  - 20220410
IS  - 1557-8615 (Electronic)
IS  - 0883-9441 (Linking)
VI  - 39
DP  - 2017 Jun
TI  - Anticoagulation practices and the prevalence of major bleeding, thromboembolic 
      events, and mortality in venoarterial extracorporeal membrane oxygenation: A 
      systematic review and meta-analysis.
PG  - 87-96
LID - S0883-9441(16)30701-8 [pii]
LID - 10.1016/j.jcrc.2017.02.014 [doi]
AB  - PURPOSE: The purpose was to evaluate the safety of anticoagulation in 
      venoarterial extracorporeal membrane oxygenation (VA-ECMO). DESIGN: We performed 
      a systematic review and meta-analysis using multiple electronic databases. 
      Studies were from 1977 to September 27, 2016. We evaluated the effect of 
      anticoagulation in VA-ECMO on outcomes including major bleeding, thromboembolic 
      events, and in-hospital mortality using a random effects model meta-analysis. 
      RESULTS: Twenty-six studies (1496 patients) were included. Ten studies only had 
      patients with postcardiotomy shock, 4 studies only included extracorporeal 
      cardiopulmonary resuscitation patients, and 10 studies had a mixture of patients. 
      Most studies (n=17) were low quality with a Newcastle-Ottawa Scale score </=5. The 
      summary prevalence of major bleeding was 27% (95% confidence interval [CI], 
      18%-35%), with considerable between-study heterogeneity (I(2)=91%). Major 
      bleeding requiring reoperation was the most common bleeding event. The summary 
      prevalence of thromboembolic events was 8% (95% CI, 4%-13%; I(2)=83%). Limb 
      ischemia, circuit-related clotting, and stroke were the most commonly reported 
      events. The summary prevalence for in-hospital mortality was 59% (95% CI, 
      52%-67%; I(2)=78%). CONCLUSIONS: The optimal targets and strategies for 
      anticoagulation in VA-ECMO are unclear. Evaluation of major bleeding and 
      thromboembolic events is limited by study quality and between-study 
      heterogeneity. Clinical trials are needed to investigate the optimal 
      anticoagulation strategy.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Sy, Eric
AU  - Sy E
AD  - Department of Critical Care, Regina General Hospital, Regina, Saskatchewan, 
      Canada; Department of Medicine, University of Saskatchewan, Saskatoon, 
      Saskatchewan, Canada; Department of Medicine, University of British Columbia, 
      Vancouver, British Columbia, Canada. Electronic address: 
      eric.julian.sy@gmail.com.
FAU - Sklar, Michael C
AU  - Sklar MC
AD  - Department of Anaesthesia, University of Toronto, Toronto, Ontario, Canada.
FAU - Lequier, Laurence
AU  - Lequier L
AD  - Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
FAU - Fan, Eddy
AU  - Fan E
AD  - Critical Care Medicine, University Health Network and Mount Sinai Hospitals, 
      Toronto, Ontario; Interdepartmental Division of Critical Care, University of 
      Toronto, Toronto General Hospital, Toronto, Ontario, Canada.
FAU - Kanji, Hussein D
AU  - Kanji HD
AD  - Department of Medicine, University of British Columbia, Vancouver, British 
      Columbia, Canada; Division of Critical Care Medicine, Department of Medicine, 
      University of British Columbia, Vancouver General Hospital, Vancouver, BC, 
      Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170212
PL  - United States
TA  - J Crit Care
JT  - Journal of critical care
JID - 8610642
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Blood Coagulation/physiology
MH  - Extracorporeal Membrane Oxygenation/*adverse effects/mortality
MH  - Female
MH  - Hemorrhage/*etiology/mortality
MH  - Hospital Mortality
MH  - Humans
MH  - Practice Patterns, Physicians'
MH  - Prevalence
MH  - Thromboembolism/*etiology/mortality/prevention & control
OTO - NOTNLM
OT  - Anticoagulants
OT  - Extracorporeal membrane oxygenation
OT  - Heparin
OT  - Meta-analysis
OT  - Systematic review
EDAT- 2017/02/27 06:00
MHDA- 2018/01/03 06:00
CRDT- 2017/02/27 06:00
PHST- 2016/10/28 00:00 [received]
PHST- 2016/12/20 00:00 [revised]
PHST- 2017/02/01 00:00 [accepted]
PHST- 2017/02/27 06:00 [pubmed]
PHST- 2018/01/03 06:00 [medline]
PHST- 2017/02/27 06:00 [entrez]
AID - S0883-9441(16)30701-8 [pii]
AID - 10.1016/j.jcrc.2017.02.014 [doi]
PST - ppublish
SO  - J Crit Care. 2017 Jun;39:87-96. doi: 10.1016/j.jcrc.2017.02.014. Epub 2017 Feb 
      12.