PMID- 31833874
OWN - NLM
STAT- MEDLINE
DCOM- 20220712
LR  - 20220712
IS  - 1536-3686 (Electronic)
IS  - 1075-2765 (Linking)
VI  - 29
IP  - 4
DP  - 2022 Jul 1
TI  - Activated Clotting Times Demonstrate Weak Correlation With Heparin Dosing in 
      Adult Extracorporeal Membrane Oxygenation.
PG  - e385-e393
LID - 10.1097/MJT.0000000000001113 [doi]
AB  - BACKGROUND: The optimal monitoring strategy for anticoagulation management in 
      extracorporeal membrane oxygenation (ECMO) remains a clinical controversy. The 
      Extracorporeal Life Support Organization Anticoagulation Guidelines suggest that 
      multiple anticoagulation assays may be needed but do not specify a preferred 
      management strategy. STUDY QUESTION: In adult ECMO patients, which 
      anticoagulation assays demonstrate the highest correlation with unfractionated 
      heparin (UFH) dose requirements? STUDY DESIGN: We performed a retrospective chart 
      review of adult patients cannulated to ECMO between February 2013 and July 2015. 
      MEASURES AND OUTCOMES: The primary outcome was the correlation between activated 
      clotting time (ACT), activated partial thromboplastin time (aPTT), and anti-Xa 
      and UFH dose. Secondary outcomes included correlations between anticoagulation 
      assays. Correlations were calculated for the entire cohort, with subgroup 
      analysis of venoarterial and venovenous ECMO patients. RESULTS: Forty-eight 
      patients were included in the analysis, 26 initially cannulated to venoarterial 
      ECMO and 22 to veno-venous ECMO. The median duration of ECMO therapy was 7 days. 
      Mean UFH requirements were 1149 units/h or 15.3 units/kg/h. Total UFH dose was 
      most correlated with anti-Xa levels (r = 0.467), whereas weight-based heparin 
      dose was most correlated with aPTT (0.405). For correlations between 
      anticoagulation assays, anti-Xa and aPTT were more highly correlated with each 
      other (r = 0.633) compared with ACT. CONCLUSIONS: In adult patients requiring 
      ECMO, anti-Xa and aPTT monitoring were correlated more closely with UFH dosing 
      than ACT.
CI  - Copyright (c) 2019 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Hohlfelder, Benjamin
AU  - Hohlfelder B
AD  - Department of Pharmacy, Cleveland Clinic, Cleveland, OH.
FAU - Kelly, Daniel
AU  - Kelly D
AD  - Division of Medicine Critical Care, Department of Medicine, Boston Children's 
      Hospital, Boston, MA.
FAU - Hoang, Minh
AU  - Hoang M
AD  - Department of Pharmacy, Penobscot Community Health Care, Bangor, ME; and.
FAU - Anger, Kevin E
AU  - Anger KE
AD  - Departments of Pharmacy Services.
FAU - Sylvester, Katelyn W
AU  - Sylvester KW
AD  - Departments of Pharmacy Services.
FAU - Kaufman, Richard M
AU  - Kaufman RM
AD  - Pathology, and.
FAU - Connors, Jean M
AU  - Connors JM
AD  - Hematology, Brigham and Women's Hospital, Boston, MA.
LA  - eng
PT  - Journal Article
DEP - 20220701
PL  - United States
TA  - Am J Ther
JT  - American journal of therapeutics
JID - 9441347
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Anticoagulants
MH  - *Extracorporeal Membrane Oxygenation
MH  - *Heparin
MH  - Heparin, Low-Molecular-Weight
MH  - Humans
MH  - Partial Thromboplastin Time
MH  - Retrospective Studies
COIS- The authors have no conflicts of interest to declare.
EDAT- 2019/12/14 06:00
MHDA- 2022/07/14 06:00
CRDT- 2019/12/14 06:00
PHST- 2019/12/14 06:00 [pubmed]
PHST- 2022/07/14 06:00 [medline]
PHST- 2019/12/14 06:00 [entrez]
AID - 00045391-202208000-00001 [pii]
AID - 10.1097/MJT.0000000000001113 [doi]
PST - epublish
SO  - Am J Ther. 2022 Jul 1;29(4):e385-e393. doi: 10.1097/MJT.0000000000001113.