PMID- 33984868
OWN - NLM
STAT- MEDLINE
DCOM- 20220519
LR  - 20230111
IS  - 2567-689X (Electronic)
IS  - 0340-6245 (Linking)
VI  - 122
IP  - 4
DP  - 2022 Apr
TI  - Optimal Tests to Minimise Bleeding and Ischaemic Complications in Patients on 
      Extracorporeal Membrane Oxygenation.
PG  - 480-491
LID - 10.1055/a-1508-8230 [doi]
AB  - Patients supported with extracorporeal membrane oxygenation (ECMO) experience a 
      very high frequency of bleeding and ischaemic complications, including stroke and 
      systemic embolism. These patients require systemic anticoagulation, mainly with 
      unfractionated heparin (UFH) to prevent clotting of the circuit and reduce the 
      risk of arterial or venous thrombosis. Monitoring of UFH can be very challenging. 
      While most centres routinely monitor the activated clotting time and activated 
      partial thromboplastin time (aPTT) to assess UFH, measurement of anti-factor Xa 
      (anti-Xa) level best correlates with heparin dose, and appears to be predictive 
      of circuit thrombosis, although aPTT may be a better predictor of bleeding. 
      Although monitoring of prothrombin time, platelet count and fibrinogen is 
      routinely undertaken to assess haemostasis, there is no clear guidance available 
      regarding the optimal test.Additional tests, including antithrombin level and 
      thromboelastography, can be used for risk stratification of patients to try and 
      predict the risks of thrombosis and bleeding. Each has their specific role, 
      strengths and limitations. Increased thrombin generation may have a role in 
      predicting thrombosis. Acquired von Willebrand syndrome is frequent with ECMO, 
      contributing to bleeding risk and can be detected by assessing the von Willebrand 
      factor activity-to-antigen ratio, while the platelet function analyser can be 
      used in urgent situations to detect this, with a high negative predictive value. 
      Tests of platelet aggregation can aid in the prediction of bleeding.To 
      personalise management, a selection of complementary tests to collectively assess 
      heparin-effect, coagulation, platelet function and platelet aggregation is 
      proposed, to optimise clinical outcomes in these high-risk patients.
CI  - Thieme. All rights reserved.
FAU - Kanji, Rahim
AU  - Kanji R
AD  - Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, 
      United Kingdom.
FAU - Vandenbriele, Christophe
AU  - Vandenbriele C
AD  - Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, 
      Belgium.
AD  - Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom.
FAU - Arachchillage, Deepa R J
AU  - Arachchillage DRJ
AD  - Haematology Department, Royal Brompton Hospital, London, United Kingdom.
AD  - Centre for Haematology, Imperial College Healthcare NHS Trust & Imperial College, 
      London, United Kingdom.
FAU - Price, Susanna
AU  - Price S
AD  - Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, 
      United Kingdom.
AD  - Intensive Care Unit, Royal Brompton Hospital, London, United Kingdom.
FAU - Gorog, Diana Adrienne
AU  - Gorog DA
AUID- ORCID: 0000-0002-9286-1451
AD  - Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, 
      United Kingdom.
LA  - eng
PT  - Journal Article
DEP - 20210621
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/adverse effects
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Hemorrhage/diagnosis/etiology/prevention & control
MH  - Heparin/adverse effects
MH  - Humans
MH  - Partial Thromboplastin Time
MH  - *Thrombosis/diagnosis/etiology/prevention & control
COIS- None declared.
EDAT- 2021/05/14 06:00
MHDA- 2022/05/20 06:00
CRDT- 2021/05/13 20:31
PHST- 2021/05/13 00:00 [aheadofprint]
PHST- 2021/05/14 06:00 [pubmed]
PHST- 2022/05/20 06:00 [medline]
PHST- 2021/05/13 20:31 [entrez]
AID - 10.1055/a-1508-8230 [doi]
PST - ppublish
SO  - Thromb Haemost. 2022 Apr;122(4):480-491. doi: 10.1055/a-1508-8230. Epub 2021 Jun 
      21.