PMID- 34109859
OWN - NLM
STAT- MEDLINE
DCOM- 20230203
LR  - 20230203
IS  - 1531-1937 (Electronic)
IS  - 0897-1900 (Linking)
VI  - 36
IP  - 1
DP  - 2023 Feb
TI  - Evaluation of a Multimodal Heparin Laboratory Monitoring Protocol in Adult 
      Extracorporeal Membrane Oxygenation Patients.
PG  - 79-86
LID - 10.1177/08971900211021249 [doi]
AB  - BACKGROUND: Anticoagulation monitoring practices vary during extracorporeal 
      membrane oxygenation (ECMO). The Extracorporeal Life Support Organization 
      describes that a multimodal approach is needed to overcome assay limitations and 
      minimize complications. OBJECTIVE: Compare activated clotting time (ACT) versus 
      multimodal approach (activated partial thromboplastin time (aPTT)/anti-factor Xa) 
      for unfractionated heparin (UFH) monitoring in adult ECMO patients. METHODS: We 
      conducted a single-center retrospective pre- (ACT) versus post-implementation 
      (multimodal approach) study. The incidence of major bleeding and thrombosis, 
      blood product and antithrombin III (ATIII) administration, and UFH infusion rates 
      were compared. RESULTS: Incidence of major bleeding (69.2% versus 62.2%, p = 
      0.345) and thrombosis (23% versus 14.9%, p = 0.369) was similar between groups. 
      Median number of ATIII doses was reduced in the multimodal group (1.0 [IQR 
      0.0-2.0] versus 0.0 [0.0 -1.0], p = 0.007). The median UFH infusion rate was 
      higher in the ACT group, but not significant (16.9 [IQR 9.6-22.4] versus 13 [IQR 
      9.6-15.4] units/kg/hr, p = 0.063). Fewer UFH infusion rate changes occurred prior 
      to steady state in the multimodal group (0.9 [IQR 0.3 -1.7] versus 0.1 [IQR 
      0.0-0.2], p < 0.001). CONCLUSION: The incidence of major bleeding and thrombosis 
      was similar between groups. Our multimodal monitoring protocol standardized UFH 
      infusion administration and reduced ATIII administration.
FAU - Northam, Kalynn A
AU  - Northam KA
AUID- ORCID: 0000-0002-2428-2431
AD  - Department of Pharmacy, 15521University of North Carolina Medical Center, Chapel 
      Hill, NC, USA.
FAU - Nguyen, Bobbie
AU  - Nguyen B
AD  - 15521Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, 
      USA.
FAU - Chen, Sheh-Li
AU  - Chen SL
AD  - Department of Pharmacy, 15521University of North Carolina Medical Center, Chapel 
      Hill, NC, USA.
FAU - Sredzienski, Edward
AU  - Sredzienski E
AD  - Department of Pharmacy, 15521University of North Carolina Medical Center, Chapel 
      Hill, NC, USA.
FAU - Charles, Anthony
AU  - Charles A
AD  - Division of General and Acute Surgery, 2331University of North Carolina Medical 
      Center, Chapel Hill, NC, USA.
LA  - eng
PT  - Journal Article
DEP - 20210610
PL  - United States
TA  - J Pharm Pract
JT  - Journal of pharmacy practice
JID - 8900945
RN  - 9005-49-6 (Heparin)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Humans
MH  - Adult
MH  - Heparin/adverse effects
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Retrospective Studies
MH  - Anticoagulants/adverse effects
MH  - *Thrombosis/epidemiology/prevention & control
OTO - NOTNLM
OT  - activated clotting time
OT  - activated partial thromboplastin time
OT  - anti-factor Xa
OT  - extracorporeal membrane oxygenation
OT  - heparin
EDAT- 2021/06/11 06:00
MHDA- 2023/02/04 06:00
CRDT- 2021/06/10 10:00
PHST- 2021/06/11 06:00 [pubmed]
PHST- 2023/02/04 06:00 [medline]
PHST- 2021/06/10 10:00 [entrez]
AID - 10.1177/08971900211021249 [doi]
PST - ppublish
SO  - J Pharm Pract. 2023 Feb;36(1):79-86. doi: 10.1177/08971900211021249. Epub 2021 
      Jun 10.