PMID- 34725832
OWN - NLM
STAT- MEDLINE
DCOM- 20220106
LR  - 20220106
IS  - 1525-1594 (Electronic)
IS  - 0160-564X (Linking)
VI  - 46
IP  - 1
DP  - 2022 Jan
TI  - Conventional versus restricted anti-Xa-guided heparin protocol in adult patients 
      undergoing extracorporeal membrane oxygenation.
PG  - 128-137
LID - 10.1111/aor.14104 [doi]
AB  - OBJECTIVE: The optimal intensity of anticoagulation for adult patients supported 
      with extracorporeal membrane oxygenation (ECMO) remains uncertain. The objective 
      of this study was to evaluate the effectiveness and safety of two anticoagulation 
      protocols using conventional (0.3-0.7 IU/ml) versus restricted (0.2-0.5 IU/ml) 
      anti-factor Xa (anti-Xa) targets for the management of unfractionated heparin 
      (UFH) in adult ECMO patients. METHODS: This retrospective before-after cohort 
      study compared two groups of ECMO patients who received UFH for at least 24-h 
      from March 2016 to May 2019. The primary outcome was the composite rate of major 
      bleeding or thrombotic events per ECMO day. Secondary outcomes included the mean 
      amount of blood products transfused per ECMO day, the proportion of patients who 
      were within the target anti-Xa at 24-h, the time to achieve target anti-Xa, and 
      the number of heparin infusion adjustments to reach target anti-Xa. RESULTS: 
      Forty-one patients were included in this analysis (conventional, n = 25; 
      restricted, n = 16). There was no difference in the composite rate of major 
      bleeding or thrombotic events per ECMO day (p = .090). The restricted group had 
      lower rates of packed red blood cells (pRBC) transfusion per ECMO day (mean 1 +/- 1 
      vs 3 +/- 2 units, p = .003) and required fewer heparin infusion adjustments to 
      reach the target (p = .007). There was no difference between the groups in the 
      number of patients who achieved target anti-Xa at 24-h (p = .940). CONCLUSION: In 
      adult ECMO patients, anticoagulation with a restricted anti-Xa target was 
      associated with lower pRBC transfusions and did not provoke an excess of 
      thrombotic events.
CI  - (c) 2021 International Center for Artificial Organs and Transplantation and Wiley 
      Periodicals LLC.
FAU - Alkazemi, Afrah
AU  - Alkazemi A
AUID- ORCID: 0000-0003-2456-8736
AD  - Center for International Studies, MCPHS University, Boston, Massachusetts, USA.
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts, USA.
FAU - Eche, Ifeoma Mary
AU  - Eche IM
AUID- ORCID: 0000-0002-6809-1813
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts, USA.
FAU - Adra, May
AU  - Adra M
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts, USA.
FAU - Cabezas, Fausto
AU  - Cabezas F
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, Massachusetts, USA.
FAU - Patel, Parth
AU  - Patel P
AD  - Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, 
      Massachusetts, USA.
FAU - Rick, Katelyn
AU  - Rick K
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, Massachusetts, USA.
FAU - Grandin, E Wilson
AU  - Grandin EW
AD  - Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, 
      Boston, Massachusetts, USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20211111
PL  - United States
TA  - Artif Organs
JT  - Artificial organs
JID - 7802778
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.6 (Factor Xa)
SB  - IM
MH  - Adult
MH  - Anticoagulants/*administration & dosage
MH  - Cohort Studies
MH  - Erythrocyte Transfusion
MH  - Extracorporeal Membrane Oxygenation/*adverse effects
MH  - Factor Xa/analysis
MH  - Female
MH  - Hemorrhage/epidemiology
MH  - Heparin/*administration & dosage
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Thrombosis/epidemiology
OTO - NOTNLM
OT  - anti-Xa
OT  - anticoagulation
OT  - bleeding
OT  - extracorporeal membrane oxygenation
OT  - thrombosis
OT  - unfractionated heparin
EDAT- 2021/11/03 06:00
MHDA- 2022/01/07 06:00
CRDT- 2021/11/02 06:28
PHST- 2021/06/27 00:00 [revised]
PHST- 2021/03/24 00:00 [received]
PHST- 2021/10/20 00:00 [accepted]
PHST- 2021/11/03 06:00 [pubmed]
PHST- 2022/01/07 06:00 [medline]
PHST- 2021/11/02 06:28 [entrez]
AID - 10.1111/aor.14104 [doi]
PST - ppublish
SO  - Artif Organs. 2022 Jan;46(1):128-137. doi: 10.1111/aor.14104. Epub 2021 Nov 11.