PMID- 35671537
OWN - NLM
STAT- MEDLINE
DCOM- 20221207
LR  - 20230203
IS  - 1538-943X (Electronic)
IS  - 1058-2916 (Linking)
VI  - 68
IP  - 12
DP  - 2022 Dec 1
TI  - Outcomes With Direct and Indirect Thrombin Inhibition During Extracorporeal 
      Membrane Oxygenation for COVID-19.
PG  - 1428-1433
LID - 10.1097/MAT.0000000000001781 [doi]
AB  - Anticoagulation during extracorporeal membrane oxygenation (ECMO) for Coronovirus 
      Disease 2019 (COVID-19) can be performed by direct or indirect thrombin 
      inhibitors but differences in outcomes with these agents are uncertain. A 
      retrospective, multicenter study was conducted. All consecutive adult patients 
      with COVID-19 placed on ECMO between March 1, 2020 and April 30, 2021 in 
      participating centers, were included. Patients were divided in groups receiving 
      either a direct thrombin inhibitor (DTI) or an indirect thrombin inhibitor such 
      as unfractionated heparin (UFH). Overall, 455 patients with COVID-19 from 17 
      centers were placed on ECMO during the study period. Forty-four patients did not 
      receive anticoagulation. Of the remaining 411 patients, DTI was used in 160 (39%) 
      whereas 251 (61%) received UFH. At 90-days, in-hospital mortality was 50% (DTI) 
      and 61% (UFH), adjusted hazard ratio: 0.81, 95% confidence interval (CI): 
      0.49-1.32. Deep vein thrombosis [adjusted odds ratio (aOR): 2.60, 95% CI: 
      0.90-6.65], ischemic (aOR: 1.58, 95% CI: 0.18-14.0), and hemorrhagic (aOR:1.22, 
      95% CI: 0.39-3.87) stroke were similar with DTI in comparison to UFH. Bleeding 
      requiring transfusion was lower in patients receiving DTI (aOR: 0.40, 95% CI: 
      0.18-0.87). Anticoagulants that directly inhibit thrombin are associated with 
      similar in-hospital mortality, stroke, and venous thrombosis and do not confer a 
      higher risk of clinical bleeding in comparison to conventional heparin during 
      ECMO for COVID-19.
CI  - Copyright (c) ASAIO 2022.
FAU - Saeed, Omar
AU  - Saeed O
AUID- ORCID: 0000-0001-6432-0730
AD  - From the Division of Cardiology, Montefiore Medical Center, Albert Einstein 
      College Medicine, Bronx, New York.
FAU - Farooq, Muhammad
AU  - Farooq M
AD  - From the Division of Cardiology, Montefiore Medical Center, Albert Einstein 
      College Medicine, Bronx, New York.
FAU - Kuntzman, Matthew
AU  - Kuntzman M
AD  - From the Division of Cardiology, Montefiore Medical Center, Albert Einstein 
      College Medicine, Bronx, New York.
FAU - Patel, Snehal R
AU  - Patel SR
AD  - From the Division of Cardiology, Montefiore Medical Center, Albert Einstein 
      College Medicine, Bronx, New York.
FAU - Stein, Louis H
AU  - Stein LH
AD  - Department of Cardiothoracic Surgery, Newark-Beth Isreal Medical Center, RWJ 
      Barnabas Health System, Newark, New Jersey.
FAU - Cavarocchi, Nicholas
AU  - Cavarocchi N
AD  - Division of Cardiothoracic Surgery, Advent Health Transplant Institute, Orlando, 
      Florida.
FAU - Silvestry, Scott
AU  - Silvestry S
AD  - Division of Cardiothoracic Surgery, Advent Health Transplant Institute, Orlando, 
      Florida.
FAU - Reyes Gil, Morayma
AU  - Reyes Gil M
AD  - Department of Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
FAU - Billett, Henny H
AU  - Billett HH
AD  - Division of Hematology, Montefiore Medical Center, Albert Einstein College 
      Medicine, Bronx, New York.
FAU - Jorde, Ulrich P
AU  - Jorde UP
AD  - Department of Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
FAU - Goldstein, Daniel J
AU  - Goldstein DJ
AD  - Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, 
      Albert Einstein College Medicine, Bronx, New York.
LA  - eng
GR  - K23 HL145140/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
DEP - 20220605
PL  - United States
TA  - ASAIO J
JT  - ASAIO journal (American Society for Artificial Internal Organs : 1992)
JID - 9204109
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.21.5 (Thrombin)
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Heparin/therapeutic use
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Thrombin
MH  - Retrospective Studies
MH  - *COVID-19/therapy
MH  - Anticoagulants/therapeutic use
MH  - Hemorrhage/etiology
MH  - *Stroke
COIS- Disclosure: The authors have no conflicts of interest to report.
EDAT- 2022/06/08 06:00
MHDA- 2022/12/15 06:00
CRDT- 2022/06/07 18:02
PHST- 2022/06/08 06:00 [pubmed]
PHST- 2022/12/15 06:00 [medline]
PHST- 2022/06/07 18:02 [entrez]
AID - 00002480-202212000-00002 [pii]
AID - 10.1097/MAT.0000000000001781 [doi]
PST - ppublish
SO  - ASAIO J. 2022 Dec 1;68(12):1428-1433. doi: 10.1097/MAT.0000000000001781. Epub 
      2022 Jun 5.