PMID- 36283541
OWN - NLM
STAT- MEDLINE
DCOM- 20221216
LR  - 20230216
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 370
DP  - 2023 Jan 1
TI  - Anticoagulant management for transition from failed thrombolysis to 
      extra-corporeal membrane oxygenation in patients with high-risk pulmonary 
      embolism: A thoughtful approach.
PG  - 378-380
LID - S0167-5273(22)01649-7 [pii]
LID - 10.1016/j.ijcard.2022.10.138 [doi]
AB  - Acute venous thromboembolism represents a spectrum of clinical syndromes of which 
      high-risk pulmonary embolism (PE) with consecutive right ventricular failure and 
      cardiogenic shock (CS) is the most severe presentation. First-line treatment 
      options are surgical pulmonary embolectomy, systemic thrombolysis or 
      catheter-based therapies. The role of mechanical circulatory support with 
      veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) is multifarious in 
      this setting and can be considered as either a bridge to pulmonary artery 
      reperfusion by any of the aforementioned options or as salvage bridge 
      intervention for patients in refractory CS after failure of another treatment. In 
      the subpopulation of patients that are placed on V-A-ECMO after failed 
      thrombolysis, the mortality rates are among the highest, partially due to the 
      high rates of bleeding events. The challenges in the interpretation of 
      anticoagulant monitoring and, consequently, the titration of anticoagulation at 
      least contribute to this high mortality. Here, we discuss the strengths and 
      limitations of different anticoagulant parameters in this setting and propose an 
      approach based on monitoring of Heparin anti-factor Xa (anti-Xa) assay and 
      activated partial thromboplastin time (APTT) in parallel to drive unfractionated 
      heparin (UFH) titration in patients with high-risk PE after fibrinolysis during 
      the first 24 h on V-A-ECMO.
CI  - Copyright (c) 2022 Elsevier B.V. All rights reserved.
FAU - Vandenbriele, Christophe
AU  - Vandenbriele C
AD  - Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; 
      Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, 
      Belgium; Department of Adult Intensive Care, Royal Brompton and Harefield NHS 
      Foundation Trust, London, UK. Electronic address: 
      christophe.vandenbriele@kuleuven.be.
FAU - Van Edom, Charlotte
AU  - Van Edom C
AD  - Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
FAU - Tavazzi, Guido
AU  - Tavazzi G
AD  - Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, University 
      of Pavia, Pavia, Italy; Intensive Care Unit, Fondazione Policlinico San Matteo 
      IRCCS, Pavia, Italy.
LA  - eng
PT  - Journal Article
DEP - 20221022
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Humans
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Anticoagulants/therapeutic use
MH  - Heparin/therapeutic use
MH  - Embolectomy
MH  - *Pulmonary Embolism/diagnosis/therapy/etiology
MH  - Shock, Cardiogenic/therapy/etiology
OTO - NOTNLM
OT  - Anticoagulation
OT  - ECMO
OT  - Failed thrombolysis
OT  - Pulmonary embolism
COIS- Declaration of Competing Interest The authors declare no conflict of interest. 
      The research received no specific grant from any funding agency in the public, 
      commercial, or not-for-profit sectors.
EDAT- 2022/10/26 06:00
MHDA- 2022/12/15 06:00
CRDT- 2022/10/25 19:25
PHST- 2022/09/13 00:00 [received]
PHST- 2022/10/12 00:00 [revised]
PHST- 2022/10/19 00:00 [accepted]
PHST- 2022/10/26 06:00 [pubmed]
PHST- 2022/12/15 06:00 [medline]
PHST- 2022/10/25 19:25 [entrez]
AID - S0167-5273(22)01649-7 [pii]
AID - 10.1016/j.ijcard.2022.10.138 [doi]
PST - ppublish
SO  - Int J Cardiol. 2023 Jan 1;370:378-380. doi: 10.1016/j.ijcard.2022.10.138. Epub 
      2022 Oct 22.