PMID- 37538041
OWN - NLM
STAT- Publisher
LR  - 20231012
IS  - 1875-9114 (Electronic)
IS  - 0277-0008 (Linking)
VI  - 43
IP  - 10
DP  - 2023 Oct
TI  - Anticoagulation strategies in patients with extracorporeal membrane oxygenation: 
      A network meta-analysis and systematic review.
PG  - 1084-1093
LID - 10.1002/phar.2859 [doi]
AB  - OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) plays an important role in 
      providing temporary life support for patients with severe cardiac or pulmonary 
      failure, but requires strict anticoagulation and monitoring. This network 
      meta-analysis systematically explored the most effective anticoagulation and 
      monitoring strategies for patients receiving ECMO. METHODS: MEDLINE, Embase, Web 
      of Science, and the Cochrane Central Register of Controlled Trials were searched 
      up to January 31, 2023, for studies comparing unfractionated heparin (UFH), 
      argatroban (Arg), bivalirudin (Biv), and/or nafamostat mesylate (NM) in patients 
      receiving ECMO. The primary outcomes included device-related thrombosis, 
      patient-related thrombosis, and major bleeding events. The secondary outcomes 
      included ECMO survival, ECMO duration, and in-hospital mortality. RESULTS: A 
      total of 2522 patients from 23 trials were included in the study. Biv was 
      associated with a decreased risk of device-related thrombosis (odd ratio [OR] 
      0.51, 95% confidence interval [CI]: 0.33-0.84) compared with UFH, whereas NM (OR 
      2.2, 95% CI: 0.24-65.0) and Arg (OR 0.92, 95% CI: 0.43-2.0) did not reduce the 
      risk of device-related thrombosis compared with UFH. Biv was superior to Arg in 
      decreasing the risk of device-related thrombosis (OR 0.14, 95% CI: 0.03-0.51). 
      Biv reduced the risk of patient-related thrombosis compared with UFH (OR 0.44, 
      95% CI: 0.18-0.85); NM (OR 0.65, 95% CI: 0.14-3.3) and Arg (OR 3.1, 95% CI: 
      0.94-12.0) did not decrease risk of patient-related thrombosis compared with UFH. 
      No significant difference was observed in the risk of major bleeding between 
      three alternatives and UFH: Biv (OR 0.54, 95% CI: 0.23-1.3), Arg (OR 1.3, 95% CI: 
      0.34-5.8), and NM (OR 0.60, 95% CI: 0.13-2.6). NM showed a reduced risk of 
      in-hospital mortality compared with UFH (OR 0.27, 95% CI: 0.091-0.77), whereas 
      Arg (OR 0.43, 95% CI: 0.15-1.2) and Biv (OR 0.75, 95% CI: 0.52-1.1) did not 
      decrease risk of in-hospital mortality. CONCLUSIONS: Compared with UFH and Arg, 
      Biv reduces the risk of thrombosis and appears to be a better choice for patients 
      requiring ECMO. NM was associated with a reduced risk of in-hospital mortality.
CI  - (c) 2023 Pharmacotherapy Publications, Inc.
FAU - Chen, Jiale
AU  - Chen J
AUID- ORCID: 0009-0005-3959-6416
AD  - Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of 
      Medicine, Jinhua, China.
FAU - Chen, Guoquan
AU  - Chen G
AUID- ORCID: 0000-0002-8385-5199
AD  - Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of 
      Medicine, Jinhua, China.
FAU - Zhao, Wenyi
AU  - Zhao W
AUID- ORCID: 0009-0009-2502-2509
AD  - Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of 
      Medicine, Jinhua, China.
FAU - Peng, Wenxing
AU  - Peng W
AUID- ORCID: 0000-0001-7653-4672
AD  - Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, 
      Beijing, China.
LA  - eng
GR  - Jinhua Central Hospital Youth Research Foundation/
PT  - Journal Article
PT  - Review
DEP - 20230811
PL  - United States
TA  - Pharmacotherapy
JT  - Pharmacotherapy
JID - 8111305
SB  - IM
OTO - NOTNLM
OT  - anticoagulation
OT  - bleeding
OT  - extracorporeal membrane oxygenation
OT  - thrombosis
EDAT- 2023/08/04 06:43
MHDA- 2023/08/04 06:43
CRDT- 2023/08/04 03:43
PHST- 2023/05/17 00:00 [revised]
PHST- 2023/03/27 00:00 [received]
PHST- 2023/05/23 00:00 [accepted]
PHST- 2023/08/04 06:43 [pubmed]
PHST- 2023/08/04 06:43 [medline]
PHST- 2023/08/04 03:43 [entrez]
AID - 10.1002/phar.2859 [doi]
PST - ppublish
SO  - Pharmacotherapy. 2023 Oct;43(10):1084-1093. doi: 10.1002/phar.2859. Epub 2023 Aug 
      11.