PMID- 38379295
OWN - NLM
STAT- Publisher
LR  - 20240221
IS  - 1477-111X (Electronic)
IS  - 0267-6591 (Linking)
DP  - 2024 Feb 20
TI  - Thromboelastography versus thromboelastometry for unfractionated heparin 
      monitoring in adult patients on extracorporeal membrane oxygenation.
PG  - 2676591241232513
LID - 10.1177/02676591241232513 [doi]
AB  - Background: Monitoring the anticoagulant effect of unfractionated heparin (UFH) 
      in extracorporeal membrane oxygenation (ECMO) patients is complex but critically 
      important to balance the risks of treatment related bleeding and circuit 
      thrombosis. While guidelines recommend using more than one method to monitor UFH 
      activity, the use of thromboelastometry (ROTEM) to monitor UFH in ECMO patients 
      has not been investigated in detail.Methods: This is an observational, 
      single-center retrospective study looking at adult ECMO patients on UFH that had 
      ROTEM and thromboelastography (TEG) tests obtained concurrently. A total of 20 
      samples were obtained from nine patients during the study period, seven of which 
      were on veno-arterial (VA) ECMO and two of which were on veno-venous (VV) 
      ECMO.Results: Under institutional standard operating practice, when TEG and/or 
      activated partial thromboplastin time (aPTT) were considered therapeutic, 
      intrinsic thromboelastometry clotting time (INTEM CT) was only 1.2 times higher 
      than the normal range. TEG based monitoring compared to aPTT based monitoring 
      tended to result in lower anti-Xa levels and less intensive anticoagulation. For 
      the total cohort, bleeding events, driven by the need for blood transfusions, 
      were more common compared to ischemic events (77% vs 11%; p = 0.02).Conclusion: 
      INTEM CT tended to be less sensitive to lower doses of UFH with a value of 1.2 
      times higher than the normal range when aPTT and/or TEG were considered 
      therapeutic. Due to the relative insensitivity of ROTEM, our institution decided 
      to continue to use TEG instead of ROTEM. Larger, multicenter trials may be 
      helpful to validate these findings.
FAU - Yin, Ellen B
AU  - Yin EB
AUID- ORCID: 0000-0003-2735-0775
AD  - Department of Pharmacy, Baylor St. Luke's Medical Center, Houston, TX, USA. 
      RINGGOLD: 24083
AD  - Department of Pharmacy, University of Texas Medical Branch, Galveston, TX, USA. 
      RINGGOLD: 12338
FAU - Bracey, Arthur W
AU  - Bracey AW
AD  - Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 
      USA.
AD  - Department of Cardiovascular Pathology, Texas Heart Institute, Houston, TX, USA.
FAU - Chatterjee, Subhasis
AU  - Chatterjee S
AD  - Michael E. DeBakey Department of Surgery, Divisions of General and Cardiothoracic 
      Surgery, Baylor College of Medicine, Houston, TX, USA.
LA  - eng
PT  - Journal Article
DEP - 20240220
PL  - England
TA  - Perfusion
JT  - Perfusion
JID - 8700166
SB  - IM
OTO - NOTNLM
OT  - anticoagulation
OT  - extracorporeal membrane oxygenation
OT  - heparin
OT  - rotational thromboelastometry
OT  - thromboelastography
COIS- Declaration of conflicting interestsThe author(s) declared no potential conflicts 
      of interest with respect to the research, authorship, and/or publication of this 
      article.
EDAT- 2024/02/21 11:15
MHDA- 2024/02/21 11:15
CRDT- 2024/02/21 02:18
PHST- 2024/02/21 11:15 [medline]
PHST- 2024/02/21 11:15 [pubmed]
PHST- 2024/02/21 02:18 [entrez]
AID - 10.1177/02676591241232513 [doi]
PST - aheadofprint
SO  - Perfusion. 2024 Feb 20:2676591241232513. doi: 10.1177/02676591241232513.