Thromboelastography-based anticoagulation management during extracorporeal membrane oxygenation

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Abstract

Background: There is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO is currently burdened by a high rate of hemostatic complications, possibly associated with inadequate monitoring of heparin anticoagulation. This study aims to assess the safety and feasibility of an anticoagulation protocol for patients undergoing ECMO based on thromboelastography (TEG) as opposed to an activated partial thromboplastin time (aPTT)-based protocol. Methods: We performed a multicenter, randomized, controlled trial in two academic tertiary care centers. Adult patients with acute respiratory failure treated with veno-venous ECMO were randomized to manage heparin anticoagulation using a TEG-based protocol (target 16–24 min of the R parameter, TEG group) or a standard of care aPTT-based protocol (target 1.5–2 of aPTT ratio, aPTT group). Primary outcomes were safety and feasibility of the study protocol. Results: Forty-two patients were enrolled: 21 were randomized to the TEG group and 21 to the aPTT group. Duration of ECMO was similar in the two groups (9 (7–16) days in the TEG group and 11 (4–17) days in the aPTT group, p = 0.74). Heparin dosing was lower in the TEG group compared to the aPTT group (11.7 (9.5–15.3) IU/kg/h vs. 15.7 (10.9–21.3) IU/kg/h, respectively, p = 0.03). Safety parameters, assessed as number of hemorrhagic or thrombotic events and transfusions given, were not different between the two study groups. As for the feasibility, the TEG-based protocol triggered heparin infusion rate adjustments more frequently (p 
Original languageEnglish
JournalAnnals of Intensive Care
Volume8
Issue number1
DOIs
Publication statusPublished - Dec 1 2018

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Thrombelastography
Extracorporeal Membrane Oxygenation
Partial Thromboplastin Time
Heparin
Safety
Feasibility Studies
Hemostatics
Standard of Care
Tertiary Care Centers
Respiratory Insufficiency
Randomized Controlled Trials

Keywords

  • Anticoagulation
  • Extracorporeal membrane oxygenation
  • Hemorrhage
  • Heparin
  • Thromboelastography
  • Thrombosis

Cite this

@article{6584efc416894de1949da80a9a1a8840,
title = "Thromboelastography-based anticoagulation management during extracorporeal membrane oxygenation",
abstract = "Background: There is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO is currently burdened by a high rate of hemostatic complications, possibly associated with inadequate monitoring of heparin anticoagulation. This study aims to assess the safety and feasibility of an anticoagulation protocol for patients undergoing ECMO based on thromboelastography (TEG) as opposed to an activated partial thromboplastin time (aPTT)-based protocol. Methods: We performed a multicenter, randomized, controlled trial in two academic tertiary care centers. Adult patients with acute respiratory failure treated with veno-venous ECMO were randomized to manage heparin anticoagulation using a TEG-based protocol (target 16–24 min of the R parameter, TEG group) or a standard of care aPTT-based protocol (target 1.5–2 of aPTT ratio, aPTT group). Primary outcomes were safety and feasibility of the study protocol. Results: Forty-two patients were enrolled: 21 were randomized to the TEG group and 21 to the aPTT group. Duration of ECMO was similar in the two groups (9 (7–16) days in the TEG group and 11 (4–17) days in the aPTT group, p = 0.74). Heparin dosing was lower in the TEG group compared to the aPTT group (11.7 (9.5–15.3) IU/kg/h vs. 15.7 (10.9–21.3) IU/kg/h, respectively, p = 0.03). Safety parameters, assessed as number of hemorrhagic or thrombotic events and transfusions given, were not different between the two study groups. As for the feasibility, the TEG-based protocol triggered heparin infusion rate adjustments more frequently (p ",
keywords = "Anticoagulation, Extracorporeal membrane oxygenation, Hemorrhage, Heparin, Thromboelastography, Thrombosis",
author = "Mauro Panigada and {E. Iapichino}, Giacomo and Matteo Brioni and Giovanna Panarello and Alessandro Protti and Giacomo Grasselli and Giovanna Occhipinti and Cristina Novembrino and Dario Consonni and Antonio Arcadipane and Luciano Gattinoni and Antonio Pesenti",
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year = "2018",
month = "12",
day = "1",
doi = "10.1186/s13613-017-0352-8",
language = "English",
volume = "8",
journal = "Annals of Intensive Care",
issn = "2110-5820",
publisher = "Springer-Verlag GmbH and Co. KG",
number = "1",

}

TY - JOUR

T1 - Thromboelastography-based anticoagulation management during extracorporeal membrane oxygenation

AU - Panigada, Mauro

AU - E. Iapichino, Giacomo

AU - Brioni, Matteo

AU - Panarello, Giovanna

AU - Protti, Alessandro

AU - Grasselli, Giacomo

AU - Occhipinti, Giovanna

AU - Novembrino, Cristina

AU - Consonni, Dario

AU - Arcadipane, Antonio

AU - Gattinoni, Luciano

AU - Pesenti, Antonio

N1 - M1 - 7

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: There is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO is currently burdened by a high rate of hemostatic complications, possibly associated with inadequate monitoring of heparin anticoagulation. This study aims to assess the safety and feasibility of an anticoagulation protocol for patients undergoing ECMO based on thromboelastography (TEG) as opposed to an activated partial thromboplastin time (aPTT)-based protocol. Methods: We performed a multicenter, randomized, controlled trial in two academic tertiary care centers. Adult patients with acute respiratory failure treated with veno-venous ECMO were randomized to manage heparin anticoagulation using a TEG-based protocol (target 16–24 min of the R parameter, TEG group) or a standard of care aPTT-based protocol (target 1.5–2 of aPTT ratio, aPTT group). Primary outcomes were safety and feasibility of the study protocol. Results: Forty-two patients were enrolled: 21 were randomized to the TEG group and 21 to the aPTT group. Duration of ECMO was similar in the two groups (9 (7–16) days in the TEG group and 11 (4–17) days in the aPTT group, p = 0.74). Heparin dosing was lower in the TEG group compared to the aPTT group (11.7 (9.5–15.3) IU/kg/h vs. 15.7 (10.9–21.3) IU/kg/h, respectively, p = 0.03). Safety parameters, assessed as number of hemorrhagic or thrombotic events and transfusions given, were not different between the two study groups. As for the feasibility, the TEG-based protocol triggered heparin infusion rate adjustments more frequently (p 

AB - Background: There is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO is currently burdened by a high rate of hemostatic complications, possibly associated with inadequate monitoring of heparin anticoagulation. This study aims to assess the safety and feasibility of an anticoagulation protocol for patients undergoing ECMO based on thromboelastography (TEG) as opposed to an activated partial thromboplastin time (aPTT)-based protocol. Methods: We performed a multicenter, randomized, controlled trial in two academic tertiary care centers. Adult patients with acute respiratory failure treated with veno-venous ECMO were randomized to manage heparin anticoagulation using a TEG-based protocol (target 16–24 min of the R parameter, TEG group) or a standard of care aPTT-based protocol (target 1.5–2 of aPTT ratio, aPTT group). Primary outcomes were safety and feasibility of the study protocol. Results: Forty-two patients were enrolled: 21 were randomized to the TEG group and 21 to the aPTT group. Duration of ECMO was similar in the two groups (9 (7–16) days in the TEG group and 11 (4–17) days in the aPTT group, p = 0.74). Heparin dosing was lower in the TEG group compared to the aPTT group (11.7 (9.5–15.3) IU/kg/h vs. 15.7 (10.9–21.3) IU/kg/h, respectively, p = 0.03). Safety parameters, assessed as number of hemorrhagic or thrombotic events and transfusions given, were not different between the two study groups. As for the feasibility, the TEG-based protocol triggered heparin infusion rate adjustments more frequently (p 

KW - Anticoagulation

KW - Extracorporeal membrane oxygenation

KW - Hemorrhage

KW - Heparin

KW - Thromboelastography

KW - Thrombosis

U2 - 10.1186/s13613-017-0352-8

DO - 10.1186/s13613-017-0352-8

M3 - Article

VL - 8

JO - Annals of Intensive Care

JF - Annals of Intensive Care

SN - 2110-5820

IS - 1

ER -