Abstract
| Original language | English |
|---|---|
| Journal | Annals of Intensive Care |
| Volume | 8 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
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Keywords
- Anticoagulation
- Extracorporeal membrane oxygenation
- Hemorrhage
- Heparin
- Thromboelastography
- Thrombosis
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Thromboelastography-based anticoagulation management during extracorporeal membrane oxygenation. / Panigada, Mauro; E. Iapichino, Giacomo; Brioni, Matteo; Panarello, Giovanna; Protti, Alessandro; Grasselli, Giacomo; Occhipinti, Giovanna; Novembrino, Cristina; Consonni, Dario; Arcadipane, Antonio; Gattinoni, Luciano; Pesenti, Antonio.
In: Annals of Intensive Care, Vol. 8, No. 1, 01.12.2018.Research output: Contribution to journal › Article
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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 -