Abstract Number: PB0093
Meeting: ISTH 2021 Congress
Background: Bleeding and thrombotic complications are the main contributors to morbidity and mortality during ECMO. Anticoagulation in patients with ECMO is challenging. There is no gold standard for anticoagulant surveillance and it is recommended to establish protocols in each institution according to the resources available.
Aims: Patients from the Intensive Care Unit treated with ECMO at the National Institute of Cardiology, assessed by Hematology, with a report of Activated Clotting Time (ACT), Activated Partial Thromboplastin Time (aPTT), Anti Xa, Antithrombin III (ATII), Fibrinogen (Fg) during ECMO use.
Methods: Observational, descriptive, retrospective, cross-sectional study. Patients from the Intensive Care Unit of the National Institute of Cardiology Dr. Ignacio Chávez treated with ECMO in the period 2019-2020 were included.
Results: Thirteen patients anticoagulated with unfractionated heparin during ECMO therapy were included. The laboratory tests for surveillance were: aPTT, Fibrinogen, platelet count, D-Dimer, Anti Xa, ACT. The ACT test had a very low correlation with heparinemia. In complications, a direct relationship was found between the report of ischemic CVD and subtherapeutic anticoagulant therapy. In the outcome, 8 patients were discharged home and 5 patients died (38.4%).
Conclusions: To achieve optimal anticoagulation of the patient on ECMO, close clinical surveillance and reliable measurements of the anticoagulation level are necessary, such as surveillance with measurement of antiXa levels. Calibration of aPTT with anti-Xa heparinemia is always recommended to be able to use aPTT in monitoring treatment with unfractionated heparin. Prospective multicenter trials are needed to investigate the optimal anticoagulation management strategy during ECMO support.
To cite this abstract in AMA style:Gonzalez-Figueroa LH, Grimaldo-Gómez FA, García-Jiménez X, Anguiano-Alvarez V, Cortina-de la Rosa E, Romero-Arroyo MO, Altamirano-Solorzano GA, Rojas-Velazco G, Izaguirre-Avila RA. Surveillance of Anticoagulation in Patients with Extracorporal Oxygenation Membrane (ECMO) [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/surveillance-of-anticoagulation-in-patients-with-extracorporal-oxygenation-membrane-ecmo/. Accessed November 29, 2023.
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