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The Entire Coagulation Process Is More Important than APTT/ACT Monitoring Alone in the Anticoagulation Management of VV-ECMO
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A5113 - The Entire Coagulation Process Is More Important than APTT/ACT Monitoring Alone in the Anticoagulation Management of VV-ECMO
Author Block: T. Xiao, B. Sun, X. Li; Respiratory and Critical Care Department, Beijing Chao-Yang Hospital, Beijing, China.
Rationale: Effective and normative anticoagulation is one of the most important components of Extracorporeal membrane oxygenation (ECMO) management. Excessive anticoagulation may lead to hemorrhage, which is the most common and serious complication. We want to develop a more effective anticoagulation strategy for patients receiving veno-venous (VV)-ECMO.
Methods: Patients receiving VV-ECMO were included in this single-center, prospective, observational cohort study from November 2009 to July 2017. Data were collected before and after VV-ECMO. Hemorrhage and thrombosis occurrence, VV-ECMO run time, VV-ECMO survived rate, hospital stays and mortality were recorded.
Results: Of the 84 patients enrolled, 42 suffered hemorrhages. The median activated partial thromboplastin time (APTT) was higher from 2009-2012 (61.85 (42.80, 87.00) s) than from 2013-2017 (46.70 (37.90, 57.60) s; p=0.000). The study groups did not differ in hemorrhage incidence. D-dimer levels were lower in the bleeding group than the non-bleeding group at both baseline and endpoints (p=0.005). The α-angle was decreased (p=0.012), and the R time was increased (p=0.021) in the bleeding group at the endpoint compared with baseline. In the non-bleeding group, fibrinogen (FBG) and PLT levels were reduced (pFBG=0.000, pPLT=0.037), while D-dimer levels were increased (p=0.005) at the endpoint compared with baseline, but there was no difference in thrombelastogram. The AUC for the ability of D-dimer levels to predict hemorrhage was 0.806 (p=0.001, 95%CI[0.660-0.953]). The D-dimer cut-off value was 19.06 mg/dl, with a sensitivity of 0.818 and specificity of 0.842.
Conclusion: We suggest that anticoagulation management during ECMO should be transformed from monitoring the APTT/ACT alone to considering the entire process of coagulation. Maintaining thrombosis ability and PLT function within normal ranges by supplement and control while performing traditional APTT/ACT monitoring may help reduce hemorrhage event and improve patient prognoses. This conclusion needs to be confirmed by a larger prospective, randomized controlled study.
Author Block: T. Xiao, B. Sun, X. Li; Respiratory and Critical Care Department, Beijing Chao-Yang Hospital, Beijing, China.
Rationale: Effective and normative anticoagulation is one of the most important components of Extracorporeal membrane oxygenation (ECMO) management. Excessive anticoagulation may lead to hemorrhage, which is the most common and serious complication. We want to develop a more effective anticoagulation strategy for patients receiving veno-venous (VV)-ECMO.
Methods: Patients receiving VV-ECMO were included in this single-center, prospective, observational cohort study from November 2009 to July 2017. Data were collected before and after VV-ECMO. Hemorrhage and thrombosis occurrence, VV-ECMO run time, VV-ECMO survived rate, hospital stays and mortality were recorded.
Results: Of the 84 patients enrolled, 42 suffered hemorrhages. The median activated partial thromboplastin time (APTT) was higher from 2009-2012 (61.85 (42.80, 87.00) s) than from 2013-2017 (46.70 (37.90, 57.60) s; p=0.000). The study groups did not differ in hemorrhage incidence. D-dimer levels were lower in the bleeding group than the non-bleeding group at both baseline and endpoints (p=0.005). The α-angle was decreased (p=0.012), and the R time was increased (p=0.021) in the bleeding group at the endpoint compared with baseline. In the non-bleeding group, fibrinogen (FBG) and PLT levels were reduced (pFBG=0.000, pPLT=0.037), while D-dimer levels were increased (p=0.005) at the endpoint compared with baseline, but there was no difference in thrombelastogram. The AUC for the ability of D-dimer levels to predict hemorrhage was 0.806 (p=0.001, 95%CI[0.660-0.953]). The D-dimer cut-off value was 19.06 mg/dl, with a sensitivity of 0.818 and specificity of 0.842.
Conclusion: We suggest that anticoagulation management during ECMO should be transformed from monitoring the APTT/ACT alone to considering the entire process of coagulation. Maintaining thrombosis ability and PLT function within normal ranges by supplement and control while performing traditional APTT/ACT monitoring may help reduce hemorrhage event and improve patient prognoses. This conclusion needs to be confirmed by a larger prospective, randomized controlled study.
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