Coagulation Factor Levels and Underlying Thrombin Generation Patterns in Adult Extracorporeal Membrane Oxygenation Patients

Mazzeffi, Michael; Strauss, Erik; Meyer, Michael J.; Hasan, Shaheer; Judd, Miranda; Abuelkasem, Ezeldeen; Chow, Jonathan H.; Nandwani, Veena; McCarthy, Paul; Tanaka, Kenichi A.

doi:10.1213/ane.0000000000004275

Cited by 41 publications

(50 citation statements)

References 22 publications

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“…Resistance to thrombo modulin is also apparent. These changes demonstrate a possible mechanism for hypercoagulability during adult VA ECMO [41].…”

Section: Complications Of Extra Corporeal Therapy Bleeding and Anticmentioning

confidence: 77%

“…Mazzeffi et al [41] observed that contact activation occurs during ECMO, but procoagulant factor levels are generally preserved. Although heparin-neutralized thrombin generation (TG) is delayed, peak TG and endogenous thrombin potential are supranormal in the setting of high FVIII and low AT and protein C levels.…”

Section: Complications Of Extra Corporeal Therapy Bleeding and Anticmentioning

confidence: 99%

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Extra Corporeal Life Support in Traumatic Brain Injury Patients

López¹,

Torre²,

Bilotta³

et al. 2019

obm neurobiol

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Purpose of review: The purpose of this review is to describe recent evidence regarding the use of Extracorporeal Membrane Oxygenation (ECMO) as rescue therapy for refractory cardiac or respiratory failure in patients with traumatic brain injury (TBI) when conventional treatments have failed. The characteristics of these patients, including the risk of bleeding and developing malignant intracranial hypertension, are generally considered as relative contraindications to ECMO treatment; however, recent evidence suggests that the use of ECMO should be considered even in this cohort. Recent findings: Recent findings suggest that venous-venous (V-V) ECMO can be feasible in the treatment of severe acute respiratory distress syndrome (ARDS) TBI-related. Venousarterial (V-A) ECMO has emerged as a salvage intervention in TBI patients complicated with cardiogenic shock and after cardiac arrest. Improvement of ECMO techniques, including the introduction of centrifugal pumps and heparin-coated circuits, are progressively reducing the amount of heparin required. Moreover, the application of low dose heparin or heparinfree protocols anticoagulation in ECMO has shown good outcome and minimal bleeding and thrombotic complications. Summary: ECMO can be considered as a safe and feasible rescue therapy even in TBI patients. However, there is a lack of evidence. Further studies are warranted, focusing on brain trauma patients undergoing ECMO to better clarify the effect on survival, the type and dose of anticoagulation, and the utility of dedicated multidisciplinary trauma-ECMO units.

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“…Resistance to thrombo modulin is also apparent. These changes demonstrate a possible mechanism for hypercoagulability during adult VA ECMO [41].…”

Section: Complications Of Extra Corporeal Therapy Bleeding and Anticmentioning

confidence: 77%

Section: Complications Of Extra Corporeal Therapy Bleeding and Anticmentioning

confidence: 99%

Extra Corporeal Life Support in Traumatic Brain Injury Patients

López¹,

Torre²,

Bilotta³

et al. 2019

obm neurobiol

View full text Add to dashboard Cite

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“…1,[14][15][16] Furthermore, pathophysiological mechanisms of ECMO-induced coagulopathy is multifactorial and involves both humoral and cellular coagulation elements as well as inflammatory system. [17][18][19] Acquired AT deficiency is not uncommon due to prolonged heparin usage on ECMO, and AT may reduce the risk of in vivo or intracircuit thrombus formation. 18,20,21 Accordingly, since children have AT deficiency at least until they are 6 months/1 year old, AT has been administered during ECMO in critically ill children in case of disseminated intravascular coagulation due to sepsis and liver impairment.…”

Section: Introductionmentioning

confidence: 99%

“…[17][18][19] Acquired AT deficiency is not uncommon due to prolonged heparin usage on ECMO, and AT may reduce the risk of in vivo or intracircuit thrombus formation. 18,20,21 Accordingly, since children have AT deficiency at least until they are 6 months/1 year old, AT has been administered during ECMO in critically ill children in case of disseminated intravascular coagulation due to sepsis and liver impairment. [22][23][24][25][26] Over the last decade, several reports and case series have suggested a potential usefulness of AT replacement in adults during veno-venous (V-V) ECMO, demonstrating lower heparin requirement, better control of anticoagulation, or lower consumptions of coagulation factors and platelets.…”

Section: Introductionmentioning

confidence: 99%

A narrative review of antithrombin use during veno-venous extracorporeal membrane oxygenation in adults: rationale, current use, effects on anticoagulation, and outcomes

et al. 2020

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Background: During extracorporeal membrane oxygenation, the large contact surface between the blood and the extracorporeal circuit causes a continuous activation of coagulation and inflammation. Unfractionated heparin, a glycosaminoglycan that must bind to antithrombin as a cofactor, is currently the standard anticoagulant adopted during extracorporeal membrane oxygenation. Antithrombin, beyond being a potent natural anticoagulant, acts in the cross-talk between coagulation and inflammatory system through anticoagulation and coagulation-independent effects. Objectives: In this review, we describe, in the adult setting of veno-venous extracorporeal membrane oxygenation, the pathophysiological rationale for antithrombin use, the current practice of administration, and the effects of antithrombin on anticoagulation, bleeding, and outcomes. Data sources: Studies on adults (18 years or older) on veno-venous extracorporeal membrane oxygenation published from 1995 to 2018 in order to evaluate the use of antithrombin. Results: In adults on veno-venous extracorporeal membrane oxygenation, antithrombin supplementation has a highly pathophysiological rationale since coagulation factor consumption, systemic inflammatory response syndrome, and endothelial activation are triggered by extracorporeal membrane oxygenation. Eleven articles are focused on the topic but among the authors there is no consensus on the threshold for supplementation (ranging from 70% to 80%) as well as on the dose (rarely standardized) and time of administration (bolus vs continuous infusion). Consistently, antithrombin is considered able to achieve better anticoagulation targets in or not in the presence of heparin resistance. The impact of antithrombin administration on bleeding still shows contrasting results. Conclusion: Antithrombin use in veno-venous extracorporeal membrane oxygenation should be investigated on the threshold for supplementation, dose, and time of administration.

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“…Reflective of the regulatory nature of these cascades is the presence of modestly elevated D-dimer levels in adult ECMO patients. 15 Intriguingly, the COVID-19 literature has within it numerous reports of elevated D-dimers, which represents the most frequently assayed fibrin degradation products (FDP), and are generated during enzymatic fibrin cleavage by plasmin. 1 , 16 D-dimer levels in COVID-19 patients serve as biomarkers, with elevated levels being associated with increased disease severity and higher in hospital mortality.…”

mentioning

confidence: 99%