Evaluation of coagulopathy on veno-arterial ECMO (VA) extracorporeal membrane oxygenation using platelet aggregometry and standard tests: A narrative review

Kapoor, Poonam Malhotra; Karanjkar, Ameya; Bhardwaj, Vandana

doi:10.1016/j.ejccm.2018.12.021

Cited by 6 publications

(2 citation statements)

References 22 publications

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“…Antithrombin is inactivated and/or consumed, while the levels of vascular heparin-like molecules may be reduced due to neutrophil activation products and inflammatory cytokines [ 42 , 43 , 44 ]. Finally, detailed information on the role of the fibrinolytic system in patients receiving ECMO support is still lacking, but recent studies reported on the association between increased fibrinolysis and bleeding complications [ 45 , 46 ].…”

Section: Inflammation Coagulation and Ecmomentioning

confidence: 99%

Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review

Bukumirić

Breitkopf

Jadžić

et al. 2022

JCM

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The development of extracorporeal life support technology has added a new dimension to the care of critically ill patients who fail conventional treatment options. Extracorporeal membrane oxygenation (ECMO)—specialized temporary life support for patients with severe cardiac or pulmonary failure—plays a role in bridging the time for organ recovery, transplant, or permanent assistance. The overall patient outcome is dependent on the underlying disease, comorbidities, patient reaction to critical illness, and potential adverse events during ECMO. Moreover, the contact of the blood with the large artificial surface of an extracorporeal system circuit triggers complex inflammatory and coagulation responses. These processes may further lead to endothelial injury and disrupted microcirculation with consequent end-organ dysfunction and the development of adverse events like thromboembolism. Therefore, systemic anticoagulation is considered crucial to alleviate the risk of thrombosis and failure of ECMO circuit components. The gold standard and most used anticoagulant during extracorporeal life support is unfractionated heparin, with all its benefits and disadvantages. However, therapeutic anticoagulation of a critically ill patient carries the risk of clinically relevant bleeding with the potential for permanent injury or death. Similarly, thrombotic events may occur. Therefore, different anticoagulation strategies are employed, while the monitoring and the balance of procoagulant and anticoagulatory factors is of immense importance. This narrative review summarizes the most recent considerations on anticoagulation during ECMO support, with a special focus on anticoagulation monitoring and future directions.

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Section: Inflammation Coagulation and Ecmomentioning

confidence: 99%

Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review

Bukumirić

Breitkopf

Jadžić

et al. 2022

JCM

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“…Finally, the role of the fibrinolytic system in ECMO patients is still not well-investigated. Recent data has shown that increased fibrinolytic activity during ECMO support is associated with an increased risk of bleeding [25,50]. In contrast, McVeen et al reported on the normalisation of increased fibrinolytic enzymes within a few days after ECMO initiation [51].…”

Section: Factors Associated With Haemorrhagementioning

confidence: 99%

The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding

Bukumirić

Breitkopf

Oezpeker

et al. 2022

JCM

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Extracorporeal membrane oxygenation (ECMO) is increasingly used in carefully selected patients with cardiac or respiratory failure. However, complications are common and can be associated with worse outcomes, while data on risk factors and outcomes are inconsistent and sparse. Therefore, we sought to investigate potential risk factors and predictors of haemorrhage and adverse events during ECMO and its influence on mortality. We retrospectively reviewed all patients on ECMO support admitted to intensive care units of a tertiary university centre in Austria. In a period of ten years, ECMO support was used in 613 patients, with 321 patients meeting the inclusion criteria of this study. Haemorrhage, occurring in more than one third of the included patients (123, 38%), represented the most common and serious ECMO complication, being associated with an increased one year mortality (51% vs. 35%, p = 0.005). The main risk factors for haemorrhage were severity of the disease (hazard ratio (HR) = 1.01, p = 0.047), a prolonged activated partial thromboplastin time (HR = 1.01, p = 0.007), and lower values of C-reactive protein (HR = 0.96, p = 0.005) and procalcitonin (HR = 0.99, p = 0.029). In summary, haemorrhage remained the main ECMO complication with increased mortality. Moreover, we reported a possible association of lower inflammation and bleeding during ECMO support for the first time. This generated a new hypothesis that warrants further research. Finally, we recommend stricter monitoring of anticoagulation especially in patients without hyperinflammation.

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Utility of Platelet Function Testing in Cardiac Surgery in 2021

Görlinger

Gandhi²

2021

Journal of Cardiac Critical Care TSS

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Evaluation of coagulopathy on veno-arterial ECMO (VA) extracorporeal membrane oxygenation using platelet aggregometry and standard tests: A narrative review

Cited by 6 publications

References 22 publications

Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review

Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review

The Role of Excessive Anticoagulation and Missing Hyperinflammation in ECMO-Associated Bleeding

Utility of Platelet Function Testing in Cardiac Surgery in 2021

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