Perfusion NewswireBlood ManagementVariability in Anticoagulation Management of Patients on Extracorporeal Membrane Oxygenation: An International Survey
Variability in Anticoagulation Management of Patients on Extracorporeal Membrane Oxygenation: An International Survey
OBJECTIVE: The objective of this study was to determine current practices of anticoagulation in patients on extracorporeal membrane oxygenation.
DESIGN: Internet-based cross-sectional survey distributed between November 2010 and May 2011.
SETTING: Extracorporeal Life Support Organization-registered extracorporeal membrane oxygenation centers internationally.
PARTICIPANTS: Extracorporealmembrane oxygenation medical directors and coordinators.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: There were 121 responses from extracorporealmembrane oxy genation medical directors and coordinators at 187 Extracorporeal Life Support Organization centers with access to the survey. Eighty-four of 117 (72%) respondents reported having a written institutional extracorporealmembrane oxy genation protocol for both anticoagulation and blood product management at their institutions. Sixty-nine of 117 (59%) respondents reported use of tip-to-tip or partially heparin-bonded circuits. Unfractionated heparin was used at all centers; only 8% of respondents indicated use of alternative anticoagulation medications in the six months prior to the survey. The preferred method of anticoagulation monitoring was the serial measurement of activated clotting time, as reported by 97% of respondents. In this survey, 82% of respondents reported antithrombin III testing, 65% reported anti-factor Xa testing, and 43% reported use of thromboelastography during extracorporealmembrane oxy genation. Goal ranges for these three tests and interventions triggered by out-of-range values were found to be variable.
CONCLUSIONS: Extracorporealmembrane oxy genation anticoagulation management policies vary widely by center. The majority of extracorporealmembrane oxy genation programs employ activated clotting time as the preferred anticoagulation monitoring tool. The coagulation system is also monitored using more specific markers such as antithrombin III, anti-factor Xa, and thromboelastography by a large number of centers. Future research is needed to elucidate optimal anticoagulation management and improve outcomes.
The perioperative course of the patients who have undergone coronary stent placement was studied. These patients were on dual antiplatelet therapy and were posted for noncardiac surgery.
