Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review
The use of extracorporeal membrane oxygenation (ECMO) has recently increased exponentially. ECMO has become the preferred mode of organ support in refractory respiratory or circulatory failure. The fragile balance of haemostasis physiology is massively altered by the patient’s critical condition and...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/18/6067 |
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| author | Ján Šoltés Michal Skribuckij Hynek Říha Michal Lipš Pavel Michálek Martin Balík Michal Pořízka |
| author_facet | Ján Šoltés Michal Skribuckij Hynek Říha Michal Lipš Pavel Michálek Martin Balík Michal Pořízka |
| author_sort | Ján Šoltés |
| collection | DOAJ |
| description | The use of extracorporeal membrane oxygenation (ECMO) has recently increased exponentially. ECMO has become the preferred mode of organ support in refractory respiratory or circulatory failure. The fragile balance of haemostasis physiology is massively altered by the patient’s critical condition and specifically the aetiology of the underlying disease. Furthermore, an application of ECMO conveys another disturbance of haemostasis due to blood-circuit interaction and the presence of an oxygenator. The purpose of this review is to summarise current knowledge on the anticoagulation management in patients undergoing ECMO therapy. The unfractionated heparin modality with monitoring of activated partial thromboplastin tests is considered to be a gold standard for anticoagulation in this specific subgroup of intensive care patients. However, alternative modalities with other agents are comprehensively discussed. Furthermore, other ways of monitoring can represent the actual state of coagulation in a more complex fashion, such as thromboelastometric/graphic methods, and might become more frequent. In conclusion, the coagulation system of patients with ECMO is altered by multiple variables, and there is a significant lack of evidence in this area. Therefore, a highly individualised approach is the best solution today. |
| first_indexed | 2024-03-10T22:35:44Z |
| format | Article |
| id | doaj.art-02c68089bd4743508962da27db73e777 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T22:35:44Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-02c68089bd4743508962da27db73e7772023-11-19T11:21:22ZengMDPI AGJournal of Clinical Medicine2077-03832023-09-011218606710.3390/jcm12186067Update on Anticoagulation Strategies in Patients with ECMO—A Narrative ReviewJán Šoltés0Michal Skribuckij1Hynek Říha2Michal Lipš3Pavel Michálek4Martin Balík5Michal Pořízka6Department of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech RepublicDepartment of Anaesthesia, Golden Jubilee University National Hospital, Clydebank G81 4DY, UKDepartment of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech RepublicDepartment of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech RepublicDepartment of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech RepublicDepartment of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech RepublicDepartment of Anaesthesiology and Intensive Care Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 12808 Prague, Czech RepublicThe use of extracorporeal membrane oxygenation (ECMO) has recently increased exponentially. ECMO has become the preferred mode of organ support in refractory respiratory or circulatory failure. The fragile balance of haemostasis physiology is massively altered by the patient’s critical condition and specifically the aetiology of the underlying disease. Furthermore, an application of ECMO conveys another disturbance of haemostasis due to blood-circuit interaction and the presence of an oxygenator. The purpose of this review is to summarise current knowledge on the anticoagulation management in patients undergoing ECMO therapy. The unfractionated heparin modality with monitoring of activated partial thromboplastin tests is considered to be a gold standard for anticoagulation in this specific subgroup of intensive care patients. However, alternative modalities with other agents are comprehensively discussed. Furthermore, other ways of monitoring can represent the actual state of coagulation in a more complex fashion, such as thromboelastometric/graphic methods, and might become more frequent. In conclusion, the coagulation system of patients with ECMO is altered by multiple variables, and there is a significant lack of evidence in this area. Therefore, a highly individualised approach is the best solution today.https://www.mdpi.com/2077-0383/12/18/6067ECMOanticoagulationheparinlow-molecular-weight heparinCOVIDcoagulation monitoring |
| spellingShingle | Ján Šoltés Michal Skribuckij Hynek Říha Michal Lipš Pavel Michálek Martin Balík Michal Pořízka Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review Journal of Clinical Medicine ECMO anticoagulation heparin low-molecular-weight heparin COVID coagulation monitoring |
| title | Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review |
| title_full | Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review |
| title_fullStr | Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review |
| title_full_unstemmed | Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review |
| title_short | Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review |
| title_sort | update on anticoagulation strategies in patients with ecmo a narrative review |
| topic | ECMO anticoagulation heparin low-molecular-weight heparin COVID coagulation monitoring |
| url | https://www.mdpi.com/2077-0383/12/18/6067 |
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