Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol
(1) Background: Extracorporeal membrane oxygenation (ECMO) is a complex procedure affecting both the risk of thrombosis and bleeding. High-quality data to personalize anticoagulation management in ECMO are lacking, resulting in a high variability in practice among centers. For this reason, we review...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/3/719 |
| _version_ | 1797318579743358976 |
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| author | Ana Bento Rodrigues Anabela Rodrigues Catarina Jacinto Correia Gustavo Nobre Jesus João Miguel Ribeiro |
| author_facet | Ana Bento Rodrigues Anabela Rodrigues Catarina Jacinto Correia Gustavo Nobre Jesus João Miguel Ribeiro |
| author_sort | Ana Bento Rodrigues |
| collection | DOAJ |
| description | (1) Background: Extracorporeal membrane oxygenation (ECMO) is a complex procedure affecting both the risk of thrombosis and bleeding. High-quality data to personalize anticoagulation management in ECMO are lacking, resulting in a high variability in practice among centers. For this reason, we review coagulation methods and monitoring and share a pragmatic proposal of coagulation management, as performed in our high-volume ECMO Referral Centre; (2) Methods: We revised the anticoagulation options and monitoring methods available for coagulation management in ECMO through PubMed search based on words including “anticoagulation,” “coagulation assays,” “ECMO,” “ELSO,” and “ISTH”; (3) Results: Actual revision of the literature was described as our routine practice regarding ECMO anticoagulation and monitoring; (4) Conclusions: No coagulation test is exclusively predictive of bleeding or thrombotic risk in patients undergoing ECMO support. An approach that allows for a tailored regimen of anticoagulation (regardless of agent used) and monitoring is mandatory. To accomplish this, we propose that the titration of anticoagulation therapies should include multiple laboratory tests, including anti-Xa, aPTT, ACT, viscoelastic tests, AT levels, platelet count, fibrinogen, and FXIII levels. Anticoagulation regimens should be tailored to a specific patient and personalized based on this complex array of essays. |
| first_indexed | 2024-03-08T03:54:23Z |
| format | Article |
| id | doaj.art-26deae966bde4411b965c03fa7cd80c4 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T03:54:23Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-26deae966bde4411b965c03fa7cd80c42024-02-09T15:15:43ZengMDPI AGJournal of Clinical Medicine2077-03832024-01-0113371910.3390/jcm13030719Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic ProtocolAna Bento Rodrigues0Anabela Rodrigues1Catarina Jacinto Correia2Gustavo Nobre Jesus3João Miguel Ribeiro4Serviço de Medicina Intensiva, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, PortugalServiço de Imuno-Hemoterapia, Blood Transfusion Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, PortugalServiço de Imuno-Hemoterapia, Blood Transfusion Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, PortugalServiço de Medicina Intensiva, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, PortugalServiço de Medicina Intensiva, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal(1) Background: Extracorporeal membrane oxygenation (ECMO) is a complex procedure affecting both the risk of thrombosis and bleeding. High-quality data to personalize anticoagulation management in ECMO are lacking, resulting in a high variability in practice among centers. For this reason, we review coagulation methods and monitoring and share a pragmatic proposal of coagulation management, as performed in our high-volume ECMO Referral Centre; (2) Methods: We revised the anticoagulation options and monitoring methods available for coagulation management in ECMO through PubMed search based on words including “anticoagulation,” “coagulation assays,” “ECMO,” “ELSO,” and “ISTH”; (3) Results: Actual revision of the literature was described as our routine practice regarding ECMO anticoagulation and monitoring; (4) Conclusions: No coagulation test is exclusively predictive of bleeding or thrombotic risk in patients undergoing ECMO support. An approach that allows for a tailored regimen of anticoagulation (regardless of agent used) and monitoring is mandatory. To accomplish this, we propose that the titration of anticoagulation therapies should include multiple laboratory tests, including anti-Xa, aPTT, ACT, viscoelastic tests, AT levels, platelet count, fibrinogen, and FXIII levels. Anticoagulation regimens should be tailored to a specific patient and personalized based on this complex array of essays.https://www.mdpi.com/2077-0383/13/3/719ECMOanticoagulationprotocolbleedingthrombosistesting |
| spellingShingle | Ana Bento Rodrigues Anabela Rodrigues Catarina Jacinto Correia Gustavo Nobre Jesus João Miguel Ribeiro Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol Journal of Clinical Medicine ECMO anticoagulation protocol bleeding thrombosis testing |
| title | Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol |
| title_full | Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol |
| title_fullStr | Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol |
| title_full_unstemmed | Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol |
| title_short | Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol |
| title_sort | anticoagulation management in v v ecmo patients a multidisciplinary pragmatic protocol |
| topic | ECMO anticoagulation protocol bleeding thrombosis testing |
| url | https://www.mdpi.com/2077-0383/13/3/719 |
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