Abstract
Objective: The optimal management of anticoagulation in neonatal/pediatric patients during extracorporeal membrane oxygenation (ECMO) has not been established yet and varies greatly among ECMO centers worldwide. Therefore, we aimed to assess whether the use of anti-factor Xa assay and/or thromboelastometry correlate better than activated clotting time with heparin dose in newborns with congenital diaphragmatic hernia during ECMO. We also examined whether these coagulation assays correlate with thrombotic and/or hemorrhagic complications, when the management of anticoagulation is based only on activated clotting time values.Methods: A prospective observational study in a neonatal ECMO center was conducted. We included all neonates with congenital diaphragmatic hernia born in our institution between March 2018 and January 2019 and requiring support with venoarterial ECMO. A total of 26 ECMO runs were analyzed. During the study, the heparin dose was still adjusted according to activated clotting time values. Measurements of anti-factor Xa assay, activated partial thromboplastin time, and a thromboelastometry from the same blood specimen were performed twice a day.Results: Anti-factor Xa levels showed a moderate correlation with heparin dose, whereas the other tests showed a weak correlation. Four patients (17.4%) had thrombotic complications, 2 patients (8.7%) experienced life-threatening bleeding, and in 11 patients (47.8%) disseminated intravascular coagulation (DIC) occurred. Anti-factor Xa levels were lower in the group with thrombotic complications (0.23 vs. 0.27 IU/ml; p = 0.002), while activated partial thromboplastin time was higher in the group with hemorrhagic complications (69.4 s vs. 59.8 s; p = 0.01). In patients experiencing DIC, heparin dose and anti-factor Xa levels were lower, while no difference in activated clotting time and clotting time in INTEM and INTEM-HEPTEM were shown.Conclusions: Anti-factor Xa levels correlate better to heparin dose than activated clotting time. The use of anti-factor Xa assay instead of activated clotting time for dosing of unfractionated heparin could reduce thrombotic complications in neonates with congenital diaphragmatic hernia on ECMO support. The thromboelastometry showed no additional benefit for this purpose.
Highlights
Extracorporeal membrane oxygenation (ECMO) is an extracorporeal technique used to support patients with respiratory and/or cardiac failure refractory to conventional treatment
We evaluated the correlation of an administrated heparin dose to different coagulation assays in newborns with Congenital diaphragmatic hernia (CDH) undergoing venoarterial ECMO and assessed whether the different coagulation assays correlated with thrombotic and/or hemorrhagic complications, when the management of anticoagulation was based only on activated clotting time (ACT) values
The levels of anti-factor Xa were lower in the group with thrombotic complications, while activated partial thromboplastin time (aPTT) was higher in the group with hemorrhagic complications
Summary
Extracorporeal membrane oxygenation (ECMO) is an extracorporeal technique used to support patients with respiratory and/or cardiac failure refractory to conventional treatment. Despite increasing clinical practice and technical improvements, the optimal management of anticoagulation in patients during ECMO is still controversial and varies greatly among the various ECMO centers worldwide [3]. Maintaining an optimal balance of hemostasis can be challenging in neonates due to their immature hemostatic systems, with decreased plasma concentrations of most procoagulants and many anticoagulant factors and the resulting lack of reserve capacity [1, 4]. These physiological differences may influence the monitoring and efficacy of the anticoagulation required during ECMO [1]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
