Abstract
BackgroundExtracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (pECLA) requires effective anticoagulation. Knowledge on the use of argatroban in patients with acute respiratory distress syndrome (ARDS) undergoing ECMO or pECLA is limited. Therefore, this study assessed the feasibility, efficacy and safety of argatroban in critically ill ARDS patients undergoing extracorporeal lung support.MethodsThis retrospective analysis included ARDS patients on extracorporeal lung support who received argatroban between 2007 and 2014 in a single ARDS referral center. As controls, patients who received heparin were matched for age, sex, body mass index and severity of illness scores. Major and minor bleeding complications, thromboembolic events, administered number of erythrocyte concentrates, thrombocytes and fresh-frozen plasmas were assessed. The number of extracorporeal circuit systems and extracorporeal lung support cannulas needed due to clotting was recorded. Also assessed was the efficacy to reach the targeted activated partial thromboplastin time (aPTT) in the first consecutive 14 days of therapy, and the controllability of aPTT values is within a therapeutic range of 50–75 s. Fisher’s exact test, Mann–Whitney U tests, Friedman tests and multivariate nonparametric analyses for longitudinal data (MANOVA; Brunner’s analysis) were applied where appropriate.ResultsOf the 535 patients who met the inclusion criteria, 39 receiving argatroban and 39 matched patients receiving heparin (controls) were included. Baseline characteristics were similar between the two groups, including severity of illness and organ failure scores. There were no significant differences in major and minor bleeding complications. Rates of thromboembolic events were generally low and were similar between the two groups, as were the rates of transfusions required and device-associated complications. The controllability of both argatroban and heparin improved over time, with a significantly increasing probability to reach the targeted aPTT corridor over the first days (p < 0.001). Over time, there were significantly fewer aPTT values below the targeted aPTT goal in the argatroban group than in the heparin group (p < 0.05). Both argatroban and heparin reached therapeutic aPTT values for adequate application of extracorporeal lung support.ConclusionsArgatroban appears to be a feasible, effective and safe anticoagulant for critically ill ARDS patients undergoing extracorporeal lung support.
Highlights
Extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist requires effective anticoagulation
Severe cases of acute respiratory distress syn‐ drome (ARDS) with life-threatening hypoxemia or hypercapnia can undergo extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist as a rescue therapy, when conservative treatment strategies such as prone positioning are exhausted and oxygenation cannot be maintained with conventional mechanical ventilation alone
There were no significant differences between the two study groups for age, sex and body mass index (BMI), or for severity of illness and organ failure scores at intensive care units (ICU) admission
Summary
Extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (pECLA) requires effective anticoagulation. Severe cases of ARDS with life-threatening hypoxemia or hypercapnia can undergo extracorporeal membrane oxygenation (ECMO) or pumpless extracorporeal lung assist (pECLA) as a rescue therapy, when conservative treatment strategies such as prone positioning are exhausted and oxygenation cannot be maintained with conventional mechanical ventilation alone. This patient population might be challenging with the simultaneous occurrence of heparin-induced thrombocytopenia (HIT). HIT is a serious immune-mediated adverse effect of heparin leading to a pro-thrombotic state [1,2,3]. Argatroban, a direct thrombin inhibitor, can be used as an alternative anticoagulant to heparin and was shown to improve outcomes in patients with HIT in a prospective, historical controlled study [6]
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.
