Monitoring Unfractionated Heparin in Adult Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO): ACT, APTT, or ANTI-XA?

Tung Phi Nguyen,Xuan Thi Phan,Ha Thi Viet Truong,Hai Ngoc Truong,Thi Thi Ho,Tuan Manh Nguyen,Thao Thi Ngoc Pham,Dai Quang Huynh,Thao Phuong Le,Yen Nguyen Hai Le,Quan Quoc Minh Du,Samuel A Tisherman

doi:10.1155/2021/5579936

Tung Phi Nguyen, Xuan Thi Phan + Show 10 more

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https://doi.org/10.1155/2021/5579936

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Abstract

Background During ECMO, anticoagulants, in particular, unfractionated heparin (UFH), are commonly used and monitored by laboratory tests, including ACT, APTT, and anti-Xa level. Method A single-center retrospective observational study was conducted on adult patients undergoing ECMO between January 2019 and January 2020 at a tertiary hospital. The correlations between ACT, APTT, anti-Xa, antithrombin, and UFH dose were assessed. Results 129 sets of measurements from 37 patients were obtained including ACT, APTT, anti-Xa, antithrombin, and UFH dose measured simultaneously. 102 out of 129 sets of values were interpreted as antithrombin deficiencies. The correlation coefficient between APTT and anti-Xa; ACT and anti-Xa are 0.72 and 0.33, respectively, p < 0.001. The patients with normal antithrombin levels exhibited a significant correlation between APTT and anti-Xa (r = 0.80, p < 0.001). ACT, on the other hand, was poorly correlated with UFH dose, whether there is AT deficiency or not. Anti-Xa and APTT are only moderately correlated with UFH dose in the group without antithrombin deficiency, with correlation coefficients of 0.62 and 0.57, respectively, p < 0.05. Conclusion APTT value is strongly correlated with anti-Xa value, particularly in patients with normal antithrombin levels. However, the ACT value was poorly correlated with anti-Xa and not with the UFH dose. In groups without antithrombin deficiency, APTT and anti-Xa values only moderately correlated with UFH dose.

Highlights

During Extracorporeal membrane oxygenation (ECMO), anticoagulants, in particular, unfractionated heparin (UFH), are commonly used and monitored by laboratory tests, including ACT, Activated Partial romboplastin Time (APTT), and anti-Xa level
E study showed a strong correlation between APTT and anti-Xa values with a correlation coefficient of 0.72. is correlation was stronger when the patients were in the group with antithrombin deficiency, which was shown in Figure 1(a): the linear regression line of the scatter plot went up following the direction of the short axis of the eclipse
For UFH dose at that time, the only anti-Xa value had a moderate positive correlation with UFH dose, while APTT value had a moderate positive correlation with UFH dosing and ACT had no correlation with UFH dosing of patients in both groups with and without antithrombin deficiency

Summary

Introduction

During ECMO, anticoagulants, in particular, unfractionated heparin (UFH), are commonly used and monitored by laboratory tests, including ACT, APTT, and anti-Xa level. E correlations between ACT, APTT, anti-Xa, antithrombin, and UFH dose were assessed. 129 sets of measurements from 37 patients were obtained including ACT, APTT, anti-Xa, antithrombin, and UFH dose measured simultaneously. E patients with normal antithrombin levels exhibited a significant correlation between APTT and anti-Xa (r 0.80, p < 0.001). The ACT value was poorly correlated with anti-Xa and not with the UFH dose. In groups without antithrombin deficiency, APTT and anti-Xa values only moderately correlated with UFH dose. Erefore, an ACT result can be prolonged by multiple factors independent of UFH doses, such as anemia, hypofibrinogenemia, thrombocytopenia, other than heparin inhibited coagulation factor deficiencies, hypothermia, and hemodilution [5, 10]. An anti-Xa value is affected by technical errors from the photo-optical method, such as hyperbilirubinemia, hemolysis, and antithrombin deficiency [4, 13]

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