Unfractionated Heparin Versus Subcutaneous Nadroparin in Adults Supported With Venovenous Extracorporeal Membrane Oxygenation: a Retrospective, Multicenter Study.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 01 2021
01 01 2021
Historique:
pubmed:
15
5
2020
medline:
27
4
2021
entrez:
15
5
2020
Statut:
ppublish
Résumé
Extracorporeal membrane oxygenation (ECMO) requires constant management of coagulation. Whereas unfractionated heparin remains the anticoagulant of choice, experienced centers report high bleeding rates. Biocompatibility of the extracorporeal circuit enables management of anticoagulation with subcutaneous low-molecular-weight heparins only. The aim of this study was to evaluate the safety and feasibility of anticoagulation with subcutaneous nadroparin compared with unfractionated heparin during respiratory ECMO in patients. We assessed for thrombotic complications and number of bleeding and life-threatening bleeding events. Additionally, we evaluated the change in resistance to flow in the oxygenator and the number of transfused blood products. Nadroparin and unfractionated heparin were comparable in terms of number of bleeding (34 vs. 53%; p = 0.12), life-threatening bleeding (2.8 vs. 9.3%; p = 0.26) events, and daily red blood cell transfusion rates (0.79 units/patient/day vs. 0.71 units/patient/day in nadroparin group; p = 0.87) during respiratory ECMO. The relative change in resistance to flow in the oxygenator was similar between groups (8.03 vs. 11.6%; p = 0.27). Nadroparin seemed equivalent to unfractionated heparin in the number of thrombotic and hemorrhagic events as well as in the daily red blood cell transfusion rates during venovenus-ECMO.
Identifiants
pubmed: 32404610
pii: 00002480-202101000-00019
doi: 10.1097/MAT.0000000000001166
doi:
Substances chimiques
Anticoagulants
0
Nadroparin
0
Heparin
9005-49-6
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
104-111Informations de copyright
Copyright © 2020 by the ASAIO.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Karagiannidis C, Brodie D, Strassmann S, et al. Extracorporeal membrane oxygenation: Evolving epidemiology and mortality. Intensive Care Med. 2016; 42:889–896
Zimmermann M, Bein T, Arlt M, et al. Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: A prospective pilot study. Crit Care. 2009; 13:R10
Aubron C, Cheng AC, Pilcher D, et al. Factors associated with outcomes of patients on extracorporeal membrane oxygenation support: A 5-year cohort study. Crit Care. 2013; 17:R73
Brodie D, Bacchetta M. Extracorporeal Membrane Oxygenation for ARDS in Adults. N Engl J Med. 2011; 365:1905–1914
Rastan AJ, Lachmann N, Walther T, et al. Autopsy findings in patients on postcardiotomy extracorporeal membrane oxygenation (ECMO). Int J Artif Organs. 2006; 29:1121–1131
Oliver WC. Anticoagulation and coagulation management for ECMO. Semin Cardiothorac Vasc Anesth. 2009; 13:154–175
Brogan T, Lequier L, Lorusso R, et al. Extracorporeal Life Support: The ELSO Red Book. 2017. Red Book 5th ed. Ann Arbor, MI: Extracorporeal Life Support Organization
Esper SA, Welsby IJ, Subramaniam K, et al. Adult extracorporeal membrane oxygenation: An international survey of transfusion and anticoagulation techniques. Vox Sang. 2017; 112:443–452
Paden ML, Conrad SA, Rycus PT. Thiagarajan RR, Registry E. Extracorporeal life support organization registry report 2012. ASAIO J. 2013; 59:202–210
Kalbhenn J, Wittau N, Schmutz A, Zieger B, Schmidt R. Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy. Perfusion. 2015; 30:675–682
Krueger K, Schmutz A, Zieger B, Kalbhenn J. Venovenous extracorporeal membrane oxygenation with prophylactic subcutaneous anticoagulation only: An Observational Study in more than 60 patients. Artif Organs. 2017; 41:186–192
Chen CY, Hsu TY, Chen WK, Muo CH, Chen HC, Shih HM. The use of extracorporeal membrane oxygenation in trauma patients: A national case-control study. Medicine (Baltimore). 2018; 97:e12223
Lubnow M, Philipp A, Foltan M, et al. Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange–retrospective analysis of 265 cases. PLoS One. 2014; 9:e112316
Vetter TR. Fundamentals of research data and variables: The devil is in the details. Anesth Analg. 2017; 125:1375–1380
Biscotti M, Gannon WD, Abrams D, et al. Extracorporeal membrane oxygenation use in patients with traumatic brain injury. Perfusion. 2015; 30:407–409
Mazzeffi M, Greenwood J, Tanaka K, et al. Bleeding, transfusion, and mortality on extracorporeal life support: ECLS Working Group on thrombosis and hemostasis. Ann Thorac Surg. 2016; 101:682–689
Aubron C, DePuydt J, Belon F, et al. Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation. Ann Intensive Care. 2016; 6:97
Yeo HJ, Kim DH, Jeon D, Kim YS, Cho WH. Low-dose heparin during extracorporeal membrane oxygenation treatment in adults. Intensive Care Med. 2015; 41:2020–2021
Agerstrand CL, Burkart KM, Abrams DC, Bacchetta MD, Brodie D. Blood conservation in extracorporeal membrane oxygenation for acute respiratory distress syndrome. Ann Thorac Surg. 2015; 99:590–595
Berei TJ, Lillyblad MP, Wilson KJ, Garberich RF, Hryniewicz KM. Evaluation of systemic heparin versus bivalirudin in adult patients. ASAIO J. 2018; 64:623–629
Abrams D, Baldwin MR, Champion M, et al. Thrombocytopenia and extracorporealmembrane oxygenation in adults with acute respiratory failure: A cohort study. Intensive Care Med. 2016; 42:844–852
Sklar MC, Sy E, Lequier L, Fan E, Kanji HD. Anticoagulation practices during venovenous extracorporeal membrane oxygenation for respiratory failure. A systematic review. Ann Am Thorac Soc. 2016; 13:2242–2250
Lango R, Szkulmowski Z, Maciejewski D, et al. Revised protocol of extracorporeal membrane oxygenation (ECMO) therapy in severe ARDS. Recommendations of the Veno-venous ECMO Expert Panel appointed in February 2016 by the national consultant on anesthesiology and intensive care. Anaesthesiol Intensive Ther. 2017; 49:88–99
Extracorporeal Life Support Organization. ELSO Anticoagulation Guideline. Available at: https://www.elso.org/Resources/Guidelines.aspx .
Hirsh J, Bauer KA, Donati MB, Gould M, Samama MM, Weitz JI. Parenteral anticoagulants: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8 th Edition). Chest. 2008; 1336 suppl141S–159S
Warkentin TE, Levine MN, Hirsh J, et al. Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med. 1995; 332:1330–1335
Simonneau G, Sors H, Charbonnier B, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l’Embolie Pulmonaire. N Engl J Med. 1997; 337:663–669
Cohen M, Demers C, Gurfinkel EP, et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group. N Engl J Med. 1997; 337:447–452
van Veen JJ, Maclean RM, Hampton KK, et al. Protamine reversal of low molecular weight heparin: Clinically effective? Blood Coagul Fibrinolysis. 2011; 22:565–570
Mayr AJ, Dünser M, Jochberger S, et al. Antifactor Xa activity in intensive care patients receiving thromboembolic prophylaxis with standard doses of enoxaparin. Thromb Res. 2002; 105:201–204
Dörffler-Melly J, de Jonge E, Pont AC, et al. Bioavailability of subcutaneous low-molecular-weight heparin to patients on vasopressors. Lancet. 2002; 359:849–850
Kreyer S, Muders T, Theuerkauf N, et al. Hemorrhage under veno-venous extracorporeal membrane oxygenation in acute respiratory distress syndrome patients: a retrospective data analysis. J Thorac Dis. 2017; 9:5017–5029
Sy E, Sklar MC, Lequier L, Fan E, Kanji HD. Anticoagulation practices and the prevalence of major bleeding, thromboembolic events, and mortality in venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis. J Crit Care. 2017; 39:87–96
Cook D, Crowther M, Meade M, et al. Deep venous thrombosis in medical-surgical critically ill patients: prevalence, incidence, and risk factors. Crit Care Med. 2005; 33:1565–1571