Anticoagulation and hemostasis on extracorporeal membrane oxygenation.
Journal
Current opinion in pediatrics
ISSN: 1531-698X
Titre abrégé: Curr Opin Pediatr
Pays: United States
ID NLM: 9000850
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
medline:
4
5
2023
pubmed:
29
3
2023
entrez:
28
3
2023
Statut:
ppublish
Résumé
The purpose of this review is to describe the hemostatic changes induced by extracorporeal membrane oxygenation (ECMO), the need to balance the risks of bleeding and clotting with anticoagulation and hemostatic transfusions, and the inherent risks to these interventions. Both bleeding and clotting are frequent complications of ECMO. To prevent clotting events, virtually, all children are anticoagulated. However, the optimal anticoagulation strategy is unknown. A recent systematic review of observational studies showed that anti-Xa-guided strategies were associated with a two-fold decrease in bleeding and no increase in clotting complications. These results need to be tested in randomized controlled trials. To avoid bleeding events, platelet transfusions are frequently prescribed to children on ECMO. However, platelet transfusions have recently been shown to be independently associated with increased bleeding and clotting. Therefore, the optimal platelet transfusion strategy must be evaluated appropriately. Most patients on ECMO will develop either a hemorrhagic or thrombotic complication. Balancing these risks involves careful titration of anticoagulation to prevent clotting and hemostatic transfusions to prevent bleeding. As the current level of evidence is low, prospective randomized trials are needed.
Identifiants
pubmed: 36974451
doi: 10.1097/MOP.0000000000001247
pii: 00008480-202306000-00002
doi:
Substances chimiques
Anticoagulants
0
Hemostatics
0
Types de publication
Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
297-302Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
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