Anti-Xa assay monitoring improves the precision of anticoagulation in venovenous extracorporeal membrane oxygenation.
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:
30 Nov 2023
30 Nov 2023
Historique:
medline:
1
12
2023
pubmed:
1
12
2023
entrez:
1
12
2023
Statut:
aheadofprint
Résumé
Unfractionated heparin (UFH) is the most used anticoagulant in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO). Its therapeutic levels are monitored using activated partial thromboplastin time ratio (aPTTr) or antifactor Xa (anti-Xa) assay. This was a retrospective, single-center, cohort study where all adult patients with viral etiology respiratory failure requiring VV-ECMO from January 2, 2015 to January 31, 2022 were included. Anticoagulation was monitored using aPTTr (until November 1, 2019) or anti-Xa assay (after November 1, 2019). We compared the accuracy and precision of anticoagulation monitoring tests using time in therapeutic range (TTR) and variance growth rate (VGR), respectively, and their impact on bleeding and thrombotic events (BTEs). A total of 254 patients, 74 in aPTTr and 180 in anti-Xa monitoring groups, were included with a total of 4,992 ECMO-person days. Accuracy was comparable: mean TTR of 47% in aPTTr and 51% in anti-Xa groups (p = 0.28). Antifactor Xa monitoring group demonstrated improved precision with a lower variance (median VGR 0.21 vs. 1.61 in aPTTr, p < 0.05). Secondary outcome of less heparin prescription changes (adjusted rate ratio [RR] = 1.01, p = 0.01), fewer blood transfusions (adjusted RR = 0.78, p < 0.05), and ECMO circuit changes (adjusted RR = 0.68, p < 0.05) were seen with anti-Xa monitoring.
Identifiants
pubmed: 38039550
doi: 10.1097/MAT.0000000000002100
pii: 00002480-990000000-00366
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © ASAIO 2023.
Déclaration de conflit d'intérêts
Disclosure: A.R. consults for Volition Diagnostics UK. Volition Diagnostics is not involved with study conception, analysis, or article development. The other authors have no conflicts of interest to report.
Références
Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E: Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: A systematic review and meta-analysis. Lancet Respir Med 7: 163–172, 2019.
Nunez JI, Gosling AF, O’Gara B, et al.: Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: An ELSO registry analysis. Intensive Care Med 48: 213–224, 2022.
Brodie D, Slutsky AS, Combes A: Extracorporeal life support for adults with respiratory failure and related indications: A review. JAMA 322: 557–568, 2019.
Aubron C, DePuydt J, Belon F, et al.: Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation. Ann Intensive Care 66: 97, 2016.
Schmidt M, Pham T, Arcadipane A, et al.: Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome. An international multicenter prospective cohort. Am J Respir Crit Care Med 200: 1002–1012, 2019.
Kato C, Oakes M, Kim M, et al.: Anticoagulation strategies in extracorporeal circulatory devices in adult populations. Eur J Haematol 106: 19–31, 2021.
Seeliger B, Döbler M, Friedrich R, et al.: Comparison of anticoagulation strategies for veno-venous ECMO support in acute respiratory failure. Crit Care 24: 701, 2021.
Lehman CM, Frank EL: Laboratory monitoring of heparin therapy: Partial thromboplastin time or anti-Xa assay? Lab Med 40: 47–51, 2009.
Whitman-Purves E, Coons JC, Miller T, et al.: Performance of anti-factor Xa versus activated partial thromboplastin time for heparin monitoring using multiple nomograms. Clin Appl Thromb Hemost 24: 310–316, 2018.
Frugé KS, Lee YR: Comparison of unfractionated heparin protocols using antifactor Xa monitoring or activated partial thrombin time monitoring. Am J Health Syst Pharm 72(17 suppl 2): S90–S97, 2015.
Basu D, Gallus A, Hirsh J, Cade J: A prospective study of the value of monitoring heparin treatment with the activated partial thromboplastin time. N Engl J Med 287: 324–327, 1972.
Samuel S, Allison TA, Sharaf S, et al.: Antifactor Xa levels vs activated partial thromboplastin time for monitoring unfractionated heparin. A pilot study. J Clin Pharm Ther 41: 499–502, 2016.
Badulak J, Antonini MV, Stead CM, et al.; ELSO COVID-19 Working Group Members: Extracorporeal membrane oxygenation for COVID-19: Updated 2021 guidelines from the extracorporeal life support organization. ASAIO J 67: 485–495, 2021.
Guervil DJ, Rosenberg AF, Winterstein AG, Harris NS, Johns TE, Zumberg MS: Activated partial thromboplastin time versus antifactor Xa heparin assay in monitoring unfractionated heparin by continuous intravenous infusion. Ann Pharmacother 45: 861–868, 2011.
Levine MN, Hirsh J, Gent M, et al.: A randomized trial comparing activated thromboplastin time with heparin assay in patients with acute venous thromboembolism requiring large daily doses of heparin. Arch Intern Med 154: 49–56, 1994.
Camporota L, Meadows C, Ledot S, et al.; NHS England ECMO Service: Consensus on the referral and admission of patients with severe respiratory failure to the NHS ECMO service. Lancet Respir Med 9: e16–e17, 2021.
Brogan TV, Lequier L, Lorusso R, MacLaren G, Peek G, Extracorporeal Life Support Organization, in Thomas B, Laurance L, Roberto L, Graeme M, Giles P (eds), Extracorporeal Life Support: The ELSO Red Book, 5th ed. Hawthorne, CA, USA, Extracorporeal Life Support Organization, 2017, p. 93.
McMichael ABV, Ryerson LM, Ratano D, Fan E, Faraoni D, Annich GM: 2021 ELSO adult and pediatric anticoagulation guidelines. ASAIO J 68: 303–310, 2022.
Medical Research Council (MRC) and Health Research Authority (HRA). Is my study research? (2022). Accessed January 30, 2023. https://www.hra-decisiontools.org.uk/research/
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP: The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet 370: 1453–1457, 9596.
Rosendaal FR, Cannegieter SC, van der Meer FJ, Briët E: A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 69: 236–239, 1993.
Fihn SD, Gadisseur AAP, Pasterkamp E, et al.: Comparison of control and stability of oral anticoagulant therapy using acenocoumarol versus phenprocoumon. Thromb Haemost 90: 260–266, 2003.
RStudio Team: RStudio: Integrated Development for R. Boston, MA, RStudio, PBC. 2020. http://www.rstudio.com/.
Arnouk S, Altshuler D, Lewis TC, et al.: Evaluation of Anti-Xa and activated partial thromboplastin time monitoring of heparin in adult patients receiving extracorporeal membrane oxygenation support. ASAIO J 66: 300–306, 2020.
Willems A, Roeleveld PP, Labarinas S, et al.: Anti-Xa versus time-guided anticoagulation strategies in extracorporeal membrane oxygenation: A systematic review and meta-analysis. Perfusion 36: 501–512, 2021.
Liveris A, Bello RA, Friedmann P, et al.: Anti-factor Xa assay is a superior correlate of heparin dose than activated partial thromboplastin time or activated clotting time in pediatric extracorporeal membrane oxygenation. Pediatr Crit Care Med 15: e72–e79, 2014.
Northrop MS, Sidonio RF, Phillips SE, et al.: The use of an extracorporeal membrane oxygenation anticoagulation laboratory protocol is associated with decreased blood product use, decreased hemorrhagic complications, and increased circuit life. Pediatr Crit Care Med 16: 66–74, 2015.
Kulig CE, Schomer KJ, Black HB, Dager WE: Activated partial thromboplastin time versus Anti-Factor Xa monitoring of heparin anticoagulation in adult venoarterial extracorporeal membrane oxygenation patients. ASAIO J 67: 411–415, 2021.
Irby K, Swearingen C, Byrnes J, Bryant J, Prodhan P, Fiser R: Unfractionated heparin activity measured by anti-factor Xa levels is associated with the need for extracorporeal membrane oxygenation circuit/membrane oxygenator change: A retrospective pediatric study. Pediatr Crit Care Med 15: e175–e182, 2014.
Oskarsdóttir AR, Gudmundsdottir BR, Indridason OS, et al.: Reduced anticoagulation variability in patients on warfarin monitored with Fiix-prothrombin time associates with reduced thromboembolism: The Fiix-trial. J Thromb Thrombolysis 43: 550–561, 2017.
van Leeuwen Y, Rosendaal FR, Cannegieter SC: Prediction of hemorrhagic and thrombotic events in patients with mechanical heart valve prostheses treated with oral anticoagulants. J Thromb Haemost 6: 451–456, 2008.
Ibrahim S, Jespersen J, Poller L; European Action on Anticoagulation: The clinical evaluation of International Normalized Ratio variability and control in conventional oral anticoagulant administration by use of the variance growth rate. J Thromb Haemost 11: 1540–1546, 2013.
Yu HY, Tsai HE, Chen YS, Hung KY: Comparison of warfarin dosage fluctuation with time in therapeutic range for bleeding or thromboembolism rate in Chinese patients. J Formos Med Assoc 118: 611–618, 2019.
Doyle AJ, Hunt BJ, Sanderson B, et al.: A comparison of thrombosis and hemorrhage rates in patients with severe respiratory failure due to coronavirus disease 2019 and influenza requiring extracorporeal membrane oxygenation. Crit Care Med 49: e663–e672, 2021.
White D, MacDonald S, Bull T, et al.: Heparin resistance in COVID-19 patients in the intensive care unit. J Thromb Thrombolysis 50: 287–291, 2020.
Levy JH, Connors JM: Heparin resistance—Clinical perspectives and management strategies. N Engl J Med 385: 826–832, 2021.
Schmitt L, Speckman J, Ansell J: Quality assessment of anticoagulation dose management: Comparative evaluation of measures of time-in-therapeutic range. J Thromb Thrombolysis 15: 213–216, 2003.
Mansour A, Flecher E, Schmidt M, et al.: Bleeding and thrombotic events in patients with severe COVID-19 supported with extracorporeal membrane oxygenation: A nationwide cohort study. Intensive Care Med 48: 1039–1052, 2022.
Chung M, Cabezas FR, Nunez JI, et al.: Hemocompatibility-related adverse events and survival on venoarterial extracorporeal life support: An ELSO registry analysis. JACC Heart Fail 8: 892–902, 2020.
Olson SR, Murphree CR, Zonies D, et al.: Thrombosis and bleeding in extracorporeal membrane oxygenation (ECMO) without anticoagulation: A systematic review. ASAIO J 67: 290–296, 2021.
Warren A, Chiu YD, Villar SS, et al.; NHS England-commissioned National ECMO Service: Outcomes of the NHS England National Extracorporeal Membrane Oxygenation Service for adults with respiratory failure: A multicentre observational cohort study. Br J Anaesth 125: 259–266, 2020.