Antithrombin levels and heparin responsiveness during veno-arterial extracorporeal membrane oxygenation: a prospective single-center cohort study.

Journal

Anesthesiology
ISSN: 1528-1175
Titre abrégé: Anesthesiology
Pays: United States
ID NLM: 1300217

Informations de publication

Date de publication:
25 Jan 2024
Historique:
medline: 25 1 2024
pubmed: 25 1 2024
entrez: 25 1 2024
Statut: aheadofprint

Résumé

Unfractionated heparin, administered during veno-arterial extracorporeal membrane oxygenation to prevent thromboembolic events, largely depend on plasma antithrombin for its antithrombotic effects. Decreased heparin responsiveness seems frequent on extracorporeal membrane oxygenation however its association with acquired antithrombin deficiency is poorly understood. Our objective was to describe longitudinal changes in plasma antithrombin levels during extracorporeal membrane oxygenation support and evaluate the association between antithrombin levels and heparin responsiveness. We hypothesized that extracorporeal membrane oxygenation support would be associated with acquired antithrombin deficiency and related decreased heparin responsiveness. Adults receiving veno-arterial extracorporeal membrane oxygenation were prospectively included. All patients received continuous intravenous unfractionated heparin using a standardized protocol (target anti-Xa 0.3-0.5 IU.mL -1). For each patient, arterial blood was withdrawn into citrate-containing tubes, at 11 time-points (from H0 up to day 7) . Anti-Xa (without dextran or antithrombin added) and antithrombin levels were measured. The primary outcome was antithrombin plasma level. In the absence of consensus, antithrombin deficiency was defined as a time-weighted average of antithrombin ≤70%. Data regarding clinical management and heparin dosage were collected. Fifty patients, including 42% post-cardiotomy, were included between April 2020 and May 2021, with a total of 447 samples. Median extracorporeal membrane oxygenation duration was 7 (interquartile range, 4-12) days. Median antithrombin level was 48 (37-60)% at H0. Antithrombin levels significantly increased throughout the follow-up. Time-weighted average of antithrombin levels was 63 (57-73)%, and was ≤70% in 32 (64%) of patients. Overall, 45 (90%) patients had at least one antithrombin value below 70%, and 35 (70%) below 50%. Antithrombin levels were not significantly associated with heparin responsiveness evaluated by anti-Xa assay or heparin dosage. Veno-arterial extracorporeal membrane oxygenation support was associated with a moderate acquired antithrombin deficiency, mainly during the first 72 hours, that did not correlate with heparin responsiveness.

Sections du résumé

BACKGROUND BACKGROUND
Unfractionated heparin, administered during veno-arterial extracorporeal membrane oxygenation to prevent thromboembolic events, largely depend on plasma antithrombin for its antithrombotic effects. Decreased heparin responsiveness seems frequent on extracorporeal membrane oxygenation however its association with acquired antithrombin deficiency is poorly understood. Our objective was to describe longitudinal changes in plasma antithrombin levels during extracorporeal membrane oxygenation support and evaluate the association between antithrombin levels and heparin responsiveness. We hypothesized that extracorporeal membrane oxygenation support would be associated with acquired antithrombin deficiency and related decreased heparin responsiveness.
METHODS METHODS
Adults receiving veno-arterial extracorporeal membrane oxygenation were prospectively included. All patients received continuous intravenous unfractionated heparin using a standardized protocol (target anti-Xa 0.3-0.5 IU.mL -1). For each patient, arterial blood was withdrawn into citrate-containing tubes, at 11 time-points (from H0 up to day 7) . Anti-Xa (without dextran or antithrombin added) and antithrombin levels were measured. The primary outcome was antithrombin plasma level. In the absence of consensus, antithrombin deficiency was defined as a time-weighted average of antithrombin ≤70%. Data regarding clinical management and heparin dosage were collected.
RESULTS RESULTS
Fifty patients, including 42% post-cardiotomy, were included between April 2020 and May 2021, with a total of 447 samples. Median extracorporeal membrane oxygenation duration was 7 (interquartile range, 4-12) days. Median antithrombin level was 48 (37-60)% at H0. Antithrombin levels significantly increased throughout the follow-up. Time-weighted average of antithrombin levels was 63 (57-73)%, and was ≤70% in 32 (64%) of patients. Overall, 45 (90%) patients had at least one antithrombin value below 70%, and 35 (70%) below 50%. Antithrombin levels were not significantly associated with heparin responsiveness evaluated by anti-Xa assay or heparin dosage.
CONCLUSIONS CONCLUSIONS
Veno-arterial extracorporeal membrane oxygenation support was associated with a moderate acquired antithrombin deficiency, mainly during the first 72 hours, that did not correlate with heparin responsiveness.

Identifiants

DOI: 10.1097/ALN.0000000000004920 PMID: 38271619
pubmed: 38271619
pii: 139727
doi: 10.1097/ALN.0000000000004920
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Anesthesiologists.

Déclaration de conflit d'intérêts

Conflicts of Interest: AM received payments made to his institution from i-SEP for consulting fees, and from LFB, Aguettant, Viatris and Pfizer for lecture fees MB declares no competing interests. JO declares no competing interests. AP declares no competing interests. AP: declares no competing interests. FR: declares no competing interests. YL: declares no competing interests. RG: declares no competing interests. EF: declares no competing interests. TL: declares no competing interests. NN: declares no competing interests. IGT: declares no competing interests

Auteurs

Alexandre Mansour (A)

Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France. Univ Rennes, CHU Rennes, Inserm, IRSET, UMR_S 1085, F35000 Rennes, France.
ORCID: 0000-0001-8955-2407

Mathilde Berahou (M)

Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France.

Joscelyn Odot (J)

Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France.

Adeline Pontis (A)

Department of Hematology, Pontchaillou, University Hospital of Rennes, France. Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France.

Alessandro Parasido (A)

Department of Thoracic and Cardiovascular Surgery, Pontchaillou, University Hospital of Rennes, France.

Florian Reizine (F)

Service des Maladies Infectieuses et Réanimation Médicale, University Hospital of Rennes, Rennes, France.

Yoann Launey (Y)

Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France.

Ronan Garlantezec (R)

Department of Epidemiology and Public Health, Pontchaillou, University Hospital of Rennes, France. Univ Rennes, CHU Rennes, Rennes, France. Univ Rennes, CHU Rennes, Inserm, irset - Inserm UMR_S 1085, F35000 Rennes, France.

Erwan Flecher (E)

Department of Thoracic and Cardiovascular Surgery, Pontchaillou, University Hospital of Rennes, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), Inserm U1099, Rennes, France.

Thomas Lecompte (T)

Department of Hematology, Pontchaillou, University Hospital of Rennes, France.

Nicolas Nesseler (N)

Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France. Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F35000 Rennes, France. Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN - UMR_A 1341, UMR_S 1241, F-35000 Rennes, France.

Isabelle Gouin-Thibault (I)

Department of Hematology, Pontchaillou, University Hospital of Rennes, France. Univ Rennes, CHU Rennes, Inserm, irset - Inserm UMR_S 1085, F35000 Rennes, France.

Classifications MeSH