1. Evaluation of Anti-Activated Factor X Activity and Activated Partial Thromboplastin Time Relations and Their Association with Bleeding and Thrombosis during Veno-Arterial ECMO Support: A Retrospective Study
- Author
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Jerome Soquet, Annabelle Dupont, Emmanuel Jeanpierre, Emmanuel Robin, Julien Labreuche, Mouhamed Djahoum Moussa, Sophie Susen, Antoine Lamer, Natacha Rousse, Caroline Brandt, Valentin Foulon, Guillaume Schurtz, Guillaume Gantois, Alain Duhamel, Guillaume Leroy, Vincent Liu, André Vincentelli, and Osama Abou-Arab
- Subjects
medicine.medical_specialty ,Concordance ,medicine.medical_treatment ,intravenous unfractionated heparin monitoring ,030204 cardiovascular system & hematology ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,Internal medicine ,activated partial thromboplastin time ,medicine ,Coagulopathy ,Extracorporeal membrane oxygenation ,medicine.diagnostic_test ,business.industry ,Cardiogenic shock ,anti-factor Xa ,030208 emergency & critical care medicine ,Retrospective cohort study ,General Medicine ,extracorporeal membrane oxygenation ,medicine.disease ,bleeding ,Thrombosis ,thrombotic complications ,Medicine ,business ,Partial thromboplastin time ,circulatory and respiratory physiology - Abstract
Background: We aimed to investigate the relationship between anti-activated Factor X (anti-FXa) and activated Partial Thromboplastin Time (aPTT), and its modulation by other haemostasis co-variables during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. We further investigated their association with serious bleeding and thrombotic complications. Methods: This retrospective single-center study included 265 adults supported by VA-ECMO for refractory cardiogenic shock from January 2015 to June 2019. The concordance of anti-FXa and aPTT and their correlations were assessed in 1699 paired samples. Their independent associations with serious bleeding or thrombotic complications were also analysed in multivariate analysis. Results: The concordance rate of aPTT with anti-FXa values was 50.7%, with 39.3% subtherapeutic aPTT values. However, anti-FXa and aPTT remained associated (β = 0.43 (95% CI 0.4–0.45) 10−2 IU/mL, p <, 0.001), with a significant modulation by several biological co-variables. There was no association between anti-FXa nor aPTT values with serious bleeding or with thrombotic complications. Conclusion: During VA-ECMO, although anti-FXa and aPTT were significantly associated, their values were highly discordant with marked sub-therapeutic aPTT values. These results should favour the use of anti-FXa. The effect of biological co-variables and the failure of anti-FXa and aPTT to predict bleeding and thrombotic complications underline the complexity of VA-ECMO-related coagulopathy.
- Published
- 2021