101. A Randomized Controlled Trial of Antithrombin Supplementation During Extracorporeal Membrane Oxygenation.
- Author
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Panigada M, Cucino A, Spinelli E, Occhipinti G, Panarello G, Novembrino C, Consonni D, Protti A, Lissoni A, Arcadipane A, Pesenti A, and Grasselli G
- Subjects
- Anticoagulants administration & dosage, Anticoagulants therapeutic use, Antithrombins blood, Female, Heparin administration & dosage, Heparin therapeutic use, Humans, Intensive Care Units, Male, Middle Aged, Respiratory Insufficiency therapy, Antithrombins therapeutic use, Extracorporeal Membrane Oxygenation methods
- Abstract
Objectives: Supplementation of antithrombin might decrease the amount of heparin needed to achieve a given anticoagulation target during extracorporeal membrane oxygenation. However, exogenous antithrombin itself may increase the risk of bleeding. We conceived a study to evaluate the effect of antithrombin supplementation in adult patients requiring venovenous extracorporeal membrane oxygenation for respiratory failure on heparin dose, adequacy of anticoagulation, and safety., Design: Prospective randomized controlled trial., Setting: ICUs of two Italian referral extracorporeal membrane oxygenation centers., Patients: Adult patients requiring venovenous extracorporeal membrane oxygenation for severe respiratory failure and unfractionated heparin for systemic anticoagulation., Interventions: Before extracorporeal membrane oxygenation start, patients were randomized to either receive antithrombin concentrate to maintain a plasmatic level 80-120% (treatment) or not (control) during the extracorporeal membrane oxygenation course., Measurements and Main Results: The primary outcome was the total amount of heparin required to maintain activated partial thromboplastin time ratio 1.5-2. Secondary outcomes were anti-factor Xa, the incidence of hemorrhagic and thrombotic events, and the amount of blood products transfused. Twenty-four patients in the treatment group and 24 in the control group were included in the intention-to-treat analysis. Antithrombin was 109.5% (93.0-123.0%) in the treatment group and 84.0% (68.5-98.0%) in the control group (p = 0.001). Supplementation of antithrombin did not decrease heparin dose (13.5 international units/kg/hr [9.6-17.9 international units/kg/hr] vs 15.1 international units/kg/hr [10.7-18.3 international units/kg/hr] in the treatment and control group, respectively; p = 0.33) and anti-Factor Xa levels (0.4 international units/mL [0.3-0.5 international units/mL] vs 0.3 international units/mL [0.2-0.5 international units/mL] in the treatment group and control group respectively; p = 0.65). Bleeding, blood product transfusions, and thrombosis were not different in the two groups., Conclusions: Antithrombin supplementation may not decrease heparin requirement nor diminish the incidence of bleeding and/or thrombosis in adult patients on venovenous extracorporeal membrane oxygenation.
- Published
- 2020
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