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Low-Dose Versus Therapeutic Anticoagulation in Patients on Extracorporeal Membrane Oxygenation: A Pilot Randomized Trial.
- Source :
-
Critical Care Medicine . Jul2019, Vol. 47 Issue 7, pe563-e571. 9p. - Publication Year :
- 2019
-
Abstract
- <bold>Objectives: </bold>To determine whether randomization of patients undergoing extracorporeal membrane oxygenation to either therapeutic or a low-dose anticoagulation protocol results in a difference in activated partial thromboplastin time and anti-Xa.<bold>Design: </bold>Randomized, controlled, unblinded study.<bold>Setting: </bold>Two ICUs of two university hospitals.<bold>Patients: </bold>Patients admitted to the ICU, who required extracorporeal membrane oxygenation (venovenous or venoarterial) and who did not have a preexisting indication for therapeutic anticoagulation.<bold>Interventions: </bold>Therapeutic anticoagulation with heparin (target activated partial thromboplastin time between 50 and 70 s) or lower dose heparin (up to 12,000 U/24 hr aiming for activated partial thromboplastin time < 45 s).<bold>Measurements and Main Results: </bold>Thirty-two patients were randomized into two study groups that were not significantly different in demographics and extracorporeal membrane oxygenation characteristics. There was a significant difference in the daily geometric mean heparin dose (11,742 U [95% CI, 8,601-16,031 U] vs 20,710 U [95% CI, 15,343-27,954 U]; p = 0.004), daily geometric mean activated partial thromboplastin time (48.1 s [95% CI, 43.5-53.2 s] vs 55.5 s [95% CI, 50.4-61.2 s]; p = 0.04), and daily geometric mean anti-Xa (0.11 international units/mL [95% CI, 0.07-0.18] vs 0.27 [95% CI, 0.17-0.42]; p = 0.01). We found similar results when considering only venovenous extracorporeal membrane oxygenation episodes; however, no difference in daily geometric mean activated partial thromboplastin time between groups when considering only venoarterial extracorporeal membrane oxygenation episodes.<bold>Conclusions: </bold>Allocating patients on extracorporeal membrane oxygenation to two different anticoagulation protocols led to a significant difference in mean daily activated partial thromboplastin time and anti-Xa levels between groups. When considering subgroups analyses, these results were consistent in patients on venovenous extracorporeal membrane oxygenation. Our results support the feasibility of a larger trial in patients undergoing venovenous extracorporeal membrane oxygenation to compare different anticoagulation protocols; however, this study does not provide evidence on the optimal anticoagulation protocol for patients undergoing extracorporeal membrane oxygenation. [ABSTRACT FROM AUTHOR]
- Subjects :
- *EXTRACORPOREAL membrane oxygenation
*PARTIAL thromboplastin time
*ACADEMIC medical centers
*ANTICOAGULANTS
*CATASTROPHIC illness
*COMPARATIVE studies
*DOSE-effect relationship in pharmacology
*HEPARIN
*LENGTH of stay in hospitals
*RESEARCH methodology
*MEDICAL cooperation
*RESEARCH
*PILOT projects
*EVALUATION research
*HOSPITAL mortality
Subjects
Details
- Language :
- English
- ISSN :
- 00903493
- Volume :
- 47
- Issue :
- 7
- Database :
- Academic Search Index
- Journal :
- Critical Care Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 136986254
- Full Text :
- https://doi.org/10.1097/CCM.0000000000003780