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A Randomized Controlled Trial of Antithrombin Supplementation During Extracorporeal Membrane Oxygenation
- Source :
- Critical Care Medicine. 48:1636-1644
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
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.
- Subjects :
- Male
medicine.medical_treatment
Critical Care and Intensive Care Medicine
Antithrombins
law.invention
03 medical and health sciences
Extracorporeal Membrane Oxygenation
0302 clinical medicine
Randomized controlled trial
law
Blood product
medicine
Extracorporeal membrane oxygenation
Humans
Adult patients
Heparin
business.industry
Antithrombin
Anticoagulants
030208 emergency & critical care medicine
Middle Aged
medicine.disease
Thrombosis
Intensive Care Units
030228 respiratory system
Respiratory failure
Anesthesia
Female
Respiratory Insufficiency
business
medicine.drug
Subjects
Details
- ISSN :
- 00903493
- Volume :
- 48
- Database :
- OpenAIRE
- Journal :
- Critical Care Medicine
- Accession number :
- edsair.doi.dedup.....4ee8a5be3cbfd978146e030155179080