Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol
Ana Bento Rodrigues 1,2,3,* , Anabela Rodrigues 4 , Catarina Jacinto Correia 4 , Gustavo Nobre Jesus 1,2,3 and João Miguel Ribeiro 1,3
1) Serviço de Medicina Intensiva, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; gustavonjesus@gmail.com (G.N.J.); jmribeiro@chln.min-saude.pt (J.M.R.)
2) Clínica Universitária de Medicina Intensiva, Faculdade de Medicina de Lisboa, 1649-028 Lisboa, Portugal
3) ECMO Referral Centre, Intensive Care Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
4) Serviço de Imuno-Hemoterapia, Blood Transfusion Department, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal; anabela.rodrigues@chln.min-saude.pt (A.R.); cfjc@campus.ul.pt (C.J.C.) *
Correspondence: bentorodrigues.ana@gmail.com
Abstract
Background
Extracorporeal membrane oxygenation (ECMO) is a complex procedure affecting both the risk of thrombosis and bleeding. High-quality data to personalize anticoagulation management in ECMO are lacking, resulting in a high variability in practice among centers. For this reason, we review coagulation methods and monitoring and share a pragmatic proposal of coagulation management, as performed in our high-volume ECMO Referral Centre; (2)
Methods
We revised the anticoagulation options and monitoring methods available for coagulation management in ECMO through PubMed search based on words including “anticoagulation,” “coagulation assays,” “ECMO,” “ELSO,” and “ISTH”; (3)
Results
Actual revision of the literature was described as our routine practice regarding ECMO anticoagulation and monitoring; (4)
Conclusions
No coagulation test is exclusively predictive of bleeding or thrombotic risk in patients undergoing ECMO support. An approach that allows for a tailored regimen of anticoagulation (regardless of agent used) and monitoring is mandatory. To accomplish this, we propose that the titration of anticoagulation therapies should include multiple laboratory tests, including anti-Xa, aPTT, ACT, viscoelastic tests, AT levels, platelet count, fibrinogen, and FXIII levels. Anticoagulation regimens should be tailored to a specific patient and personalized based on this complex array of essays.