Systematic review and meta-analysis of the clinical effectiveness of point-of-care testing for anticoagulation management during ECMO
Copyright © 2021 Elsevier Inc. All rights reserved..
STUDY OBJECTIVE: Viscoelastic point-of-care (POC) tests are commonly used to provide prompt diagnosis of coagulopathy and allow targeted treatments in bleeding patients on ECMO. We evaluated the clinical effectiveness of point-of-care (POC) testing for anticoagulation management in patients on extracorporeal membrane oxygenation (ECMO).
DESIGN: Systematic review and meta-analysis. Eligible studies evaluating the use of thromboelastography- or thromboelastometry-guided algorithms, anti-factor Xa and platelet function testing were selected after screening the literature from July 1975 to January 2020.
SETTING: Patients on ECMO support.
PATIENTS: Anticoagulation management on ECMO patients.
INTERVENTIONS: Rotational thromboelastometry, thromboelastography, alone or combined with platelet function testing. Trials monitoring the anticoagulation effects during ECMO using an anti-factor Xa assay were included in the systematic review.
MEASUREMENTS: The primary outcomes were bleeding events, surgical revisions, thrombosis events and ECMO circuit change/failure. Secondary outcomes were blood-product transfusions, cerebrovascular accidents, mortality on ECMO, ECMO duration, intensive care unit and hospital discharge rates, and in-hospital mortality.
MAIN RESULTS: Thirty-one trials enrolling 1684 participants were included in the systematic review. Four trials enrolling 547 subjects were included in the meta-analysis. The use of a POC testing device resulted in improved detection of surgical bleeding (RR: 0.68, 95% CI 0.49 to 0.94, I2 = 0%; χ2 test for heterogeneity, P = 0.02). The use of POC-guided algorithms did not affect bleeding (RR:0.78, 95% CI 0.58 to 1.04, I2 = 47%; χ2 test for heterogeneity, P = 0.09), thrombosis events (RR:1.35, 95% CI 0.86 to 2.12, I2 = 37%; χ2 test for heterogeneity, P = 0.19), or ECMO circuit/change (RR:0.90, 95% CI 0.48 to 1.71, I2 = 28%; χ2 test for heterogeneity, P = 0.75).
CONCLUSION: Routine use of POC tests did not improve the main clinical outcomes beyond suggesting a diagnosis of surgical bleeding in ECMO patients.
Medienart: |
E-Artikel |
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Erscheinungsjahr: |
2021 |
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Erschienen: |
2021 |
Enthalten in: |
Zur Gesamtaufnahme - volume:73 |
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Enthalten in: |
Journal of clinical anesthesia - 73(2021) vom: 09. Okt., Seite 110330 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Jiritano, Federica [VerfasserIn] |
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Links: |
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Themen: |
Anticoagulants |
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Anmerkungen: |
Date Completed 02.07.2021 Date Revised 02.07.2021 published: Print-Electronic Citation Status MEDLINE |
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doi: |
10.1016/j.jclinane.2021.110330 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM32514169X |
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500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2021 Elsevier Inc. All rights reserved. | ||
520 | |a STUDY OBJECTIVE: Viscoelastic point-of-care (POC) tests are commonly used to provide prompt diagnosis of coagulopathy and allow targeted treatments in bleeding patients on ECMO. We evaluated the clinical effectiveness of point-of-care (POC) testing for anticoagulation management in patients on extracorporeal membrane oxygenation (ECMO) | ||
520 | |a DESIGN: Systematic review and meta-analysis. Eligible studies evaluating the use of thromboelastography- or thromboelastometry-guided algorithms, anti-factor Xa and platelet function testing were selected after screening the literature from July 1975 to January 2020 | ||
520 | |a SETTING: Patients on ECMO support | ||
520 | |a PATIENTS: Anticoagulation management on ECMO patients | ||
520 | |a INTERVENTIONS: Rotational thromboelastometry, thromboelastography, alone or combined with platelet function testing. Trials monitoring the anticoagulation effects during ECMO using an anti-factor Xa assay were included in the systematic review | ||
520 | |a MEASUREMENTS: The primary outcomes were bleeding events, surgical revisions, thrombosis events and ECMO circuit change/failure. Secondary outcomes were blood-product transfusions, cerebrovascular accidents, mortality on ECMO, ECMO duration, intensive care unit and hospital discharge rates, and in-hospital mortality | ||
520 | |a MAIN RESULTS: Thirty-one trials enrolling 1684 participants were included in the systematic review. Four trials enrolling 547 subjects were included in the meta-analysis. The use of a POC testing device resulted in improved detection of surgical bleeding (RR: 0.68, 95% CI 0.49 to 0.94, I2 = 0%; χ2 test for heterogeneity, P = 0.02). The use of POC-guided algorithms did not affect bleeding (RR:0.78, 95% CI 0.58 to 1.04, I2 = 47%; χ2 test for heterogeneity, P = 0.09), thrombosis events (RR:1.35, 95% CI 0.86 to 2.12, I2 = 37%; χ2 test for heterogeneity, P = 0.19), or ECMO circuit/change (RR:0.90, 95% CI 0.48 to 1.71, I2 = 28%; χ2 test for heterogeneity, P = 0.75) | ||
520 | |a CONCLUSION: Routine use of POC tests did not improve the main clinical outcomes beyond suggesting a diagnosis of surgical bleeding in ECMO patients | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Meta-Analysis | |
650 | 4 | |a Review | |
650 | 4 | |a Systematic Review | |
650 | 4 | |a Anticoagulation | |
650 | 4 | |a Bleeding | |
650 | 4 | |a Extracorporeal membrane oxygenation | |
650 | 4 | |a Point of care | |
650 | 4 | |a Viscoelastic test | |
650 | 7 | |a Anticoagulants |2 NLM | |
700 | 1 | |a Fina, Dario |e verfasserin |4 aut | |
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700 | 1 | |a Ten Cate, Hugo |e verfasserin |4 aut | |
700 | 1 | |a Kowalewski, Mariusz |e verfasserin |4 aut | |
700 | 1 | |a Matteucci, Matteo |e verfasserin |4 aut | |
700 | 1 | |a Serra, Raffaele |e verfasserin |4 aut | |
700 | 1 | |a Mastroroberto, Pasquale |e verfasserin |4 aut | |
700 | 1 | |a Serraino, Giuseppe Filiberto |e verfasserin |4 aut | |
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