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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| 245 | 1 | 0 | |a Systematic review and meta-analysis of the clinical effectiveness of point-of-care testing for anticoagulation management during ECMO |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 02.07.2021 | ||
| 500 | |a Date Revised 02.07.2021 | ||
| 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 | |
| 700 | 1 | |a Lorusso, Roberto |e verfasserin |4 aut | |
| 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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