Anticoagulation and Bleeding during Veno-Venous Extracorporeal Membrane Oxygenation : Insights from the PROTECMO Study
Rationale: Definitive guidelines for anticoagulation management during veno-venous extracorporeal membrane oxygenation (VV ECMO) are lacking, whereas bleeding complications continue to pose major challenges. Objectives: To describe anticoagulation modalities and bleeding events in adults receiving VV ECMO. Methods: This was an international prospective observational study in 41 centers, from December 2018 to February 2021. Anticoagulation was recorded daily in terms of type, dosage, and monitoring strategy. Bleeding events were reported according to site, severity, and impact on mortality. Measurements and Main Results: The study cohort included 652 patients, and 8,471 days on ECMO were analyzed. Unfractionated heparin was the initial anticoagulant in 77% of patients, and the most frequently used anticoagulant during the ECMO course (6,221 d; 73%). Activated partial thromboplastin time (aPTT) was the most common test for monitoring coagulation (86% of days): the median value was 52 seconds (interquartile range, 39 to 61 s) but dropped by 5.3 seconds after the first bleeding event (95% confidence interval, -7.4 to -3.2; P < 0.01). Bleeding occurred on 1,202 days (16.5%). Overall, 342 patients (52.5%) experienced at least one bleeding event (one episode every 215 h on ECMO), of which 10 (1.6%) were fatal. In a multiple penalized Cox proportional hazard model, higher aPTT was a potentially modifiable risk factor for the first episode of bleeding (for 20-s increase; hazard ratio, 1.07). Conclusions: Anticoagulation during VV ECMO was a dynamic process, with frequent stopping in cases of bleeding and restart according to the clinical picture. Future studies might explore lower aPTT targets to reduce the risk of bleeding.
| Errataetall: |
CommentIn: Am J Respir Crit Care Med. 2024 Feb 15;209(4):353-354. - PMID 38054752 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:209 |
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| Enthalten in: |
American journal of respiratory and critical care medicine - 209(2024), 4 vom: 15. Feb., Seite 417-426 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Martucci, Gennaro [VerfasserIn] |
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| Links: |
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| Themen: |
9005-49-6 |
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| Anmerkungen: |
Date Completed 16.02.2024 Date Revised 16.02.2024 published: Print CommentIn: Am J Respir Crit Care Med. 2024 Feb 15;209(4):353-354. - PMID 38054752 Citation Status MEDLINE |
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| doi: |
10.1164/rccm.202305-0896OC |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364348372 |
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| 100 | 1 | |a Martucci, Gennaro |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Anticoagulation and Bleeding during Veno-Venous Extracorporeal Membrane Oxygenation |b Insights from the PROTECMO Study |
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| 500 | |a Date Completed 16.02.2024 | ||
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| 500 | |a CommentIn: Am J Respir Crit Care Med. 2024 Feb 15;209(4):353-354. - PMID 38054752 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Rationale: Definitive guidelines for anticoagulation management during veno-venous extracorporeal membrane oxygenation (VV ECMO) are lacking, whereas bleeding complications continue to pose major challenges. Objectives: To describe anticoagulation modalities and bleeding events in adults receiving VV ECMO. Methods: This was an international prospective observational study in 41 centers, from December 2018 to February 2021. Anticoagulation was recorded daily in terms of type, dosage, and monitoring strategy. Bleeding events were reported according to site, severity, and impact on mortality. Measurements and Main Results: The study cohort included 652 patients, and 8,471 days on ECMO were analyzed. Unfractionated heparin was the initial anticoagulant in 77% of patients, and the most frequently used anticoagulant during the ECMO course (6,221 d; 73%). Activated partial thromboplastin time (aPTT) was the most common test for monitoring coagulation (86% of days): the median value was 52 seconds (interquartile range, 39 to 61 s) but dropped by 5.3 seconds after the first bleeding event (95% confidence interval, -7.4 to -3.2; P < 0.01). Bleeding occurred on 1,202 days (16.5%). Overall, 342 patients (52.5%) experienced at least one bleeding event (one episode every 215 h on ECMO), of which 10 (1.6%) were fatal. In a multiple penalized Cox proportional hazard model, higher aPTT was a potentially modifiable risk factor for the first episode of bleeding (for 20-s increase; hazard ratio, 1.07). Conclusions: Anticoagulation during VV ECMO was a dynamic process, with frequent stopping in cases of bleeding and restart according to the clinical picture. Future studies might explore lower aPTT targets to reduce the risk of bleeding | ||
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a antithrombin | |
| 650 | 4 | |a fibrinogen | |
| 650 | 4 | |a hemorrhage | |
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| 700 | 1 | |a Tabatabai, Ali |e verfasserin |4 aut | |
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| 700 | 1 | |a Agerstrand, Cara |e verfasserin |4 aut | |
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| 700 | 1 | |a Grasselli, Giacomo |e verfasserin |4 aut | |
| 700 | 1 | |a Ait Hssain, Ali |e verfasserin |4 aut | |
| 700 | 1 | |a Gannon, Whitney D |e verfasserin |4 aut | |
| 700 | 1 | |a Buabbas, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Gorjup, Vojka |e verfasserin |4 aut | |
| 700 | 1 | |a Trethowan, Brian |e verfasserin |4 aut | |
| 700 | 1 | |a Rizzo, Monica |e verfasserin |4 aut | |
| 700 | 1 | |a Fanelli, Vito |e verfasserin |4 aut | |
| 700 | 1 | |a Jeon, Kyeongman |e verfasserin |4 aut | |
| 700 | 1 | |a De Pascale, Gennaro |e verfasserin |4 aut | |
| 700 | 1 | |a Combes, Alain |e verfasserin |4 aut | |
| 700 | 1 | |a Ranieri, Marco V |e verfasserin |4 aut | |
| 700 | 1 | |a Duburcq, Thibault |e verfasserin |4 aut | |
| 700 | 1 | |a Foti, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Chico, Juan I |e verfasserin |4 aut | |
| 700 | 1 | |a Balik, Martin |e verfasserin |4 aut | |
| 700 | 1 | |a Broman, Lars Mikael |e verfasserin |4 aut | |
| 700 | 1 | |a Schellongowski, Peter |e verfasserin |4 aut | |
| 700 | 1 | |a Buscher, Hergen |e verfasserin |4 aut | |
| 700 | 1 | |a Lorusso, Roberto |e verfasserin |4 aut | |
| 700 | 1 | |a Brodie, Daniel |e verfasserin |4 aut | |
| 700 | 1 | |a Arcadipane, Antonio |e verfasserin |4 aut | |
| 700 | 0 | |a International ECMO Network (ECMONet) |e verfasserin |4 aut | |
| 700 | 1 | |a Brioni, Matteo |e investigator |4 oth | |
| 700 | 1 | |a Pesenti, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Montini, Luca |e investigator |4 oth | |
| 700 | 1 | |a Bosa, Linda |e investigator |4 oth | |
| 700 | 1 | |a Brazzi, Luca |e investigator |4 oth | |
| 700 | 1 | |a Curcio, Pierfrancesco |e investigator |4 oth | |
| 700 | 1 | |a Garofalo, Eugenio |e investigator |4 oth | |
| 700 | 1 | |a Martin-Villen, Luis |e investigator |4 oth | |
| 700 | 1 | |a Garcìa-Álvarez, Raquel |e investigator |4 oth | |
| 700 | 1 | |a Sanchez, Marta Lopez |e investigator |4 oth | |
| 700 | 1 | |a Principe, Nuno |e investigator |4 oth | |
| 700 | 1 | |a Saez, Violeta Chica |e investigator |4 oth | |
| 700 | 1 | |a Freita, Santiago |e investigator |4 oth | |
| 700 | 1 | |a Colomina-Climent, Joaquin |e investigator |4 oth | |
| 700 | 1 | |a Pacheco, Andres F |e investigator |4 oth | |
| 700 | 1 | |a Goutay, Julien |e investigator |4 oth | |
| 700 | 1 | |a Szułdrzyński, Konstanty |e investigator |4 oth | |
| 700 | 1 | |a Kowalewski, Mariusz |e investigator |4 oth | |
| 700 | 1 | |a Eller, Philipp |e investigator |4 oth | |
| 700 | 1 | |a Lobmeyr, Elisabeth |e investigator |4 oth | |
| 700 | 1 | |a Mariani, Silvia |e investigator |4 oth | |
| 700 | 1 | |a Suk, Pavel |e investigator |4 oth | |
| 700 | 1 | |a Maly, Michal |e investigator |4 oth | |
| 700 | 1 | |a Forestier, Jakob |e investigator |4 oth | |
| 700 | 1 | |a Rizzitello, Nicolò |e investigator |4 oth | |
| 700 | 1 | |a Barbara, Marco |e investigator |4 oth | |
| 700 | 1 | |a Holsworth, Tyler |e investigator |4 oth | |
| 700 | 1 | |a Serra, Alexis |e investigator |4 oth | |
| 700 | 1 | |a Cavayas, Yiorgos A |e investigator |4 oth | |
| 700 | 1 | |a Menaker, Jay |e investigator |4 oth | |
| 700 | 1 | |a Galvagno, Samuel |e investigator |4 oth | |
| 700 | 1 | |a Rice, Todd W |e investigator |4 oth | |
| 700 | 1 | |a Grandin, Wilson E |e investigator |4 oth | |
| 700 | 1 | |a Nunez, Jose |e investigator |4 oth | |
| 700 | 1 | |a Cheplic, Collette |e investigator |4 oth | |
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| 700 | 1 | |a Rivosecchi, Ryan |e investigator |4 oth | |
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| 700 | 1 | |a Kwan, Ming Chit |e investigator |4 oth | |
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