D R Padhya1, G J Prutsky2, M E Nemergut3, G S Schears3, R P Flick3, W Farah4, Z Wang5, L J Prokop6, M H Murad5, M Alsawas5. 1. Department of Pediatrics, Reading Hospital, Reading, PA, USA. 2. Department of Pediatrics, Mayo Clinic Health System, Mankato, MN, USA; Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: Prutskylopez.gabriela@mayo.edu. 3. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA. 4. Internal Medicine, St Joseph Mercy Hospital, Ann Arbor, MA, USA. 5. Mayo Clinic, Evidence-based Practice Center, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA. 6. Mayo Clinic Libraries, Rochester, MN, USA.
Abstract
OBJECTIVE: Specific protocols for anticoagulation for children on ECMO vary across institutions, with most using a continuous infusion of unfractionated heparin. The goal of this study is to aid clinician's decision on the best measure of heparin anticoagulation test; which would be the one that correlates well with heparin activity and helps in predicting hemorrhagic and thrombotic complications. DATA SOURCES: A comprehensive search of MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus was conducted from each database's inception to 07/13/2018. STUDY SELECTION: Studies evaluating children (<18 years) treated with ECMO and evaluating ACT, aPTT, TEG and Anti-Xa in any language were included. DATA EXTRACTION: Two reviewers selected and appraised studies independently, and abstracted data. RESULTS: We included 19 studies (759 patients, mean age 19.8 months). Meta-analysis showed strong correlation between heparin dosing and anti-Xa. Additionally, there was not a strong correlation between laboratory tests and complications (hemorrhagic and thrombosis), or mortality. CONCLUSION: Based on current evidence, Anti-Xa is the only laboratory test that shows strong correlation with heparin infusion dose and seems like the most suitable test for monitoring of anticoagulation with heparin in children on ECMO.
OBJECTIVE: Specific protocols for anticoagulation for children on ECMO vary across institutions, with most using a continuous infusion of unfractionated heparin. The goal of this study is to aid clinician's decision on the best measure of heparin anticoagulation test; which would be the one that correlates well with heparin activity and helps in predicting hemorrhagic and thrombotic complications. DATA SOURCES: A comprehensive search of MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus was conducted from each database's inception to 07/13/2018. STUDY SELECTION: Studies evaluating children (<18 years) treated with ECMO and evaluating ACT, aPTT, TEG and Anti-Xa in any language were included. DATA EXTRACTION: Two reviewers selected and appraised studies independently, and abstracted data. RESULTS: We included 19 studies (759 patients, mean age 19.8 months). Meta-analysis showed strong correlation between heparin dosing and anti-Xa. Additionally, there was not a strong correlation between laboratory tests and complications (hemorrhagic and thrombosis), or mortality. CONCLUSION: Based on current evidence, Anti-Xa is the only laboratory test that shows strong correlation with heparin infusion dose and seems like the most suitable test for monitoring of anticoagulation with heparin in children on ECMO.
Authors: Shyam J Deshpande; Sally Vitali; Ravi Thiagarajan; Steven Brediger; Michael McManus; Alon Geva Journal: Pediatr Crit Care Med Date: 2021-06-01 Impact factor: 3.971
Authors: Ariane Willems; Peter P Roeleveld; Sonia Labarinas; John W Cyrus; Jennifer A Muszynski; Marianne E Nellis; Oliver Karam Journal: Perfusion Date: 2020-08-29 Impact factor: 1.972