Evaluation of Anti-Xa and Activated Partial Thromboplastin Time Monitoring of Heparin in Adult Patients Receiving Extracorporeal Membrane Oxygenation Support. Issue 3 (March 2020)

• Record Type: Journal Article
• Authors: Arnouk, Serena; Altshuler, Diana; Lewis, Tyler C.; Merchan, Cristian; Smith, Deane E.; Toy, Bridget; Zakhary, Bishoy; Papadopoulos, John
• Is Part Of: ASAIO journal. Volume 66:Issue 3(2020)
• Publication Date: 2020-03
• Subjects: ECMO -- anticoagulation -- heparin; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001004
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : The approach to monitoring anticoagulation in adult patients receiving heparin on extracorporeal membrane oxygenation (ECMO) support is controversial. The objective of this study was to compare the correlation between anti-Xa and activated partial thromboplastin time (aPTT) with heparin dose and to describe their association with clinical events in adult ECMO patients. We conducted a retrospective single-center study of 34 adult ECMO patients whose heparin was monitored by anti-Xa and/or aPTT. The heparin dose-to-assay correlation coefficient was 0.106 for aPTT and 0.414 for anti-Xa ( p < 0.001). Major thrombotic and hemorrhagic events occurred in 14.7% and 26.5% of patients, respectively. The median anti-Xa in patients who experienced a major thrombotic event was 0.09 (0.06–0.25) IU/mL compared with 0.36 (0.26–0.44) IU/mL in patients who did not ( p = 0.031), whereas the median aPTT did not differ between these groups. The maximum aPTT in patients who experienced a major bleed was 96.9 (76.0–200) seconds compared with 63.5 (44.4–98.6) seconds in patients who did not ( p = 0.049), whereas the maximum anti-Xa did not differ between these groups. Monitoring both anti-Xa and aPTT may be warranted to safely provide understanding of pure heparin activity as well as underlying bleeding diatheses in adult ECMO patients. Abstract : Supplemental Digital Content is available in the text.