Anti-Factor-Xa and Activated Partial Thromboplastin Time Concordance and Outcomes in Adults Undergoing Extracorporeal Membrane Oxygenation: A Secondary Analysis of the Pilot Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation Randomized Trial

被引：4

作者：

Aubron, Cecile ^{[1
,2
]}

Chapalain, Xavier ^{[3
]}

Bailey, Michael ^{[1
]}

Board, Jasmin ^{[4
]}

Buhr, Heidi ^{[5
]}

Cartwright, Bruce ^{[6
]}

Dennis, Mark ^{[7
]}

Hodgson, Carol ^{[1
]}

Forrest, Paul ^{[6
]}

Mcilroy, David ^{[8
]}

Murphy, Deirdre ^{[4
]}

Murray, Lynne ^{[1
]}

Pellegrino, Vincent ^{[1
,4
]}

Pilcher, David ^{[1
,4
]}

Sheldrake, Jayne ^{[4
]}

Tran, Huyen ^{[9
]}

Vallance, Shirley ^{[4
]}

Cooper, D. James ^{[1
,4
]}

Mcquilten, Zoe ^{[1
]}

机构：

[1] Monash Univ, Australian & New Zealand Intens Care Res Ctr ANZ R, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia

[2] Univ Bretagne Occidentale, Ctr Hospitalier Univ Brest, Dept Medecine Intens Reanimat, Site La Cavale Blanche, Brest, France

[3] Univ Bretagne Occidentale, Ctr Hospitalier Univ Brest, Dept Anesthesie Reanimat, Site La Cavale Blanche, Brest, France

[4] Alfred Hosp, Intens Care Unit, Melbourne, Vic, Australia

[5] Royal Prince Alfred Hosp, Intens Care Serv, Sydney, NSW, Australia

[6] Royal Prince Alfred Hosp, Dept Anaesthesia, Sydney, NSW, Australia

[7] Royal Prince Alfred Hosp, Cardiol Dept, Sydney, NSW, Australia

[8] Alfred Hosp, Dept Anaesthesia & Perioperat Med, Melbourne, Vic, Australia

[9] Alfred Hosp, Clin Haematol Dept, Melbourne, Vic, Australia

来源：

CRITICAL CARE EXPLORATIONS | 2023年 / 5卷 / 11期

关键词：

activated partial thromboplastin time; anticoagulation; anti-factor-Xa; extracorporeal membrane oxygenation; heparin resistance; MANAGEMENT; ASSAY;

D O I：

10.1097/CCE.0000000000000999

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

OBJECTIVES:To determine the concordance between activated partial thromboplastin time (aPTT) and anti-factor-Xa (anti-Xa) in adults undergoing extracorporeal membrane oxygenation (ECMO) and to identify the factors associated with discordant paired aPTT/anti-Xa.DESIGN:Pre-planned secondary analysis of the Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation pilot randomized unblinded, parallel-group controlled trial.SETTING:Two ICUs in two university hospitals.PATIENTS:Thirty-two critically ill patients who underwent ECMO and who had at least one paired aPTT and anti-Xa assay performed at the same time.INTERVENTIONS:We analyzed the concordance between aPTT and anti-Xa and identified factors associated with discordant paired aPTT/anti-Xa based on their respective therapeutic ranges. We also compared biological parameters between heparin resistance episode and no heparin resistance.MEASUREMENTS AND MAIN RESULTS:Of the 32 patients who were included in this study, 24 (75%) had at least one discordant paired aPTT/anti-Xa. Of the 581 paired aPTT/anti-Xa that were analyzed, 202 were discordant. The aPTT was relatively lower than anti-Xa in 66 cases (32.7%) or relatively higher than anti-Xa in 136 cases (67.3%). Thirty-three heparin resistance episodes were identified in six patients (19%).CONCLUSIONS:In these critically ill patients undergoing ECMO, one third of paired aPTT/anti-Xa measures was discordant. Coagulopathy and heparin resistance might be the reasons for discordance. Our results support the potential importance of routinely monitoring both tests in this setting.

引用

页数：10

共 11 条

[11] Outcomes of heparinized adult veno-arterial extracorporeal membrane oxygenation patients managed with low and high activated partial thromboplastin time targets: A systematic review and meta-analysis
Mazzeffi, Michael
Lin, Dora
Gonzalez-Almada, Alberto
Stombaugh, D. Keegan
Curley, Jonathan
Mangunta, Venkat
Teman, Nicholas
Yarboro, Leora T.
Thiele, Robert
PERFUSION-UK, 2024, 39 (03): : 525 - 535

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