Antithrombin supplementation in adult patients receiving extracorporeal membrane oxygenation.

Perfusion 2020 01 19;35(1):66-72. Epub 2019 Jun 19.

Department of Pharmacy Services, University of Virginia Health System, Charlottesville, VA, USA.

Introduction: Extracorporeal membrane oxygenation is associated with an increased risk of thrombosis and hemorrhage. Acquired antithrombin deficiency often occurs in patients receiving extracorporeal membrane oxygenation, necessitating supplementation to restore adequate anticoagulation. Criteria for antithrombin supplementation in adult extracorporeal membrane oxygenation patients are not well defined.

Methods: In this retrospective observational study, adult patients receiving antithrombin supplementation while supported on extracorporeal membrane oxygenation were evaluated. Antithrombin was supplemented when anti-Xa levels were subtherapeutic with unfractionated heparin infusion rates of 15-20 units/kg/h and measured antithrombin activity <50%. Patients were evaluated for changes in degree of anticoagulation and signs of bleeding 24 hours pre- and post-antithrombin supplementation.

Results: A total of 14 patients received antithrombin supplementation while on extracorporeal membrane oxygenation. The median percentage of time therapeutic anti-Xa levels were maintained was 0% (0-43%) and 40% (9-84%) in the pre-antithrombin and post-antithrombin groups, respectively (p = 0.13). No difference was observed in the number of patients attaining a single therapeutic anti-Xa level (pre-antithrombin = 6, post-antithrombin = 13; p = 0.37) or unfractionated heparin infusion rate (pre-antithrombin = 7.35 (1.95-10.71) units/kg/h, post-antithrombin = 6.81 (3.45-12.58) units/kg/h; p = 0.33). Thirteen patients (92%) achieved an antithrombin activity at goal following supplementation. Antithrombin activity was maintained within goal range 52% of the time during the replacement period. Four bleeding events occurred pre-antithrombin and 10 events post-antithrombin administration (p = 0.26) with significantly more platelets administered post-antithrombin (pre-antithrombin = 0.5 units, post-antithrombin = 4.5 units; p = 0.01).

Conclusion: Therapeutic anticoagulation occurred more frequently following antithrombin supplementation; however, this difference was not statistically significant. More bleeding events occurred following antithrombin supplementation while observing an increase in platelet transfusions.

Download full-text PDF

Source
http://dx.doi.org/10.1177/0267659119856229DOI Listing
January 2020

Publication Analysis

Top Keywords

extracorporeal membrane
20
membrane oxygenation
20
antithrombin supplementation
12
patients receiving
12
adult patients
8
supplementation adult
8
receiving extracorporeal
8
antithrombin
6
membrane
5
oxygenation
5
extracorporeal
5
observational study
4
retrospective observational
4
study adult
4
receiving antithrombin
4
supported extracorporeal
4
supplementation supported
4
definedmethods retrospective
4
well definedmethods
4
oxygenation evaluated
4

Similar Publications

Exogenous supplementation of antithrombin III in adult and pediatric patients receiving extracorporeal membrane oxygenation.

Int J Artif Organs 2020 May 21;43(5):315-322. Epub 2019 Nov 21.

Department of Pharmacy, Lifespan-Rhode Island Hospital & Hasbro Children's Hospital, Providence, RI, USA.

Background: Antithrombin III deficiency can occur with heparin anticoagulation during extracorporeal membrane oxygenation leading to heparin resistance. Antithrombin III supplementation has been shown to improve anticoagulation; however, there is no consensus on appropriate administration. We described the effect of antithrombin III supplementation on coagulation parameters in adult and pediatric extracorporeal membrane oxygenation patients. Read More

View Article and Full-Text PDF
May 2020

Age-based difference in activation markers of coagulation and fibrinolysis in extracorporeal membrane oxygenation.

Pediatr Crit Care Med 2014 Jun;15(5):e198-205

1Section of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 2Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 3Department of Pathology & Immunology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 4Cancer and Hematology Centers, Baylor College of Medicine, Texas Children's Hospital, Houston, TX. 5Department of Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.

Objective: Coagulation system activation in extracorporeal membrane oxygenation results in hemostatic derangements. Thrombin generation markers like prothrombin fragment 1+2 and thrombin-antithrombin complex are sensitive markers of hypercoagulability. Plasmin-antiplasmin complex is a sensitive marker for fibrinolysis. Read More

View Article and Full-Text PDF
June 2014

Pilot study evaluating a non-titrating, weight-based anticoagulation scheme for patients on veno-venous extracorporeal membrane oxygenation.

Perfusion 2020 01 23;35(1):13-18. Epub 2019 May 23.

Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD, USA.

Objective: There is no universally accepted algorithm for anticoagulation in patients on veno-venous extracorporeal membrane oxygenation. The purpose of this pilot study was to compare a non-titrating weight-based heparin infusion to that of a standard titration algorithm.

Methods: We performed a prospective randomized non-blinded study of patients: Arm 1-standard practice of titrating heparin to activated partial thromboplastin times goal of 45-55 seconds, and Arm 2-a non-titrating weight-based (10 units/kg/h) infusion. Read More

View Article and Full-Text PDF
January 2020

Impact of anticoagulation strategy and agents on extracorporeal membrane oxygenation therapy.

Perfusion 2019 11 6;34(8):671-678. Epub 2019 May 6.

Department of Pharmacy, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.

Introduction: Extracorporeal membrane oxygenation mandates balancing the risk of thromboembolic complications with bleeding. We aimed to evaluate pragmatic anticoagulation regimens during extracorporeal membrane oxygenation and compare thromboembolic and bleeding outcomes.

Methods: This retrospective, single-center study reviewed patients on venovenous or venoarterial extracorporeal membrane oxygenation for a minimum of 24 hours over a 5-year period. Read More

View Article and Full-Text PDF
November 2019