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Anticoagulation Management during Extracorporeal Membrane Oxygenation—A Mini-Review

Extracorporeal membrane oxygenation (ECMO) has been established as a life-saving technique for patients with the most severe forms of respiratory or cardiac failure. It can, however, be associated with severe complications. Anticoagulation therapy is required to prevent ECMO circuit thrombosis. It i...

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Autores principales: Burša, Filip, Sklienka, Peter, Frelich, Michal, Jor, Ondřej, Ekrtová, Tereza, Máca, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9782867/
https://www.ncbi.nlm.nih.gov/pubmed/36556985
http://dx.doi.org/10.3390/medicina58121783
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author Burša, Filip
Sklienka, Peter
Frelich, Michal
Jor, Ondřej
Ekrtová, Tereza
Máca, Jan
author_facet Burša, Filip
Sklienka, Peter
Frelich, Michal
Jor, Ondřej
Ekrtová, Tereza
Máca, Jan
author_sort Burša, Filip
collection PubMed
description Extracorporeal membrane oxygenation (ECMO) has been established as a life-saving technique for patients with the most severe forms of respiratory or cardiac failure. It can, however, be associated with severe complications. Anticoagulation therapy is required to prevent ECMO circuit thrombosis. It is, however, associated with an increased risk of hemocoagulation disorders. Thus, safe anticoagulation is a cornerstone of ECMO therapy. The most frequently used anticoagulant is unfractionated heparin, which can, however, cause significant adverse effects. Novel drugs (e.g., argatroban and bivalirudin) may be superior to heparin in the better predictability of their effects, functioning independently of antithrombin, inhibiting thrombin bound to fibrin, and eliminating heparin-induced thrombocytopenia. It is also necessary to keep in mind that hemocoagulation tests are not specific, and their results, used for setting up the dosage, can be biased by many factors. The knowledge of the advantages and disadvantages of particular drugs, limitations of particular tests, and individualization are cornerstones of prevention against critical events, such as life-threatening bleeding or acute oxygenator failure followed by life-threatening hypoxemia and hemodynamic deterioration. This paper describes the effects of anticoagulant drugs used in ECMO and their monitoring, highlighting specific conditions and factors that might influence coagulation and anticoagulation measurements.
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spelling pubmed-97828672022-12-24 Anticoagulation Management during Extracorporeal Membrane Oxygenation—A Mini-Review Burša, Filip Sklienka, Peter Frelich, Michal Jor, Ondřej Ekrtová, Tereza Máca, Jan Medicina (Kaunas) Review Extracorporeal membrane oxygenation (ECMO) has been established as a life-saving technique for patients with the most severe forms of respiratory or cardiac failure. It can, however, be associated with severe complications. Anticoagulation therapy is required to prevent ECMO circuit thrombosis. It is, however, associated with an increased risk of hemocoagulation disorders. Thus, safe anticoagulation is a cornerstone of ECMO therapy. The most frequently used anticoagulant is unfractionated heparin, which can, however, cause significant adverse effects. Novel drugs (e.g., argatroban and bivalirudin) may be superior to heparin in the better predictability of their effects, functioning independently of antithrombin, inhibiting thrombin bound to fibrin, and eliminating heparin-induced thrombocytopenia. It is also necessary to keep in mind that hemocoagulation tests are not specific, and their results, used for setting up the dosage, can be biased by many factors. The knowledge of the advantages and disadvantages of particular drugs, limitations of particular tests, and individualization are cornerstones of prevention against critical events, such as life-threatening bleeding or acute oxygenator failure followed by life-threatening hypoxemia and hemodynamic deterioration. This paper describes the effects of anticoagulant drugs used in ECMO and their monitoring, highlighting specific conditions and factors that might influence coagulation and anticoagulation measurements. MDPI 2022-12-03 /pmc/articles/PMC9782867/ /pubmed/36556985 http://dx.doi.org/10.3390/medicina58121783 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Burša, Filip
Sklienka, Peter
Frelich, Michal
Jor, Ondřej
Ekrtová, Tereza
Máca, Jan
Anticoagulation Management during Extracorporeal Membrane Oxygenation—A Mini-Review
title Anticoagulation Management during Extracorporeal Membrane Oxygenation—A Mini-Review
title_full Anticoagulation Management during Extracorporeal Membrane Oxygenation—A Mini-Review
title_fullStr Anticoagulation Management during Extracorporeal Membrane Oxygenation—A Mini-Review
title_full_unstemmed Anticoagulation Management during Extracorporeal Membrane Oxygenation—A Mini-Review
title_short Anticoagulation Management during Extracorporeal Membrane Oxygenation—A Mini-Review
title_sort anticoagulation management during extracorporeal membrane oxygenation—a mini-review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9782867/
https://www.ncbi.nlm.nih.gov/pubmed/36556985
http://dx.doi.org/10.3390/medicina58121783
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