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Current and future strategies to monitor and manage coagulation in ECMO patients

Extracorporeal membrane oxygenation (ECMO) can provide life-saving support for critically ill patients suffering severe respiratory and/or cardiac failure. However, thrombosis and bleeding remain common and complex problems to manage. Key causes of thrombosis in ECMO patients include blood contact t...

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Autores principales: Zeibi Shirejini, Saeedreza, Carberry, Josie, McQuilten, Zoe K., Burrell, Aidan J. C., Gregory, Shaun D., Hagemeyer, Christoph E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878987/
https://www.ncbi.nlm.nih.gov/pubmed/36703184
http://dx.doi.org/10.1186/s12959-023-00452-z
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author Zeibi Shirejini, Saeedreza
Carberry, Josie
McQuilten, Zoe K.
Burrell, Aidan J. C.
Gregory, Shaun D.
Hagemeyer, Christoph E.
author_facet Zeibi Shirejini, Saeedreza
Carberry, Josie
McQuilten, Zoe K.
Burrell, Aidan J. C.
Gregory, Shaun D.
Hagemeyer, Christoph E.
author_sort Zeibi Shirejini, Saeedreza
collection PubMed
description Extracorporeal membrane oxygenation (ECMO) can provide life-saving support for critically ill patients suffering severe respiratory and/or cardiac failure. However, thrombosis and bleeding remain common and complex problems to manage. Key causes of thrombosis in ECMO patients include blood contact to pro-thrombotic and non-physiological surfaces, as well as high shearing forces in the pump and membrane oxygenator. On the other hand, adverse effects of anticoagulant, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis are all established as causes of bleeding. Finding safe and effective anticoagulants that balance thrombosis and bleeding risk remains challenging. This review highlights commonly used anticoagulants in ECMO, including their mechanism of action, monitoring methods, strengths and limitations. It further elaborates on existing anticoagulant monitoring strategies, indicating their target range, benefits and drawbacks. Finally, it introduces several highly novel approaches to real-time anticoagulation monitoring methods including sound, optical, fluorescent, and electrical measurement as well as their working principles and future directions for research.
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spelling pubmed-98789872023-01-27 Current and future strategies to monitor and manage coagulation in ECMO patients Zeibi Shirejini, Saeedreza Carberry, Josie McQuilten, Zoe K. Burrell, Aidan J. C. Gregory, Shaun D. Hagemeyer, Christoph E. Thromb J Review Extracorporeal membrane oxygenation (ECMO) can provide life-saving support for critically ill patients suffering severe respiratory and/or cardiac failure. However, thrombosis and bleeding remain common and complex problems to manage. Key causes of thrombosis in ECMO patients include blood contact to pro-thrombotic and non-physiological surfaces, as well as high shearing forces in the pump and membrane oxygenator. On the other hand, adverse effects of anticoagulant, thrombocytopenia, platelet dysfunction, acquired von Willebrand syndrome, and hyperfibrinolysis are all established as causes of bleeding. Finding safe and effective anticoagulants that balance thrombosis and bleeding risk remains challenging. This review highlights commonly used anticoagulants in ECMO, including their mechanism of action, monitoring methods, strengths and limitations. It further elaborates on existing anticoagulant monitoring strategies, indicating their target range, benefits and drawbacks. Finally, it introduces several highly novel approaches to real-time anticoagulation monitoring methods including sound, optical, fluorescent, and electrical measurement as well as their working principles and future directions for research. BioMed Central 2023-01-26 /pmc/articles/PMC9878987/ /pubmed/36703184 http://dx.doi.org/10.1186/s12959-023-00452-z Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Zeibi Shirejini, Saeedreza
Carberry, Josie
McQuilten, Zoe K.
Burrell, Aidan J. C.
Gregory, Shaun D.
Hagemeyer, Christoph E.
Current and future strategies to monitor and manage coagulation in ECMO patients
title Current and future strategies to monitor and manage coagulation in ECMO patients
title_full Current and future strategies to monitor and manage coagulation in ECMO patients
title_fullStr Current and future strategies to monitor and manage coagulation in ECMO patients
title_full_unstemmed Current and future strategies to monitor and manage coagulation in ECMO patients
title_short Current and future strategies to monitor and manage coagulation in ECMO patients
title_sort current and future strategies to monitor and manage coagulation in ecmo patients
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878987/
https://www.ncbi.nlm.nih.gov/pubmed/36703184
http://dx.doi.org/10.1186/s12959-023-00452-z
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