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- Title
Current and future strategies to monitor and manage coagulation in ECMO patients.
- Authors
Zeibi Shirejini, Saeedreza; Carberry, Josie; McQuilten, Zoe K.; Burrell, Aidan J. C.; Gregory, Shaun D.; Hagemeyer, Christoph E.
- Abstract
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.
- Subjects
HEMORRHAGE prevention; THROMBOSIS prevention; THROMBOSIS; RESPIRATORY insufficiency; CRITICALLY ill; EXTRACORPOREAL membrane oxygenation; ANTICOAGULANTS; BLOOD coagulation; PATIENTS; PATIENT monitoring; HEART failure; HEMORRHAGE
- Publication
Thrombosis Journal, 2023, Vol 21, Issue 1, p1
- ISSN
1477-9560
- Publication type
Article
- DOI
10.1186/s12959-023-00452-z