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- Title
Evaluation of a Multimodal Heparin Laboratory Monitoring Protocol in Adult Extracorporeal Membrane Oxygenation Patients.
- Authors
Northam, Kalynn A.; Nguyen, Bobbie; Chen, Sheh-Li; Sredzienski, Edward; Charles, Anthony
- Abstract
Background: Anticoagulation monitoring practices vary during extracorporeal membrane oxygenation (ECMO). The Extracorporeal Life Support Organization describes that a multimodal approach is needed to overcome assay limitations and minimize complications. Objective: Compare activated clotting time (ACT) versus multimodal approach (activated partial thromboplastin time (aPTT)/anti-factor Xa) for unfractionated heparin (UFH) monitoring in adult ECMO patients. Methods: We conducted a single-center retrospective pre- (ACT) versus post-implementation (multimodal approach) study. The incidence of major bleeding and thrombosis, blood product and antithrombin III (ATIII) administration, and UFH infusion rates were compared. Results: Incidence of major bleeding (69.2% versus 62.2%, p = 0.345) and thrombosis (23% versus 14.9%, p = 0.369) was similar between groups. Median number of ATIII doses was reduced in the multimodal group (1.0 [IQR 0.0-2.0] versus 0.0 [0.0 -1.0], p = 0.007). The median UFH infusion rate was higher in the ACT group, but not significant (16.9 [IQR 9.6-22.4] versus 13 [IQR 9.6-15.4] units/kg/hr, p = 0.063). Fewer UFH infusion rate changes occurred prior to steady state in the multimodal group (0.9 [IQR 0.3 -1.7] versus 0.1 [IQR 0.0-0.2], p < 0.001). Conclusion: The incidence of major bleeding and thrombosis was similar between groups. Our multimodal monitoring protocol standardized UFH infusion administration and reduced ATIII administration.
- Subjects
THROMBOSIS prevention; PARTIAL thromboplastin time; LIFE support systems in critical care; TIME; ANTICOAGULANTS; EXTRACORPOREAL membrane oxygenation; LABORATORIES; BLOOD coagulation; RETROSPECTIVE studies; DISEASE incidence; PATIENT monitoring; HUMAN services programs; COMPARATIVE studies; DRUG monitoring; DESCRIPTIVE statistics; HEPARIN; BLOOD coagulation factors; ADULTS
- Publication
Journal of Pharmacy Practice, 2023, Vol 36, Issue 1, p79
- ISSN
0897-1900
- Publication type
Article
- DOI
10.1177/08971900211021249