Traditional and non-traditional anticoagulation management during extracorporeal membrane oxygenation.

Autor:	Koster A; Institute of Anesthesiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany., Ljajikj E; Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany., Faraoni D; Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	Annals of cardiothoracic surgery [Ann Cardiothorac Surg] 2019 Jan; Vol. 8 (1), pp. 129-136.
DOI:	10.21037/acs.2018.07.03
Abstrakt:	Unfractionated heparin (UFH) is the anticoagulant of choice during extracorporeal membrane oxygenation (ECMO) support. Despite its favorable pharmacologic properties, management of heparin anticoagulation during ECMO remains a major challenge. To date, little is known about the optimal monitoring strategy or the heparin dose offering the best safety/efficacy profile. Therefore, it remains unclear if the heparin dose should be adapted to target a specific "clotting time" [e.g., activated clotting time (ACT) or activated partial thromboplastin time (aPTT)] or a heparin concentration, measured by coagulation factor anti-Xa assay. In addition, no study has compared the relevance of modern viscoelastic coagulation tests over the single value of a clotting time or heparin concentration value. Although guidelines for anticoagulation during ECMO support have been published, the absence of evidence limits the quality of the recommendations provided, which explains the major intra- and inter-institutional variability observed. Large prospective multicenter trials are urgently needed to investigate the optimal anticoagulation management strategy during ECMO support. Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.
Databáze:	MEDLINE
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