Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study.

Autor: Descamps R; Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France. descamps-r@chu-caen.fr., Moussa MD; Inserm, CHU Lille, Surgical Critical Care, Department of Anesthesiology and Critical Care, Institut Pasteur de Lille, UMR1011-EGID, Univ. Lille, 59000, Lille, France., Besnier E; Department of Anesthesiology and Critical Care, Rouen University Hospital, 76000, Rouen, France., Fischer MO; Department of Anesthesiology and Critical Care, Caen University Hospital, 14000, Caen, France., Preau S; Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France., Tamion F; UNIROUEN, Inserm U1096, FHU- REMOD-VHF, Normandie Univ, 76000, Rouen, France.; Department of Medical Intensive Care, Rouen University Hospital, 76000, Rouen, France., Daubin C; Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France., Cousin N; Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France., Vincentelli A; Inserm, CHU Lille, Department of Cardiac Surgery, Institut Pasteur de Lille, UMR1011-EGID, Univ. Lille, 59000, Lille, France., Goutay J; Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France., Du Cheyron D; Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2021 Apr 02; Vol. 25 (1), pp. 127. Date of Electronic Publication: 2021 Apr 02.
DOI: 10.1186/s13054-021-03554-0
Abstrakt: Background: Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring.
Methods: We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding.
Results: Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29-0.67] vs 0.33 [0.22-0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47-1.46] vs 0.66 [0.36-0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan-Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006).
Conclusion: In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.
Databáze: MEDLINE
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