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

Autor:	Descamps, Richard, Moussa, Mouhamed D., Besnier, Emmanuel, Fischer, Marc-Olivier, Preau, Sébastien, Tamion, Fabienne, Daubin, Cédric, Cousin, Nicolas, Vincentelli, André, Goutay, Julien, Du Cheyron, Damien
Předmět:	HEMORRHAGE diagnosis RESEARCH RESEARCH methodology EXTRACORPOREAL membrane oxygenation ANTICOAGULANTS PHARMACOKINETICS RETROSPECTIVE studies MEDICAL cooperation EVALUATION research COMPARATIVE studies RECEIVER operating characteristic curves PROPORTIONAL hazards models LONGITUDINAL method HEMORRHAGE
Zdroj:	Critical Care; 6/14/2021, Vol. 25 Issue 1, p1-11, 11p
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. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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