scholarly journals Preoperative and intraoperative argatroban as anticoagulant for bridging a patient with heparin-induced thrombocytopaenia to lung transplantation

2019 ◽  
Vol 57 (5) ◽  
pp. 1005-1006 ◽  
Author(s):  
Dong Kyu Oh ◽  
Dong Kwan Kim ◽  
Sehoon Choi ◽  
Sang-Bum Hong
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
Thrombotic Complications

Abstract A 65-year-old male was bridged to lung transplantation with veno-venous extracorporeal membrane oxygenation (ECMO). After experiencing heparin-induced thrombocytopaenia, heparin was replaced with argatroban. After 24 days, bilateral sequential lung transplantation was performed with argatroban anticoagulation. Intraoperative argatroban doses ranged between 0.4 and 0.6 μg/kg/min, resulting in activated clotting time of 169–216 s and activated partial thromboplastin time of 45–75 s. The patient was weaned from ECMO immediately after lung transplantation, and no bleeding or thrombotic complications were observed. He was discharged home on postoperative day 140.

scholarly journals Use of Thromboelastogram in Venovenous Extracorporeal Membrane Oxygenation for a Patient with Pulmonary Hemorrhage due to Microscopic Polyangiitis

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Chak-Kwan Tong ◽  
Jun Jin ◽  
Qian Du
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Microscopic Polyangiitis ◽  
Pulmonary Hemorrhage ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Heparin Dose ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
Venovenous Extracorporeal Membrane Oxygenation

Systemic heparinisation is required for extracorporeal membrane oxygenation therapy, to prevent clotting of circuit and formation of thrombus in patient. Activated clotting time (ACT) or activated partial thromboplastin time (aPTT) has been the mainstay of monitoring of heparin dose. Thromboelastogram (TEG) is increasingly being used again in recent years with the advancement in technology. Its clinical usefulness in the monitoring of anticoagulation of ECMO therapy is demonstrated in the case presented. Our patient suffered from severe hemoptysis due to active microscopic polyangiitis and respiratory failure. Heparin infusion was given at the initiation of ECMO support without further aggravation of hemoptysis. Dose of heparin was adjusted successfully with the integration of the clotting profile and TEG results.

Clinical safety and cost of heparin titration using bedside activated clotting time

1993 ◽  
Vol 2 (1) ◽  
pp. 81-87 ◽  
Author(s):  
T Thomason ◽  
B Riegel ◽  
D Jessen ◽  
Smith SCJr ◽  
I Gocka ◽  
...  
Keyword(s):  
Partial Thromboplastin Time ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Heparin Therapy ◽  
Activated Partial Thromboplastin Time ◽  
Clotting Time ◽  
Clinical Safety ◽  
Activated Clotting Time ◽  
Intravenous Heparin ◽  
Transluminal Coronary Angioplasty ◽  
Percutaneous Transluminal

OBJECTIVE: To evaluate the clinical safety of heparin titration and the procedural cost of anticoagulation measurement using bedside low-range activated clotting time. DESIGN: Quasi-experimental study using data gathered through retrospective record review. SETTING: Coronary care, medical intensive care and telemetry units of a community hospital. SUBJECTS: Sample of 102 patients undergoing elective percutaneous transluminal coronary angioplasty. INTERVENTION: Intravenous heparin therapy was titrated using low-range activated clotting time in 51 percutaneous transluminal coronary angioplasty patients. Data from this group were compared to a matched sample of 51 angioplasty patients whose intravenous heparin therapy was titrated using activated partial thromboplastin time. RESULTS: No differences in procedural, early or late complications were found between the groups. The cost of managing heparin therapy with low-range activated clotting time was less than with activated partial thromboplastin time. CONCLUSION: These results suggest that titrating heparin therapy based on bedside low-range activated clotting time for the angioplasty patients in this sample was as safe as with activated partial thromboplastin time. Use of bedside low-range activated clotting time saved money for the hospital.

Propofol-based sedation does not negatively influence oxygenator running time compared to midazolam in patients with extracorporeal membrane oxygenation

2019 ◽  
Vol 42 (5) ◽  
pp. 233-240 ◽  
Author(s):  
Wolfgang Lamm ◽  
Bernhard Nagler ◽  
Alexander Hermann ◽  
Oliver Robak ◽  
Peter Schellongowski ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Analysis ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Free Hemoglobin ◽  
Running Time ◽  
Laboratory Parameters ◽  
Membrane Oxygenation ◽  
Midazolam Group

Objective: Patients on extracorporeal membrane oxygenation are frequently in need for sedation. Use of propofol has been associated with impaired oxygenator function due to adsorption to the membrane as well as lipid load. The aim of our retrospective analysis was to compare two different sedation regimens containing either propofol or midazolam with respect to oxygenator running time. Methods: Midazolam was used in 73 patients whereas propofol was used in 49 patients, respectively. In the propofol group, veno-arterial–extracorporeal membrane oxygenation was used predominantly (84%), while veno-venous–extracorporeal membrane oxygenation was used more often in the midazolam group (64%). Results: Oxygenator running time until first exchange was 7 days in both groups ( p = 0.759). No statistically significant differences could be observed between the subgroup of patients receiving lipid-free (n = 24) and lipid-containing (n = 31) parenteral nutrition, respectively. Laboratory parameters like triglycerides, free hemoglobin, fibrinogen, platelets, and activated partial thromboplastin time were not significantly different between both sedation regimens ( p = 0.462, p = 0.489, p = 0.960, p = 0.134, and p = 0.843) and were not associated with oxygenator running time. Conclusion: The use of propofol as sedative seems suitable in patients undergoing extracorporeal membrane oxygenation therapy.

Evaluation of a pharmacy managed heparin protocol for extracorporeal membrane oxygenation patients

Perfusion ◽  
2016 ◽  
Vol 32 (3) ◽  
pp. 238-244 ◽  
Author(s):  
Kalliopi Fitousis ◽  
Robin Klasek ◽  
Phillip E Mason ◽  
Faisal Masud
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Study Groups ◽  
Similar Rate ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Activated Clotting Time ◽  
Primary Endpoints ◽  
Significant Difference ◽  
Heparin Anticoagulation ◽  
Thrombotic Complications

Introduction: Unfractionated heparin is the preferred anticoagulant in extracorporeal membrane oxygenation (ECMO) patients. However, there is a lack of consensus on its titration and monitoring. The objective of this study was to describe the efficacy and safety of a pharmacy managed heparin protocol utilizing activated partial thromboplastin time (aPTT) in comparison to our standard physician-managed activated clotting time (ACT)-based anticoagulation in ECMO patients. Methods: Patients administered a heparin drip while on ECMO were included in the study. The primary endpoints were the incidence of hemorrhagic and thrombotic complications. Results: A total of 122 adult patients were identified who were on ECMO with heparin anticoagulation; sixty-one patients were managed with each of the physician-managed ACT and pharmacy managed aPTT protocols. No statistically significant difference was observed between the physician ACT and the pharmacy aPTT groups in overall hemorrhagic (69% vs 80%, p=0.145) or thrombotic complications (41% vs 39%, p=0.853). Conclusion: There was a similar rate of thrombotic and bleeding events between the two study groups. A pharmacy managed heparin protocol utilizing aPTT monitoring appears to be a safe and effective method of providing anticoagulation in adult ECMO patients.

Sign in / Sign up

Export Citation Format

Share Document