Procedural variables which affect activated clotting time test results during extracorporeal membrane oxygenation therapy

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.

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Evaluation of the activated clotting time and activated partial thromboplastin time for the monitoring of heparin in adult extracorporeal membrane oxygenation patients

Perfusion ◽

10.1177/0267659114524264 ◽

2014 ◽

Vol 29 (5) ◽

pp. 456-461 ◽

Cited By ~ 30

Author(s):

S Atallah ◽

M Liebl ◽

K Fitousis ◽

F Bostan ◽

F Masud

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Partial Thromboplastin Time ◽

Activated Partial Thromboplastin Time ◽

Clotting Time ◽

Membrane Oxygenation ◽

Activated Clotting Time

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Whole blood activated clotting time in infants during extracorporeal membrane oxygenation

Critical Care Medicine ◽

10.1097/00003246-199005000-00006 ◽

1990 ◽

Vol 18 (5) ◽

pp. 494-498 ◽

Cited By ~ 29

Author(s):

THOMAS P. GREEN ◽

BARBARA ISHAM-SCHOPF ◽

ROBIN H. STEINHORN ◽

CLARK SMITH ◽

RICHARD J. IRMITER

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Whole Blood ◽

Clotting Time ◽

Membrane Oxygenation ◽

Activated Clotting Time

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Evaluation of the TAS Analyzer and the Low-Range Heparin Management Test in Patients Undergoing Extracorporeal Membrane Oxygenation

Clinical Chemistry ◽

10.1093/clinchem/47.5.858 ◽

2001 ◽

Vol 47 (5) ◽

pp. 858-866 ◽

Cited By ~ 12

Author(s):

Theresa M Ambrose ◽

Curtis A Parvin ◽

Eric Mendeloff ◽

Lori Luchtman-Jones

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Management Strategy ◽

Point Of Care ◽

Point Of Care Testing ◽

Clotting Time ◽

Blood Draw ◽

Membrane Oxygenation ◽

Activated Clotting Time ◽

The Relationship ◽

Heparin Dosage

Abstract Background: The new Low-Range Heparin Management Test (LHMT), a method for point-of-care testing (POCT) of heparinization, has been designed to function at the low to moderate heparin concentrations typically found in patients undergoing extracorporeal membrane oxygenation (ECMO). In this study, the new method is compared with two POCT methods and a laboratory-based anti-Xa assay. Methods: We obtained 760 whole blood samples from 13 patients undergoing ECMO. All samples were tested immediately by the LHMT, the Activated Clotting Time (ACT) test, and its low-range counterpart (ACT-LR). Aliquots from the same blood draw were frozen for later anti-Xa analysis using the Diagnostica Stago method on the Roche Cobas Fara-II. Results: The precision was best for duplicate citrated LHMT samples (CV = 3.1%). LHMT clotting times (overall median, 162 s) were typically shorter than ACT or ACT-LR times (247 and 235 s, respectively). The relationship between the LHMT and the other POCT methods differed significantly from patient to patient (P <0.0001), and a meaningful single relationship between the methods could not be obtained. The overall correlation coefficient between clotting time values and actual heparin concentrations was ≤0.48 for each of the instruments tested, although time plots of each analyzer’s data suggested that they detected heparin dosage changes within single patients. Conclusions: The performance of the LHMT on the TAS Analyzer is equivalent to that of currently commercially available POCT methods. The lack of agreement between absolute clotting time values and heparin concentrations suggests the need for reexamination of current ECMO patient management strategy.

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Anticoagulation Practices Using Activated Clotting Time in Veno-Venous Extracorporeal Membrane Oxygenation for Patients with Respiratory Failure: A Systematic Review and Met-Analysis

Blood ◽

10.1182/blood-2021-151903 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 2137-2137

Author(s):

Kanak Parmar ◽

Wasawat Vutthikraivit ◽

Amritpal Singh ◽

Christina Morataya ◽

Gaspar Del Rio Pertuz ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Risk Ratio ◽

Bleeding Complications ◽

Cochrane Central Register ◽

Clotting Time ◽

Membrane Oxygenation ◽

Activated Clotting Time ◽

Bedside Test ◽

Vv Ecmo

Abstract Background Veno-Venous Extracorporeal Membrane Oxygenation (ECMO) technology provides as a alternative approach in the intensive care of patients with respiratory failure due to varied causes who are not responsive to conventional treatment. As per the 2014 Extracorporeal Life Support Organization (ELSO) guidelines, in order to to maintain circuit patency and minimize thromboembolic complications, anticoagulation is used, but the optimal strategy remains to be defined. Activated clotting time (ACT) is the most utilized bedside test to adjust anticoagulation. Therefore, we performed an extended analysis of all published studies on the incidence of thromboembolic and bleeding events in patients with acute respiratory distress syndrome who were put on ECMO. Methods A comprehensive search of several databases from inception to November 25, 2020, limited to English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The studies were classified into low anticoagulation target (ACT<180) or high anticoagulation target (ACT>180). A meta-analysis was performed of all eligible studies with the data on the incidences of thromboembolic and bleeding complications in patients with ARDS on VV-ECMO during different intensities of anticoagulation. Results A total of 6 eligible studies (4 retrospective and 2 case series) were identified, including in total 190 patients for 100 patient years. Our study showed that there is two times higher chances of bleeding when ACT goal is >180 versus a lower ACT range of <180 (Risk ratio 2.07, 95% CI 1.23-3.46, P 0.0056). The incidence of thrombosis did not change in the two group (Risk ratio 1.17, 95% CI 0.45-3, P 0.7516). Conclusions Currently there is a lack of data for anticoagulation strategies during VV-ECMO for patients in respiratory failure. Our study aimed to find an appropriate anticoagulation target for this patient group. The results show that although anticoagulation is required for circuit patency, there is an increased risk of bleeding when higher anticoagulation targets are set. Disclosures No relevant conflicts of interest to declare.

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