scholarly journals Correlation Among Antifactor Xa, Activated Partial Thromboplastin Time, and Heparin Dose and Association with Pediatric Extracorporeal Membrane Oxygenation Complications

ASAIO Journal ◽  
2020 ◽  
Vol 66 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Ali B. V. McMichael ◽  
Christoph P. Hornik ◽  
Susan R. Hupp ◽  
Sharon E. Gordon ◽  
Caroline P. Ozment
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Heparin Dose ◽  
Membrane Oxygenation ◽  
Antifactor Xa

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.

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.

The Influence of Free Hemoglobin and Bilirubin on Heparin Monitoring by Activated Partial Thromboplastin Time and Anti-Xa Assay

2014 ◽  
Vol 138 (11) ◽  
pp. 1503-1506 ◽  
Author(s):  
Vadim Kostousov ◽  
Kim Nguyen ◽  
Shilpa G. Hundalani ◽  
Jun Teruya
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Partial Thromboplastin Time ◽  
Therapy Monitoring ◽  
Activated Partial Thromboplastin Time ◽  
Moderate Increase ◽  
Free Hemoglobin ◽  
Clinical Patient ◽  
Membrane Oxygenation ◽  
Significant Prolongation

Context Elevated free hemoglobin (Hb) and bilirubinemia complicate extracorporeal membrane oxygenation and could affect unfractionated heparin (UH) therapy monitoring by anti-Xa assay and activated partial thromboplastin time (aPTT). Objectives To compare in vitro response of anti-Xa and aPTT assays to UH in samples with artificial hyperbilirubinemia and hyperhemoglobinemia and to estimate if this interference is also observed in vivo in pediatric extracorporeal membrane oxygenation. Design Measurement of aPTT and anti-Xa activity in plasma spiked with UH and increased concentration of free Hb and/or conjugated bilirubin. All samples with anti-Xa activity, antithrombin, free Hb, and bilirubin determination and infused dose of UH from inpatients on extracorporeal membrane oxygenation were extracted from the clinical patient database and analyzed. Results Each increment of free Hb by 100 mg/dL significantly shortened aPTT, whereas an increment of bilirubin by 6 mg/dL caused significant prolongation of aPTT and stepwise increase of free Hb and/or bilirubin in plasma decreased anti-Xa activity by 0.03 to 0.05 IU/mL. Extracorporeal membrane oxygenation samples with free Hb 50 mg/dL or greater had significantly lower anti-Xa activity compared with normal ones: 0.33 (0.25–0.42) versus 0.4 (0.31–0.48) IU/mL (P = .01), despite the identical UH infusion and similar antithrombin activity. Moderate increase of free Hb by 59 mg/dL was associated with absolute decrease of anti-Xa activity by 0.07 IU/mL. Conclusions Activated partial thromboplastin time and anti-Xa assay are affected by elevated level of free Hb and/or bilirubin in the presence of UH, and lower anti-Xa activity is noted in extracorporeal membrane oxygenation patients with elevated free Hb. Severe hemolysis and/or hyperbilirubinemia could compromise UH monitoring based on these assays.

Activated partial thromboplastin time is a better trending tool in pediatric extracorporeal membrane oxygenation

2012 ◽  
Vol 13 (6) ◽  
pp. e363-e371 ◽  
Author(s):  
Timothy M. Maul ◽  
Erin L. Wolff ◽  
Bradley A. Kuch ◽  
Adam Rosendorff ◽  
Victor O. Morell ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Partial Thromboplastin Time ◽  
Activated Partial Thromboplastin Time ◽  
Membrane Oxygenation

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.

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