scholarly journals Anticoagulation management in neonatal and pediatric ECMO

2019 ◽  
pp. 29-36
Author(s):  
Agustin Elias ◽  
Carlos Casado ◽  
Ana Mayordomo ◽  
Rianseres Garcia ◽  
Diego Solis ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Body Weight ◽  
Laboratory Test ◽  
Major Bleeding ◽  
Randomized Clinical Trials ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Heparin Dose ◽  
Anticoagulation Management ◽  
Drug Of Choice

Introduction: Despite significant advances in the materials, components and techniques used for extracorporeal life support in recent years, the management of anticoagulation in ECMO remains controversial, the objective of this protocol is to develop an update for anticoagulation and its control for infants ECMO. Development: Unfractionated heparin is the drug of choice for anticoagulation in ECMO. The heparin dose used in pediatrics have been mostly adapted from the experience in adults without a corresponding validation, as well as limiting the absence of randomized clinical trials in children. After the assessment of the patient and a possible correction of coagulopathies, prior to establishment of ECMO, as well as decide the administration of a heparin bolus of 50-100 IU/kg of body weight at the time prior to cannulation. At 5-10’ of beginning ECMO a ACT control is made, if the value is greater than 300 sg, ACT is repeated at 30-60’. Once the ACT is less than 300, an infusion starts between 10-20 IU/kg/h, in the absence of major bleeding. Controls will be carried out every 30’ to stabilize the ACT in the chosen range. For the control, the ACT will be used, mainly, and the APTT, with better results the higher the child's age, although the anti-Xa test is the only laboratory test that shows a strong correlation with the heparin dose administered in ECMO.

Evaluation of a Multimodal Heparin Laboratory Monitoring Protocol in Adult Extracorporeal Membrane Oxygenation Patients

2021 ◽  
pp. 089719002110212
Author(s):  
Kalynn A. Northam ◽  
Bobbie Nguyen ◽  
Sheh-Li Chen ◽  
Edward Sredzienski ◽  
Anthony Charles
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Major Bleeding ◽  
Infusion Rate ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Factor Xa ◽  
Median Number ◽  
Multimodal Approach ◽  
Membrane Oxygenation ◽  
Monitoring Protocol

Background: Anticoagulation monitoring practices vary during extracorporeal membrane oxygenation (ECMO). The Extracorporeal Life Support Organization describes that a multimodal approach is needed to overcome assay limitations and minimize complications. Objective: Compare activated clotting time (ACT) versus multimodal approach (activated partial thromboplastin time (aPTT)/anti-factor Xa) for unfractionated heparin (UFH) monitoring in adult ECMO patients. Methods: We conducted a single-center retrospective pre- (ACT) versus post-implementation (multimodal approach) study. The incidence of major bleeding and thrombosis, blood product and antithrombin III (ATIII) administration, and UFH infusion rates were compared. Results: Incidence of major bleeding (69.2% versus 62.2%, p = 0.345) and thrombosis (23% versus 14.9%, p = 0.369) was similar between groups. Median number of ATIII doses was reduced in the multimodal group (1.0 [IQR 0.0-2.0] versus 0.0 [0.0 -1.0], p = 0.007). The median UFH infusion rate was higher in the ACT group, but not significant (16.9 [IQR 9.6-22.4] versus 13 [IQR 9.6-15.4] units/kg/hr, p = 0.063). Fewer UFH infusion rate changes occurred prior to steady state in the multimodal group (0.9 [IQR 0.3 -1.7] versus 0.1 [IQR 0.0-0.2], p < 0.001). Conclusion: The incidence of major bleeding and thrombosis was similar between groups. Our multimodal monitoring protocol standardized UFH infusion administration and reduced ATIII administration.

scholarly journals Organization and Application of ECLS Therapy—A Nationwide Survey in German Cardiosurgical Departments

2018 ◽  
Vol 67 (03) ◽  
pp. 164-169
Author(s):  
Alexander Assmann ◽  
Udo Boeken ◽  
Stefan Klotz ◽  
Wolfgang Harringer ◽  
Andreas Beckmann
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Extracorporeal Circulation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Nationwide Survey ◽  
Left Ventricular ◽  
Local Application ◽  
Circulatory Support ◽  
Anticoagulation Management ◽  
The Status

Background In context of the multidisciplinary German scientific guideline “Use of extracorporeal circulation (extracorporeal life support [ECLS]/extracorporeal membrane oxygenation) for cardiac and circulatory failure,” a nationwide survey should depict the status of organization and application of ECLS therapy in Germany. Methods Between June and October 2017, a standardized questionnaire consisting of 30 items related to ECLS therapy was sent to all German cardiosurgical departments, and all returned results were analyzed and evaluated. Results The return rate amounted to 92.9% (78 out of 84 departments). In the participating departments, ECLS therapy is subject to different responsibilities, and exhibits divergent processes and various ways for specialization of the involved personnel. This also concerns local application standards, such as cannulation strategies, anticoagulation management, left ventricular unloading, antiwatershed treatment, and weaning from circulatory support. Conclusion This nationwide survey underlines the necessity of a multidisciplinary guideline concerning ECLS therapy.

Fixed Dose IV rt-PA and Clinical Outcome in Ischemic Stroke Patients With Body Weight >100 kg: Pooled Data From 3 Randomized Clinical Trials

2018 ◽  
Vol 27 (10) ◽  
pp. 2843-2848
Author(s):  
Shahram Majidi ◽  
Christopher R. Leon Guerrero ◽  
Kathleen M. Burger ◽  
Dimitri Sigounas ◽  
Wayne J. Olan ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Body Weight ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Randomized Clinical Trials ◽  
Fixed Dose ◽  
Stroke Patients ◽  
Pooled Data

The effects of garlic supplementation on weight loss: A systematic review and meta-analysis of randomized controlled trials

2019 ◽  
pp. 1-13 ◽  
Author(s):  
Manije Darooghegi Mofrad ◽  
Jamal Rahmani ◽  
Hamed Kord Varkaneh ◽  
Alireza Teymouri ◽  
Seyed Mohammad Mousavi
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Body Weight ◽  
Waist Circumference ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Random Effects Models ◽  
Online Databases

Abstract. Obesity is related to increase in the incidence of morbidity and mortality. Studies have suggested anti-obesity properties of garlic; however, results are inconsistent. This systematic review and meta-analysis is done to summarize the data obtained from available randomized clinical trials on the effect of garlic supplementation on body weight, Body Mass Index (BMI), and Waist Circumference (WC). The online databases of Scopus, PubMed, Google Scholar and Cochrane library were searched until March 2018 for related publications using relevant keywords. Effect sizes of eligible studies were pooled using random-effects models. Cochran’s Q-test and I2 index were used for assessing heterogeneity. We found 1241 records in our initial search, of which 13 randomized clinical trials (RCTs) with 15 treatment arms were included. Pooled analysis showed that garlic administration might significantly decrease WC (Weighed Mean Difference (WMD): −1.10 cm, 95% CI: −2.13, −0.07, P = 0.03, I2 = 0%). However, garlic intervention had no significant effect on body weight (WMD): −0.17 kg, 95% CI: −0.75 to 0.39, P = 0.54, I2 = 0%) and BMI (WMD: −0.17 kg/m2, 95% CI: −0.52, 0.16, P = 0.30, I2 = 44.5%) as compared to controls. From Subgroup analysis, it was ascertained that the effect of garlic supplementation on BMI was significant in trials with duration < 12 weeks (WMD: −0.58 kg/m2, 95% CI: −1.08, −0.08, I2 = 19.8%, P = 0.02) compared to those with higher duration (>12 weeks). The current meta-analysis results suggest that garlic supplementation seems to reduce waist circumference unlike body weight and BMI.

P190 ABROCITINIB EFFICACY AND SAFETY BY BODY WEIGHT: POOLED ANALYSIS OF 3 RANDOMIZED CLINICAL TRIALS

2021 ◽  
Vol 127 (5) ◽  
pp. S53-S54
Author(s):  
J. Thyssen ◽  
J. Silverberg ◽  
M. Cork ◽  
A. Taieb ◽  
B. Malhotra ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Body Weight ◽  
Randomized Clinical Trials ◽  
Pooled Analysis ◽  
Efficacy And Safety

scholarly journals Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Adam Flaczyk ◽  
Rachel P. Rosovsky ◽  
Clay T. Reed ◽  
Brittany K. Bankhead-Kendall ◽  
Edward A. Bittner ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Anticoagulation Management ◽  
Randomized Controlled Clinical Trials ◽  
Increased Risk ◽  
Individualized Approach

Abstract Critically ill patients with COVID-19 are at increased risk for thrombotic complications which has led to an intense debate surrounding their anticoagulation management. In the absence of data from randomized controlled clinical trials, a number of consensus guidelines and recommendations have been published to facilitate clinical decision-making on this issue. However, substantive differences exist between these guidelines which can be difficult for clinicians. This review briefly summarizes the major societal guidelines and compares their similarities and differences. A common theme in all of the recommendations is to take an individualized approach to patient management and a call for prospective randomized clinical trials to address important anticoagulation issues in this population.

scholarly journals The Effect of L-Arginine Supplementation on Obesity-Related Indices: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

2019 ◽  
pp. 1-11 ◽  
Author(s):  
Seyed Mohammad Mousavi ◽  
Alireza Milajerdi ◽  
Somaye Fatahi ◽  
Jamal Rahmani ◽  
Meysam Zarezadeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Body Weight ◽  
Waist Circumference ◽  
Randomized Clinical Trials ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Statistical Heterogeneity ◽  
Mean Differences ◽  
Arginine Supplementation

Abstract. The clinical studies regarding the effect of L-arginine in human anthropometry have not been fully consistent, therefore, we carried out a systematic review and meta-analysis of randomized clinical trials in order to precisely evaluate and quantify the efficacy of L-arginine on weight, waist circumference, and BMI. We searched online databases including PubMed, SCOPUS, and Google Scholar for relevant articles up to September 2017. Eligible articles were reviewed by two independent investigators. Mean differences of the outcomes were used for calculation of weighted mean difference (WMD) derived from the random-effects model. Statistical heterogeneity between studies was examined using Cochran’s Q-test and I 2 index. Funnel plot and Egger’s tests were performed to assess the publication bias. In our initial search, we found 1598 publications, of which 8 RCTs (9 treatment arms) were included. The results of the meta-analysis displayed a significant reduction in WC following L-arginine supplementation (WMD: −2.97 cm; 95% CI: −4.75 to −1.18, P = 0.001). However, L-arginine intervention had not elicited a significant effect on BMI (WMD: −0.51 kg/m2; 95% CI: −1.11 to .08, P = 0.09) and body weight (WMD: −0.57 kg; 95% CI: −1.77 to 0.61, P = 0.34). Subgroup analyses displayed that longer-term interventions (≥8 weeks) had a positive effect on body weight and using < 8 g/day L-arginine with longer duration (≥8 weeks) could significantly decrease BMI. In conclusion, this meta-analysis result suggested L-arginine supplementation could reduce waist circumference without any significant effect on body weight and body mass index.

Abstract 261: Applying Clinical Trial Data to Real-World: Apixaban, Dabigatran, and Rivaroxaban

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Alpesh Amin ◽  
Michael Stokes ◽  
Ning Wu ◽  
Elyse Gatt ◽  
Dinara Makenbaeva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Relative Risk ◽  
Clinical Outcome ◽  
Intracranial Hemorrhage ◽  
Major Bleeding ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Absolute Risk ◽  
The Real

BACKGROUND: Data from randomized controlled trials and a real-world sample of non-valvular atrial fibrillation patients were combined to estimate the absolute effect of each new oral anticoagulant (NOAC, apixaban, dabigatran, and rivaroxaban) versus warfarin on stroke and major bleeding rates in real-world clinical practice. METHODS: Non-valvular atrial fibrillation patients were selected from Medco healthplans during 2007-2010. Reference rates for stroke and major bleeding excluding intracranial hemorrhage (to avoid double counting) were calculated for real-world Medco patients during warfarin use. Real-world event rates for NOACs were estimated by multiplying the corresponding relative risk from the randomized clinical trials by each reference rate. Absolute risk reductions and numbers needed to treat (NNT) or numbers needed to harm (NNH) for each NOAC vs. warfarin were then estimated. Reduction in net clinical outcome was calculated by summing the absolute risk reductions for stroke and major bleeding excluding intracranial hemorrhage for each NOAC versus warfarin. RESULTS: Each NOAC resulted in a reduction in stroke events compared with warfarin in the real-world (TABLE). Apixaban was the only NOAC to reduce the rate of major bleeding excluding intracranial hemorrhage compared with warfarin. The NNT to avoid one net clinical outcome (stroke plus major bleeding excluding intracranial hemorrhage) per year was 32 and 84 for apixaban and dabigatran, respectively. Rivaroxaban resulted in an increase in net clinical outcome (NNH=166). CONCLUSIONS: If relative risk reductions from randomized clinical trials persist in the real-world, apixaban would result in the greatest clinical benefit versus warfarin of all NOACs in terms of stroke and major bleeding excluding intracranial hemorrhage events avoided.

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