Association of Activated Clotting Time-Guided Anticoagulation with Complications during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis.

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2024-09-07 DOI:10.1053/j.jvca.2024.09.003

Daniel Schwaiger, Lukas Schausberger, Benedikt Treml, Dragana Jadzic, Nicole Innerhofer, Christoph Oberleitner, Zoran Bukumiric, Sasa Rajsic

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引用次数: 0

Abstract

Objective: Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to reduce the risk of thromboembolic events. Despite its historic role, activated clotting time (ACT) remains a widely used heparin monitoring method. Systematic evidence on the association of ACT-guided monitoring with hemorrhagic or thromboembolic complications does not exist.

Design: Systematic literature review and meta-analysis (Scopus and PubMed, July 2023).

Setting: All cohort studies.

Participants: Patients receiving ECMO support.

Intervention: Anticoagulation monitoring with ACT.

Measurements and main results: We identified 3,177 publications, with 8 studies reporting the average ACT values for patients with and without bleeding. Meta-analysis revealed no significant difference in the compared groups (SMD = 0.69; 95% CI -0.05 to 1.43, p = 0.069; I² = 87.4%). Three studies (n = 117 patients) reported on the average ACT values for patients with thrombosis, without significant differences in ACT between patients with and without thrombosis (SMD = 0.47; 95% CI -0.50 to 1.44, p = 0.342; I² = 81.1%).

Conclusions: Even though ACT is a widely used heparin monitoring tool, the evidence on its association with hemorrhagic or thromboembolic events is still controversial and limited. Further studies are essential to elucidate the role of ACT in anticoagulation monitoring during ECMO support.

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激活凝血时间引导的抗凝与体外膜氧合支持期间并发症的关系：系统回顾与元分析》。

目的：体外膜肺氧合（ECMO）需要全身抗凝，以降低血栓栓塞事件的风险。尽管活化凝血时间（ACT）具有历史性作用，但它仍是一种广泛使用的肝素监测方法。目前还没有系统性证据表明 ACT 指导下的监测与出血或血栓栓塞并发症有关：系统文献综述和荟萃分析（Scopus 和 PubMed，2023 年 7 月）：所有队列研究：干预措施：使用 ACT 进行抗凝监测：干预措施：使用 ACT 进行抗凝监测：我们发现了 3,177 篇文献，其中 8 项研究报告了有出血和无出血患者的平均 ACT 值。Meta 分析显示，比较组间无显著差异（SMD = 0.69；95% CI -0.05 至 1.43，p = 0.069；I2 = 87.4%）。三项研究（n = 117 例患者）报告了血栓形成患者的平均 ACT 值，有血栓形成和无血栓形成患者的 ACT 无显著差异（SMD = 0.47；95% CI -0.50 至 1.44，p = 0.342；I2 = 81.1%）：尽管 ACT 是一种广泛使用的肝素监测工具，但其与出血或血栓栓塞事件相关性的证据仍存在争议且有限。进一步的研究对于阐明 ACT 在 ECMO 支持期间抗凝监测中的作用至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.