Anticoagulation and associated complications in veno-arterial extracorporeal membrane oxygenation in adult patients: A systematic review and meta-analysis

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE

Critical Care and Resuscitation Pub Date : 2024-12-01 DOI:10.1016/j.ccrj.2024.10.003

Ruan Vlok MBBS , Hergen Buscher FCICM , Anthony Delaney FCICM, PhD , Tessa Garside FCICM, PhD , Gabrielle McDonald MD , Richard Chatoor MD , John Myburgh FCICM, PhD , Priya Nair FCICM, PhD

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引用次数: 0

Abstract

Objective

To describe the incidence of bleeding and thrombotic complications in VA-ECMO according to anticoagulation strategy.

Design

This systematic review and meta-analysis included randomised controlled trials (RCTs) and observational studies reporting bleeding and thrombotic complications in VA-ECMO. The incidence of primary outcomes according to anticoagulation drug and monitoring test was described.

Data sources

CENTRAL, MEDLINE, Embase and CINAHL (2010–January 2024).

Review methods

Data was extracted using Covidence. A meta-analysis of proportions was performed using STATA MP v18.1 metaprop.

Results

We included 159 studies with 21,942 patients. No studies were at low risk of bias. The incidence of major bleeding or thrombotic events was similar among heparin-, bivalirudin- and anticoagulation-free cohorts. The pooled incidence of major bleeding and thrombotic complications were 40% (95%CI 36–44, I² = 97.12) and 17% (95%CI 14–19, I² = 92.60%), respectively. The most common bleeding site was thoracic. The most common ischaemic complication was limb ischaemia. The incidences of major bleeding or thrombotic events, intracranial haemorrhage and ischaemic stroke were similar among all monitoring tests. Mechanical unloading was associated with a high incidence of major bleeding events (60%, 95%CI 43–77, I² = 93.32), and ischaemic strokes (13%, 95%CI 7–19, I² = 81.80).

Conclusions

Available literature assessing the association between anticoagulation strategies in VA-ECMO, and bleeding and thrombosis is of limited quality. We identified a substantially higher incidence of major bleeding events than a previous meta-analysis. Limited numbers of patients anticoagulated with alternatives to heparin were reported. Patients with additional mechanical LV unloading represent a cohort at particular risk of bleeding and thrombotic complications.

查看原文本刊更多论文

成人患者静脉-动脉体外膜氧合中的抗凝及相关并发症：系统回顾和荟萃分析。

目的：根据抗凝策略描述VA-ECMO出血及血栓并发症的发生率。设计：本系统综述和荟萃分析包括随机对照试验（rct）和观察性研究，报告了VA-ECMO中出血和血栓形成并发症。根据抗凝药物和监测试验描述主要结局的发生率。数据来源：CENTRAL， MEDLINE， Embase和CINAHL（2010- 2024年1月）。回顾方法：使用covid - ence提取数据。采用STATA MP v18.1 meta- prop对比例进行meta分析。结果：我们纳入159项研究，21,942例患者。没有低偏倚风险的研究。肝素组、比伐鲁定组和无抗凝组中大出血或血栓事件的发生率相似。大出血和血栓形成并发症的合并发生率分别为40% （95%CI 36-44, I2 = 97.12）和17% （95%CI 14-19, I2 = 92.60%）。最常见的出血部位是胸部。最常见的缺血并发症是肢体缺血。在所有监测试验中，大出血或血栓形成事件、颅内出血和缺血性脑卒中的发生率相似。机械卸荷与大出血事件（60%,95%CI 43-77, I2 = 93.32）和缺血性卒中（13%,95%CI 7-19, I2 = 81.80）的高发相关。结论：评估VA-ECMO抗凝策略与出血和血栓形成之间关系的现有文献质量有限。我们发现大出血事件的发生率比之前的荟萃分析高得多。据报道，使用肝素替代抗凝治疗的患者数量有限。附加机械性左室卸荷的患者是一个具有特殊出血和血栓并发症风险的队列。

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

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.