Target for Anticoagulation in the Management of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

IF 2.7

CHEST critical care Pub Date : 2025-12-01 Epub Date: 2025-07-21 DOI:10.1016/j.chstcc.2025.100198

Shingo Kazama MD, PhD , Toru Kondo MD, PhD , Hiraiwa Hiroaki MD, PhD , Ryota Morimoto MD, PhD , Takahiro Okumura MD, PhD , Junta Honda MD , Taku Tanaka MD, PhD , Michiko Higashi MD , Takanori Yamamoto MD, PhD , Atsushi Numaguchi MD, PhD , Yachiyo Kuwatsuka MD, PhD , Masahiko Ando MD, PhD , Shogo Yamaguchi MD, PhD , Yusuke Uemura MD, PhD , Akinori Sawamura MD, PhD , Naoki Watanabe MD, PhD , Itsuro Morishima MD, PhD , Tomoaki Haga MD, PhD , Masanori Shinoda MD, PhD , Toyoaki Murohara MD, PhD , Daisuke Kasugai MD, PhD

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Abstract

Background

Bleeding and thromboembolic complications are significant challenges in the treatment of patients with cardiogenic shock (CS) who require venoarterial extracorporeal membrane oxygenation (VA-ECMO). Anticoagulation strategies that target higher activated partial thromboplastin time (aPTT) may exacerbate bleeding and lead to poor outcomes. However, there is a lack of sufficient randomized trials to determine the optimal aPTT target for this patient population.

Research Question

Does anticoagulation management with a lower aPTT target range improve outcomes compared with a higher aPTT target range in patients with CS who are treated with VA-ECMO?

Study Design and Methods

The Target for Anticoagulation in the Management of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock (TARGET-ECMO) trial is a multicenter, randomized controlled trial designed to evaluate the impact of different aPTT target ranges on outcomes in patients with CS who are treated with VA-ECMO. Patients are randomized into 1 of 2 groups: a lower aPTT target group (aPTT, 1.5 to1.8 times) or a higher aPTT target group (aPTT, 2.2 to 2.5 times).

Results

The primary end point is a hierarchic composite outcome assessed at 7 days that consists of (1) death from any cause, (2) major bleeding, (3) thromboembolic events, and (4) total transfusion of RBC concentrates, which are evaluated with the use of a win ratio.

Interpretation

Anticoagulation targets in VA-ECMO management typically are determined at the discretion of individual centers and clinicians. The Target for Anticoagulation in the Management of Venoarterial Extracorporeal Membrane Oxygenation for CS trial aims to improve the prognosis of patients with CS who are treated with VA-ECMO by exploring optimal aPTT target range for anticoagulation management.

Clinical Trial Registration

Certified Review Board of Nagoya University Hospital (approval number: 2024-0166) and the Japan Registry of Clinical Trials (jRCT1041240069).

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心源性休克静脉体外膜氧合治疗中的抗凝靶点

出血和血栓栓塞并发症是需要静脉动脉体外膜氧合（VA-ECMO）治疗心源性休克（CS）患者的重大挑战。靶向较高活化部分凝血活素时间（aPTT）的抗凝策略可能加剧出血并导致不良结果。然而，缺乏足够的随机试验来确定该患者群体的最佳aPTT靶点。在接受VA-ECMO治疗的CS患者中，较低aPTT靶标范围的抗凝管理与较高aPTT靶标范围相比，是否能改善预后？研究设计和方法心源性休克静脉体外膜氧合抗凝治疗靶点（Target - ecmo）试验是一项多中心、随机对照试验，旨在评估不同aPTT靶点范围对接受VA-ECMO治疗的CS患者预后的影响。患者随机分为2组中的1组：低aPTT目标组（aPTT, 1.5 ~ 1.8倍）或高aPTT目标组（aPTT, 2.2 ~ 2.5倍）。主要终点是7天评估的分层复合结局，包括：(1)任何原因导致的死亡，(2)大出血，(3)血栓栓塞事件，(4)红细胞浓缩物总输注，使用赢比进行评估。解释VA-ECMO管理中的抗凝目标通常由各个中心和临床医生自行决定。静脉体外膜氧合治疗CS的抗凝目标试验旨在通过探索最佳aPTT抗凝目标范围，改善VA-ECMO治疗CS患者的预后。名古屋大学医院临床试验注册认证审查委员会（批准号：2024-0166）和日本临床试验注册（jRCT1041240069）。

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

CHEST critical care Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine

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