Sasa Rajsic MD, PhD, Robert Breitkopf MD, MBA, Benedikt Treml MD, MBA, Dragana Jadzic MD, PhD, Nicole Innerhofer MD, Christine Eckhardt MD, PhD, Christoph Oberleitner MD, Zoran Bukumiric MD
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PROSPERO: CRD42023448888.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-six studies comprising 2293 patients were included in the analysis, with six works being part of the meta-analysis. The mean anti-Xa values did not show a significant difference between patients with and without hemorrhage (standardized mean difference −0.05; 95% confidence interval [CI]: −0.19; 0.28, <i>p</i> = .69). We found a positive correlation between anti-Xa levels and unfractionated heparin dose (UFH; pooled estimate of correlation coefficients 0.44; 95% CI: 0.33; 0.55, <i>p</i> < .001). The most frequent complications were any type of hemorrhage (pooled 36%) and thrombosis (33%). Nearly half of the critically ill patients did not survive to hospital discharge (47%).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The most appropriate tool for anticoagulation monitoring in ECMO patients is uncertain. Our analysis did not reveal a significant difference in anti-Xa levels in patients with and without hemorrhagic events. However, we found a moderate correlation between anti-Xa and the UFH dose, supporting its utilization in monitoring UFH anticoagulation. Given the limitations of time-guided monitoring methods, the role of anti-Xa is promising and further research is warranted.</p>\n </section>\n </div>","PeriodicalId":2,"journal":{"name":"ACS Applied Bio Materials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.24273","citationCount":"0","resultStr":"{\"title\":\"Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta-analysis\",\"authors\":\"Sasa Rajsic MD, PhD, Robert Breitkopf MD, MBA, Benedikt Treml MD, MBA, Dragana Jadzic MD, PhD, Nicole Innerhofer MD, Christine Eckhardt MD, PhD, Christoph Oberleitner MD, Zoran Bukumiric MD\",\"doi\":\"10.1002/clc.24273\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>The use of extracorporeal membrane oxygenation (ECMO) is associated with complex hemostatic changes. 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引用次数: 0
摘要
背景 使用体外膜肺氧合（ECMO）与复杂的止血变化有关。为了防止 ECMO 系统中的凝血，需要进行全身抗凝治疗，但这也增加了出血的风险。在 ECMO 支持期间使用抗 Xa 指导监测以预防出血的证据有限。因此，我们旨在分析抗 Xa 因子指导的抗凝与 ECMO 期间出血之间的关系。 方法 我们进行了系统回顾和荟萃分析（截至 2023 年 8 月）。prospero：CRD42023448888。 结果 共有 26 项研究，2293 名患者参与了分析，其中 6 项研究参与了荟萃分析。有出血和无出血患者的抗 Xa 平均值没有明显差异（标准化平均差异-0.05；95% 置信区间 [CI]：-0.19; 0.28, p = .69).我们发现抗 Xa 水平与非丝裂肝素剂量（UFH；相关系数的集合估计值为 0.44；95% CI：0.33；0.55，P = .001）呈正相关。最常见的并发症是各种类型的出血（合计 36%）和血栓形成（33%）。近一半的危重病人没有活到出院（47%）。 结论 ECMO 患者抗凝监测的最合适工具尚不确定。我们的分析并未发现有出血事件和无出血事件患者的抗 Xa 水平有明显差异。然而，我们发现抗 Xa 与 UFH 剂量之间存在适度相关性，这支持了在监测 UFH 抗凝时使用抗 Xa。鉴于时间引导监测方法的局限性，抗 Xa 的作用很有前景，值得进一步研究。
Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta-analysis
Background
The use of extracorporeal membrane oxygenation (ECMO) is associated with complex hemostatic changes. Systemic anticoagulation is initiated to prevent clotting in the ECMO system, but this comes with an increased risk of bleeding. Evidence on the use of anti-Xa-guided monitoring to prevent bleeding during ECMO support is limited. Therefore, we aimed to analyze the association between anti-factor Xa-guided anticoagulation and hemorrhage during ECMO.
Methods
A systematic review and meta-analysis was performed (up to August 2023). PROSPERO: CRD42023448888.
Results
Twenty-six studies comprising 2293 patients were included in the analysis, with six works being part of the meta-analysis. The mean anti-Xa values did not show a significant difference between patients with and without hemorrhage (standardized mean difference −0.05; 95% confidence interval [CI]: −0.19; 0.28, p = .69). We found a positive correlation between anti-Xa levels and unfractionated heparin dose (UFH; pooled estimate of correlation coefficients 0.44; 95% CI: 0.33; 0.55, p < .001). The most frequent complications were any type of hemorrhage (pooled 36%) and thrombosis (33%). Nearly half of the critically ill patients did not survive to hospital discharge (47%).
Conclusions
The most appropriate tool for anticoagulation monitoring in ECMO patients is uncertain. Our analysis did not reveal a significant difference in anti-Xa levels in patients with and without hemorrhagic events. However, we found a moderate correlation between anti-Xa and the UFH dose, supporting its utilization in monitoring UFH anticoagulation. Given the limitations of time-guided monitoring methods, the role of anti-Xa is promising and further research is warranted.
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