Article ; Online: Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta-analysis.
2024 Volume 47, Issue 5, Page(s) e24273
Abstract: 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 ...
Abstract | 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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MeSH term(s) | Extracorporeal Membrane Oxygenation/adverse effects ; Extracorporeal Membrane Oxygenation/methods ; Humans ; Hemorrhage/chemically induced ; Factor Xa Inhibitors/therapeutic use ; Factor Xa Inhibitors/adverse effects ; Anticoagulants/adverse effects ; Blood Coagulation/drug effects ; Factor Xa/metabolism ; Risk Factors |
Chemical Substances | Factor Xa Inhibitors ; Anticoagulants ; Factor Xa (EC 3.4.21.6) |
Language | English |
Publishing date | 2024-04-25 |
Publishing country | United States |
Document type | Systematic Review ; Journal Article ; Meta-Analysis |
ZDB-ID | 391935-3 |
ISSN | 1932-8737 ; 0160-9289 |
ISSN (online) | 1932-8737 |
ISSN | 0160-9289 |
DOI | 10.1002/clc.24273 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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