Anti-Factor-Xa and Activated Partial Thromboplastin Time Concordance and Outcomes in Adults Undergoing Extracorporeal Membrane Oxygenation: A Secondary Analysis of the Pilot Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation Randomized Trial
| Title: | Anti-Factor-Xa and Activated Partial Thromboplastin Time Concordance and Outcomes in Adults Undergoing Extracorporeal Membrane Oxygenation: A Secondary Analysis of the Pilot Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation Randomized Trial |
|---|---|
| Authors: | Cécile Aubron, MD, PhD, Xavier Chapalain, MD, Michael Bailey, PhD, Jasmin Board, MPH, Heidi Buhr, RN, MScMed (ClinEpid), Bruce Cartwright, MBBS, Mark Dennis, PhD, Carol Hodgson, PhD, FACP, BAppSc, Paul Forrest, MBChB, David McIlroy, MBBS, MClinEpi, FANZCA, Deirdre Murphy, MBBchBAO, Lynne Murray, BAppSci, FAIMS, Vincent Pellegrino, MBBS, MD, David Pilcher, MBBS, Jayne Sheldrake, RN, PGCert, Huyen Tran, MBBS, MClinEpi, Shirley Vallance, MClinResMeth, D. James Cooper, AO BMBS, MD, Zoe McQuilten, MBBS, PhD |
| Source: | Critical Care Explorations, Vol 5, Iss 11, p e0999 (2023) |
| Publisher Information: | Wolters Kluwer, 2023. |
| Publication Year: | 2023 |
| Collection: | LCC:Medical emergencies. Critical care. Intensive care. First aid |
| Subject Terms: | Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9 |
| More Details: | OBJECTIVES:. To determine the concordance between activated partial thromboplastin time (aPTT) and anti-factor-Xa (anti-Xa) in adults undergoing extracorporeal membrane oxygenation (ECMO) and to identify the factors associated with discordant paired aPTT/anti-Xa. DESIGN:. Pre-planned secondary analysis of the Low-Dose Heparin in Critically Ill Patients Undergoing Extracorporeal Membrane Oxygenation pilot randomized unblinded, parallel-group controlled trial. SETTING:. Two ICUs in two university hospitals. PATIENTS:. Thirty-two critically ill patients who underwent ECMO and who had at least one paired aPTT and anti-Xa assay performed at the same time. INTERVENTIONS:. We analyzed the concordance between aPTT and anti-Xa and identified factors associated with discordant paired aPTT/anti-Xa based on their respective therapeutic ranges. We also compared biological parameters between heparin resistance episode and no heparin resistance. MEASUREMENTS AND MAIN RESULTS:. Of the 32 patients who were included in this study, 24 (75%) had at least one discordant paired aPTT/anti-Xa. Of the 581 paired aPTT/anti-Xa that were analyzed, 202 were discordant. The aPTT was relatively lower than anti-Xa in 66 cases (32.7%) or relatively higher than anti-Xa in 136 cases (67.3%). Thirty-three heparin resistance episodes were identified in six patients (19%). CONCLUSIONS:. In these critically ill patients undergoing ECMO, one third of paired aPTT/anti-Xa measures was discordant. Coagulopathy and heparin resistance might be the reasons for discordance. Our results support the potential importance of routinely monitoring both tests in this setting. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 2639-8028 00000000 |
| Relation: | http://journals.lww.com/10.1097/CCE.0000000000000999; https://doaj.org/toc/2639-8028 |
| DOI: | 10.1097/CCE.0000000000000999 |
| Access URL: | https://doaj.org/article/396b26023b2a4e808b78009f6fb89bca |
| Accession Number: | edsdoj.396b26023b2a4e808b78009f6fb89bca |
| Database: | Directory of Open Access Journals |
| ISSN: | 26398028 00000000 |
|---|---|
| DOI: | 10.1097/CCE.0000000000000999 |
| Published in: | Critical Care Explorations |
| Language: | English |