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Multicenter Study
. 2021 Apr 2;25(1):127.
doi: 10.1186/s13054-021-03554-0.

Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

Richard Descamps  1 , Mouhamed D Moussa  2 , Emmanuel Besnier  3 , Marc-Olivier Fischer  4 , Sébastien Preau  5 , Fabienne Tamion  6   7 , Cédric Daubin  8 , Nicolas Cousin  5 , André Vincentelli  9 , Julien Goutay  5 , Damien Du Cheyron  8
Affiliations
Multicenter Study

Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

Richard Descamps et al. Crit Care. .

Abstract

Background: Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring.

Methods: We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding.

Results: Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29-0.67] vs 0.33 [0.22-0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47-1.46] vs 0.66 [0.36-0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan-Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006).

Conclusion: In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.

Keywords: Acute respiratory distress syndrome (ARDS); Anti-Xa; Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO); Hemorrhage.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study
Fig. 2
Fig. 2
Two hourly mean anti-Xa activity evolution during the first two days. Precisely timed data on anti-Xa levels was only available during the first 48 h. The bars represent standard deviations. p = 0.04 by repeated measures regression analysis
Fig. 3
Fig. 3
Kaplan–Meier curve showing the probability of survival without a bleeding event under ECMO depending on anti-Xa value. The cutoff of 0.46 IU/mL is the value with the best sensibility/specificity to predict the occurrence of a hemorrhagic event (Sensibility: 46%, Specificity: 87%, AUROC: 0.65; 95%CI, 0.58–0.73; p = 0.018)
See this image and copyright information in PMC

Comment in

References

    1. ECMO Registry of the Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan, July, 2020.
    1. Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: a review. JAMA. 2019;322(6):557. doi: 10.1001/jama.2019.9302. - DOI - PubMed
    1. Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, Da Silva D, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965–1975. doi: 10.1056/NEJMoa1800385. - DOI - PubMed
    1. Schmidt M, Pham T, Arcadipane A, Agerstrand C, Ohshimo S, Pellegrino V, Vuylsteke A, Guervilly C, McGuinness S, Pierard S, Breeding J, Stewart C, Sin Wai Ching S, Camuso J, Stephens RS, King B, Herr D, Schultz MJ, Neuville M, Zogheib E, Mira JP, Rozé H, Pierrot M, Tobin A, Hodgson C, Chevret S, Brodie D, Combes A. Mechanical ventilation management during ECMO for ARDS: an international multicenter prospective cohort. Am J Respir Crit Care Med. 2019;15:1002–1012. doi: 10.1164/rccm.201806-1094OC. - DOI - PubMed
    1. Jiritano F, Serraino GF, ten Cate H, Fina D, Matteucci M, Mastroroberto P, Lorusso R. Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis. Intensive Care Med. 2020;46:1154–1169. doi: 10.1007/s00134-020-06031-4. - DOI - PMC - PubMed

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