Routine laboratory measures of heparin anticoagulation for children on extracorporeal membrane oxygenation: Systematic review and meta-analysis

D. P. Padhya, G. J. Prutsky, M. E. Nemergut, G. S. Schears, Randall Flick, W. Farah, Zhen Wang, L. J. Prokop, Mohammad H Murad, M. Alsawas

Research output: Contribution to journalReview article

1 Scopus citations


Objective: Specific protocols for anticoagulation for children on ECMO vary across institutions, with most using a continuous infusion of unfractionated heparin. The goal of this study is to aid clinician's decision on the best measure of heparin anticoagulation test; which would be the one that correlates well with heparin activity and helps in predicting hemorrhagic and thrombotic complications. Data sources: A comprehensive search of MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus was conducted from each database's inception to 07/13/2018. Study selection: Studies evaluating children (<18 years)treated with ECMO and evaluating ACT, aPTT, TEG and Anti-Xa in any language were included. Data extraction: Two reviewers selected and appraised studies independently, and abstracted data. Results: We included 19 studies (759 patients, mean age 19.8 months). Meta-analysis showed strong correlation between heparin dosing and anti-Xa. Additionally, there was not a strong correlation between laboratory tests and complications (hemorrhagic and thrombosis), or mortality. Conclusion: Based on current evidence, Anti-Xa is the only laboratory test that shows strong correlation with heparin infusion dose and seems like the most suitable test for monitoring of anticoagulation with heparin in children on ECMO.

Original languageEnglish (US)
Pages (from-to)132-139
Number of pages8
JournalThrombosis research
StatePublished - Jul 1 2019



  • Anticoagulation
  • Complications
  • Extracorporeal membrane oxygenation
  • Laboratory measures
  • Pediatrics

ASJC Scopus subject areas

  • Hematology

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