Abstract
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 language | English (US) |
|---|---|
| Pages (from-to) | 132-139 |
| Number of pages | 8 |
| Journal | Thrombosis research |
| Volume | 179 |
| DOIs | |
| State | Published - Jul 1 2019 |
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Keywords
- Anticoagulation
- Complications
- Extracorporeal membrane oxygenation
- Laboratory measures
- Pediatrics
ASJC Scopus subject areas
- Hematology
Cite this
Routine laboratory measures of heparin anticoagulation for children on extracorporeal membrane oxygenation : Systematic review and meta-analysis. / Padhya, D. P.; Prutsky, G. J.; Nemergut, M. E.; Schears, G. S.; Flick, Randall; Farah, W.; Wang, Zhen; Prokop, L. J.; Murad, Mohammad H; Alsawas, M.
In: Thrombosis research, Vol. 179, 01.07.2019, p. 132-139.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Routine laboratory measures of heparin anticoagulation for children on extracorporeal membrane oxygenation
T2 - Systematic review and meta-analysis
AU - Padhya, D. P.
AU - Prutsky, G. J.
AU - Nemergut, M. E.
AU - Schears, G. S.
AU - Flick, Randall
AU - Farah, W.
AU - Wang, Zhen
AU - Prokop, L. J.
AU - Murad, Mohammad H
AU - Alsawas, M.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - 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.
AB - 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.
KW - Anticoagulation
KW - Complications
KW - Extracorporeal membrane oxygenation
KW - Laboratory measures
KW - Pediatrics
UR - http://www.scopus.com/inward/record.url?scp=85066078924&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85066078924&partnerID=8YFLogxK
U2 - 10.1016/j.thromres.2019.05.006
DO - 10.1016/j.thromres.2019.05.006
M3 - Review article
VL - 179
SP - 132
EP - 139
JO - Thrombosis Research
JF - Thrombosis Research
SN - 0049-3848
ER -