Outcomes of heparinized adult veno-arterial extracorporeal membrane oxygenation patients managed with low and high activated partial thromboplastin time targets: A systematic review and meta-analysis

Author:

Mazzeffi Michael1ORCID,Lin Dora2,Gonzalez-Almada Alberto2,Stombaugh D Keegan1ORCID,Curley Jonathan1,Mangunta Venkat1,Teman Nicholas3,Yarboro Leora T3,Thiele Robert1

Affiliation:

1. Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, USA

2. Department of Anesthesiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

3. Department of Surgery Division of Cardiothoracic Surgery, University of Virginia Health, Charlottesville, VA, USA

Abstract

Introduction There are no randomized controlled trials comparing low and high activated partial thromboplastin time (aPTT) targets in heparinized adult veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) patients. Our systematic review and meta-analysis summarized complication rates in adult VA ECMO patients treated with low and high aPTT targets. Methods Studies published from January 2000 to May 2022 were identified using Pubmed, Embase, Cochrane Library, and LILACS (Latin American and Caribbean Health Sciences Literature). Studies were included if aPTT was primarily used to guide heparin anticoagulation. For the low aPTT group, we included studies where aPTT goal was ≤60 seconds and for the high aPTT group, we included studies where aPTT goal was ≥60 seconds. Proportional meta-analysis with a random effects model was used to calculate pooled complication rates for patients in the two aPTT groups. Results Twelve studies met inclusion criteria (5 in the low aPTT group and 7 in the high aPTT group). The pooled bleeding complication incidence for low aPTT studies was 53.6% (95% CI = 37.4%–69.4%, I2 = 60.8%) and for high aPTT studies was 43.8% (95% CI = 21.7%–67.1%, I2 = 91.8%). No studies in the low aPTT group reported overall thrombosis incidence, while three studies in the high aPTT group reported overall thrombosis incidence. The pooled thrombosis incidence for high aPTT studies was 16.1% (95% CI = 9.0%–24.5%, I2 = 13.1%). Conclusions Adult ECMO patients managed with low and high aPTT goals appeared to have similar bleeding and other complication rates further highlighting the need for a randomized controlled trial.

Publisher

SAGE Publications

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Safety Research,Radiology, Nuclear Medicine and imaging,General Medicine

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