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Anticoagulation and hemostasis on extracorporeal membrane oxygenation.
Carmona, Carlos; Nellis, Marianne E; Karam, Oliver.
Afiliação
  • Carmona C; Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia.
  • Nellis ME; Division of Pediatric Critical Care Medicine, NY Presbyterian Hospital - Weill Cornell Medicine, New York, New York.
  • Karam O; Section of Pediatric Critical Care Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
Curr Opin Pediatr ; 35(3): 297-302, 2023 06 01.
Article em En | MEDLINE | ID: mdl-36974451
PURPOSE OF REVIEW: The purpose of this review is to describe the hemostatic changes induced by extracorporeal membrane oxygenation (ECMO), the need to balance the risks of bleeding and clotting with anticoagulation and hemostatic transfusions, and the inherent risks to these interventions. RECENT FINDINGS: Both bleeding and clotting are frequent complications of ECMO. To prevent clotting events, virtually, all children are anticoagulated. However, the optimal anticoagulation strategy is unknown. A recent systematic review of observational studies showed that anti-Xa-guided strategies were associated with a two-fold decrease in bleeding and no increase in clotting complications. These results need to be tested in randomized controlled trials. To avoid bleeding events, platelet transfusions are frequently prescribed to children on ECMO. However, platelet transfusions have recently been shown to be independently associated with increased bleeding and clotting. Therefore, the optimal platelet transfusion strategy must be evaluated appropriately. SUMMARY: Most patients on ECMO will develop either a hemorrhagic or thrombotic complication. Balancing these risks involves careful titration of anticoagulation to prevent clotting and hemostatic transfusions to prevent bleeding. As the current level of evidence is low, prospective randomized trials are needed.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Hemostáticos / Oxigenação por Membrana Extracorpórea Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Hemostáticos / Oxigenação por Membrana Extracorpórea Idioma: En Ano de publicação: 2023 Tipo de documento: Article