Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study
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 multi...
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doaj-93b5537171834a9c8bb029c13bc8507e2021-04-04T11:20:11ZengBMCCritical Care1364-85352021-04-0125111110.1186/s13054-021-03554-0Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort studyRichard Descamps0Mouhamed D. Moussa1Emmanuel Besnier2Marc-Olivier Fischer3Sébastien Preau4Fabienne Tamion5Cédric Daubin6Nicolas Cousin7André Vincentelli8Julien Goutay9Damien Du Cheyron10Department of Medical Intensive Care, Caen University HospitalInserm, CHU Lille, Surgical Critical Care, Department of Anesthesiology and Critical Care, Institut Pasteur de Lille, UMR1011-EGID, Univ. LilleDepartment of Anesthesiology and Critical Care, Rouen University HospitalDepartment of Anesthesiology and Critical Care, Caen University HospitalDepartment of Medical Intensive Care, Lille University HospitalUNIROUEN, Inserm U1096, FHU- REMOD-VHF, Normandie UnivDepartment of Medical Intensive Care, Caen University HospitalDepartment of Medical Intensive Care, Lille University HospitalInserm, CHU Lille, Department of Cardiac Surgery, Institut Pasteur de Lille, UMR1011-EGID, Univ. LilleDepartment of Medical Intensive Care, Lille University HospitalDepartment of Medical Intensive Care, Caen University HospitalAbstract 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.https://doi.org/10.1186/s13054-021-03554-0Acute respiratory distress syndrome (ARDS)Extracorporeal membrane oxygenation (ECMO)Extracorporeal life support (ECLS)HemorrhageAnti-Xa |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Richard Descamps Mouhamed D. Moussa Emmanuel Besnier Marc-Olivier Fischer Sébastien Preau Fabienne Tamion Cédric Daubin Nicolas Cousin André Vincentelli Julien Goutay Damien Du Cheyron |
spellingShingle |
Richard Descamps Mouhamed D. Moussa Emmanuel Besnier Marc-Olivier Fischer Sébastien Preau Fabienne Tamion Cédric Daubin Nicolas Cousin André Vincentelli Julien Goutay Damien Du Cheyron Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study Critical Care Acute respiratory distress syndrome (ARDS) Extracorporeal membrane oxygenation (ECMO) Extracorporeal life support (ECLS) Hemorrhage Anti-Xa |
author_facet |
Richard Descamps Mouhamed D. Moussa Emmanuel Besnier Marc-Olivier Fischer Sébastien Preau Fabienne Tamion Cédric Daubin Nicolas Cousin André Vincentelli Julien Goutay Damien Du Cheyron |
author_sort |
Richard Descamps |
title |
Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study |
title_short |
Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study |
title_full |
Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study |
title_fullStr |
Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study |
title_full_unstemmed |
Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study |
title_sort |
anti-xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ecmo): a multicenter cohort study |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2021-04-01 |
description |
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. |
topic |
Acute respiratory distress syndrome (ARDS) Extracorporeal membrane oxygenation (ECMO) Extracorporeal life support (ECLS) Hemorrhage Anti-Xa |
url |
https://doi.org/10.1186/s13054-021-03554-0 |
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