Abstract：
Background: Monitoring the anticoagulant effect of unfractionated heparin (UFH) in extracorporeal membrane oxygenation (ECMO) patients is complex but critically important to balance the risks of treatment related bleeding and circuit thrombosis. While guidelines recommend using more than one method to monitor UFH activity, the use of thromboelastometry (ROTEM) to monitor UFH in ECMO patients has not been investigated in detail.Methods: This is an observational, single-center retrospective study looking at adult ECMO patients on UFH that had ROTEM and thromboelastography (TEG) tests obtained concurrently. A total of 20 samples were obtained from nine patients during the study period, seven of which were on veno-arterial (VA) ECMO and two of which were on veno-venous (VV) ECMO.Results: Under institutional standard operating practice, when TEG and/or activated partial thromboplastin time (aPTT) were considered therapeutic, intrinsic thromboelastometry clotting time (INTEM CT) was only 1.2 times higher than the normal range. TEG based monitoring compared to aPTT based monitoring tended to result in lower anti-Xa levels and less intensive anticoagulation. For the total cohort, bleeding events, driven by the need for blood transfusions, were more common compared to ischemic events (77% vs 11%; p = 0.02).Conclusion: INTEM CT tended to be less sensitive to lower doses of UFH with a value of 1.2 times higher than the normal range when aPTT and/or TEG were considered therapeutic. Due to the relative insensitivity of ROTEM, our institution decided to continue to use TEG instead of ROTEM. Larger, multicenter trials may be helpful to validate these findings.
摘要：
背景：监测普通肝素（UFH）在体外膜氧合（ECMO）患者中的抗凝作用是复杂的，但对于平衡治疗相关出血和回路血栓形成的风险至关重要。虽然指南建议使用多种方法来监测UFH活动，在ECMO患者中使用血栓弹力图(ROTEM)监测UFH尚未得到详细研究.方法：这是一个观察性的，单中心回顾性研究观察同时接受ROTEM和血栓弹力图(TEG)检测的UFH成年ECMO患者.在研究期间，共从9名患者中获得20个样本，其中7个在静脉动脉（VA）ECMO上，其中2个在静脉静脉（VV）ECMO上。结果：在机构标准操作实践下，当TEG和/或活化部分凝血活酶时间（aPTT）被认为是治疗性的，固有血栓弹性测定凝血时间(INTEMCT)仅比正常范围高1.2倍.与基于aPTT的监测相比,基于TEG的监测倾向于导致较低的抗Xa水平和较少强度的抗凝。对于总队列，出血事件,在输血需求的驱使下，与缺血事件相比更常见（77％vs11％；p=0.02）。结论：当aPTT和/或TEG被认为是治疗性的时，INTEMCT对较低剂量的UFH的敏感性较低，其值比正常范围高1.2倍。由于ROTEM的相对不敏感,我们的机构决定继续使用TEG而不是ROTEM。较大,多中心试验可能有助于验证这些发现.
