PDF(Pubmed)
Abstract：
BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) is associated with complex hemostatic changes. Systemic anticoagulation is initiated to prevent clotting in the ECMO system, but this comes with an increased risk of bleeding. Evidence on the use of anti-Xa-guided monitoring to prevent bleeding during ECMO support is limited. Therefore, we aimed to analyze the association between anti-factor Xa-guided anticoagulation and hemorrhage during ECMO.
METHODS: A systematic review and meta-analysis was performed (up to August 2023).
UNASSIGNED: CRD42023448888.
RESULTS: Twenty-six studies comprising 2293 patients were included in the analysis, with six works being part of the meta-analysis. The mean anti-Xa values did not show a significant difference between patients with and without hemorrhage (standardized mean difference -0.05; 95% confidence interval [CI]: -0.19; 0.28, p = .69). We found a positive correlation between anti-Xa levels and unfractionated heparin dose (UFH; pooled estimate of correlation coefficients 0.44; 95% CI: 0.33; 0.55, p < .001). The most frequent complications were any type of hemorrhage (pooled 36%) and thrombosis (33%). Nearly half of the critically ill patients did not survive to hospital discharge (47%).
CONCLUSIONS: The most appropriate tool for anticoagulation monitoring in ECMO patients is uncertain. Our analysis did not reveal a significant difference in anti-Xa levels in patients with and without hemorrhagic events. However, we found a moderate correlation between anti-Xa and the UFH dose, supporting its utilization in monitoring UFH anticoagulation. Given the limitations of time-guided monitoring methods, the role of anti-Xa is promising and further research is warranted.
METHODS: A systematic review and meta-analysis was performed (up to August 2023).
UNASSIGNED: CRD42023448888.
RESULTS: Twenty-six studies comprising 2293 patients were included in the analysis, with six works being part of the meta-analysis. The mean anti-Xa values did not show a significant difference between patients with and without hemorrhage (standardized mean difference -0.05; 95% confidence interval [CI]: -0.19; 0.28, p = .69). We found a positive correlation between anti-Xa levels and unfractionated heparin dose (UFH; pooled estimate of correlation coefficients 0.44; 95% CI: 0.33; 0.55, p < .001). The most frequent complications were any type of hemorrhage (pooled 36%) and thrombosis (33%). Nearly half of the critically ill patients did not survive to hospital discharge (47%).
CONCLUSIONS: The most appropriate tool for anticoagulation monitoring in ECMO patients is uncertain. Our analysis did not reveal a significant difference in anti-Xa levels in patients with and without hemorrhagic events. However, we found a moderate correlation between anti-Xa and the UFH dose, supporting its utilization in monitoring UFH anticoagulation. Given the limitations of time-guided monitoring methods, the role of anti-Xa is promising and further research is warranted.
摘要：
背景：使用体外膜氧合（ECMO）与复杂的止血变化有关。启动全身性抗凝以防止ECMO系统中的凝血，但这会增加出血的风险.在ECMO支持期间使用抗Xa指导监测来预防出血的证据有限。因此,我们旨在分析抗因子Xa引导抗凝与ECMO期间出血的相关性.
方法：进行了系统评价和荟萃分析（截至2023年8月）。
■CRD42023448888。
结果：分析包括2293名患者的26项研究，六部作品是荟萃分析的一部分。平均抗Xa值在有出血和无出血的患者之间没有显着差异（标准化平均差-0.05;95％置信区间[CI]：-0.19;0.28，p=.69）。我们发现抗Xa水平与普通肝素剂量之间存在正相关（UFH;相关系数的合并估计0.44;95％CI：0.33;0.55，p<.001）。最常见的并发症是任何类型的出血（36％）和血栓形成（33％）。将近一半的危重病人无法出院（47％）。
结论：ECMO患者抗凝监测的最合适工具尚不确定。我们的分析未显示有和没有出血事件的患者的抗Xa水平存在显着差异。然而,我们发现抗Xa和UFH剂量之间存在中度相关性，支持其在UFH抗凝监测中的应用。鉴于时间引导监测方法的局限性，抗Xa的作用是有希望的,需要进一步的研究.
方法：进行了系统评价和荟萃分析（截至2023年8月）。
■CRD42023448888。
结果：分析包括2293名患者的26项研究，六部作品是荟萃分析的一部分。平均抗Xa值在有出血和无出血的患者之间没有显着差异（标准化平均差-0.05;95％置信区间[CI]：-0.19;0.28，p=.69）。我们发现抗Xa水平与普通肝素剂量之间存在正相关（UFH;相关系数的合并估计0.44;95％CI：0.33;0.55，p<.001）。最常见的并发症是任何类型的出血（36％）和血栓形成（33％）。将近一半的危重病人无法出院（47％）。
结论：ECMO患者抗凝监测的最合适工具尚不确定。我们的分析未显示有和没有出血事件的患者的抗Xa水平存在显着差异。然而,我们发现抗Xa和UFH剂量之间存在中度相关性，支持其在UFH抗凝监测中的应用。鉴于时间引导监测方法的局限性，抗Xa的作用是有希望的,需要进一步的研究.
