Abstract：
OBJECTIVE: The initiation of extracorporeal membrane oxygenation (ECMO) triggers complex coagulation processes necessitating systemic anticoagulation. Therefore, anticoagulation monitoring is crucial to avoid adverse events such as thrombosis and hemorrhage. The main aim of this work was to analyze the association between anti-Xa levels and thrombosis occurrence during ECMO support.
METHODS: Systematic literature review and meta-analysis (Scopus and PubMed, up to July 29, 2023).
METHODS: All retrospective and prospective studies.
METHODS: Patients receiving ECMO support.
METHODS: Anticoagulation monitoring during ECMO support.
RESULTS: A total of 16 articles with 1,968 patients were included in the review and 7 studies in the meta-analysis (n = 374). Patients with thrombosis had significantly lower mean anti-Xa values (standardized mean difference -0.36, 95% confidence interval [CI] -0.62 to -0.11, p < 0.01). Furthermore, a positive correlation was observed between unfractionated heparin infusion and anti-Xa levels (pooled estimate of correlation coefficients 0.31, 95% CI 0.19 to 0.43, p < 0.001). The most common adverse events were major bleeding (42%) and any kind of hemorrhage (36%), followed by thromboembolic events (30%) and circuit or oxygenator membrane thrombosis (19%). More than half of the patients did not survive to discharge (52%).
CONCLUSIONS: This work revealed significantly lower levels of anti-Xa in patients experiencing thromboembolic events and a positive correlation between anti-Xa and unfractionated heparin infusion. Considering the contemplative limitations of conventional monitoring tools, further research on the role of anti-Xa is warranted. New trials should be encouraged to confirm these findings and determine the most suitable monitoring strategy for patients receiving ECMO support.
METHODS: Systematic literature review and meta-analysis (Scopus and PubMed, up to July 29, 2023).
METHODS: All retrospective and prospective studies.
METHODS: Patients receiving ECMO support.
METHODS: Anticoagulation monitoring during ECMO support.
RESULTS: A total of 16 articles with 1,968 patients were included in the review and 7 studies in the meta-analysis (n = 374). Patients with thrombosis had significantly lower mean anti-Xa values (standardized mean difference -0.36, 95% confidence interval [CI] -0.62 to -0.11, p < 0.01). Furthermore, a positive correlation was observed between unfractionated heparin infusion and anti-Xa levels (pooled estimate of correlation coefficients 0.31, 95% CI 0.19 to 0.43, p < 0.001). The most common adverse events were major bleeding (42%) and any kind of hemorrhage (36%), followed by thromboembolic events (30%) and circuit or oxygenator membrane thrombosis (19%). More than half of the patients did not survive to discharge (52%).
CONCLUSIONS: This work revealed significantly lower levels of anti-Xa in patients experiencing thromboembolic events and a positive correlation between anti-Xa and unfractionated heparin infusion. Considering the contemplative limitations of conventional monitoring tools, further research on the role of anti-Xa is warranted. New trials should be encouraged to confirm these findings and determine the most suitable monitoring strategy for patients receiving ECMO support.
摘要：
目的：体外膜氧合（ECMO）的启动引发复杂的凝血过程，需要全身抗凝。因此,抗凝监测对于避免血栓和出血等不良事件至关重要。这项工作的主要目的是分析ECMO支持期间抗Xa水平与血栓形成发生之间的关系。
方法：系统文献综述和荟萃分析(Scopus和PubMed，截至2023年7月29日）。
方法：所有回顾性和前瞻性研究。
方法：接受ECMO支持的患者。
方法：ECMO支持期间的抗凝监测。
结果：共有16篇文章纳入1,968例患者纳入综述，7篇研究纳入荟萃分析（n=374）。血栓形成患者的平均抗Xa值显着降低（标准化平均差-0.36，95％置信区间[CI]-0.62至-0.11，p<0.01）。此外，在普通肝素输注和抗Xa水平之间观察到正相关(相关系数的合并估计值0.31,95%CI0.19~0.43,p<0.001).最常见的不良事件是大出血（42%）和任何类型的出血（36%）。其次是血栓栓塞事件(30%)和回路或氧合器膜血栓形成(19%).超过一半的患者无法生存到出院（52％）。
结论：这项工作表明，在发生血栓栓塞事件的患者中，抗Xa水平显著降低，抗Xa与普通肝素输注之间呈正相关。考虑到传统监测工具的预期局限性，需要进一步研究抗Xa的作用。应该鼓励新的试验来确认这些发现，并为接受ECMO支持的患者确定最合适的监测策略。
方法：系统文献综述和荟萃分析(Scopus和PubMed，截至2023年7月29日）。
方法：所有回顾性和前瞻性研究。
方法：接受ECMO支持的患者。
方法：ECMO支持期间的抗凝监测。
结果：共有16篇文章纳入1,968例患者纳入综述，7篇研究纳入荟萃分析（n=374）。血栓形成患者的平均抗Xa值显着降低（标准化平均差-0.36，95％置信区间[CI]-0.62至-0.11，p<0.01）。此外，在普通肝素输注和抗Xa水平之间观察到正相关(相关系数的合并估计值0.31,95%CI0.19~0.43,p<0.001).最常见的不良事件是大出血（42%）和任何类型的出血（36%）。其次是血栓栓塞事件(30%)和回路或氧合器膜血栓形成(19%).超过一半的患者无法生存到出院（52％）。
结论：这项工作表明，在发生血栓栓塞事件的患者中，抗Xa水平显著降低，抗Xa与普通肝素输注之间呈正相关。考虑到传统监测工具的预期局限性，需要进一步研究抗Xa的作用。应该鼓励新的试验来确认这些发现，并为接受ECMO支持的患者确定最合适的监测策略。
