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.
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。