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Anticoagulation Levels and Bleeding After Emergency Department Extracorporeal Cardiopulmonary Resuscitation

  • Kimberly TerryEmail author
  • Nick Lonardo
  • Joseph Tonna
Pharmacology Care (J Fanikos, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pharmacology Care
  2. Topical Collection on Pharmacology Care

Abstract

Purpose of Review

We aimed to describe bleeding events associated with extracorporeal cardiopulmonary resuscitation (eCPR) using two institutional heparin protocols. In addition, we discuss current barriers to optimal anticoagulation in this critical population.

Recent Findings

Patients initiated on venoarterial membrane oxygenation (VA-ECMO) are at risk of bleeding and thrombosis; both conditions can lead to severe morbidity or mortality. Intravenous heparin is the preferred form of anticoagulation for VA-ECMO. Prior studies have found elevated activated partial thromboplastin time (aPTT) may be an independent risk factor for bleeding; however, many studies lack standardization of bleeding scores and optimal anticoagulation targets.

Summary

All six patients initiated on VA-ECMO experienced at least one bleeding event. Of 71 aPTT levels collected, 44% were within therapeutic range, 18% were subtherapeutic, and 38% were supratherapeutic. There were no obvious correlation between aPTT levels and bleeding. Future studies are needed to evaluate anticoagulation strategies in this population.

Keywords

Extracorporeal membrane oxygenation (ECMO) Bleeding Extracorporeal cardiopulmonary resuscitation (eCPR) Anticoagulation Anticoagulation monitoring 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pharmacy ServicesUniversity of Utah HealthSalt Lake CityUSA
  2. 2.Division of Cardiothoracic Surgery and Division of Emergency Medicine, Department of SurgeryUniversity of Utah HealthSalt Lake CityUSA

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