Lack of efficacy: case report

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    An event is serious (based on the ICH definition) when the patient outcome is:

    • * death

    • * life-threatening

    • * hospitalisation

    • * disability

    • * congenital anomaly

    • * other medically important event

    “ ”

    A 29-year-old woman exhibited lack of effect of plasma, indicated for thrombosis.

    The woman had underlying obesity, hypothyroidism and polycystic ovary disease. She was admitted to the ICU of the Nicosia General Hospital, Cyprus with type I respiratory failure due to COVID-19 infection. On day 4 of mechanical ventilation, she presented with severe respiratory deterioration. She then underwent venovenous extracorporeal membrane oxygenation (VV ECMO) support. Heparin infusion was started prophylactically with a target to maintain activated partial thromboplastin time (aPTT) 1.5−2 times initial patient values. During the first 48 hours of ECMO support, she was unable to maintain anticoagulation targets, despite progressively increased heparin dose. She exhibited signs of thrombosis on her left index finger. Plasma [fresh frozen plasma; dosage and route not stated] administration was not effective. Heparin infusion switched to argatroban. During Argatroban administration, she presented a non-clinically significant bleeding from the tracheostomy [aetiology not stated] and the ECMO intravenous cannulas. There were no apparent thrombotic events and the thrombosis on the index finger resolved without further intervention. She was successfully weaned off the ECMO after 10 days following a full recovery.


    1. Efseviou C, et al. Heparin resistance during ECMO-alternative anticoagulation with Argatroban. Intensive Care Medicine Experimental 8 (Suppl.): 206 abstr. 000736, 2020. Available from: URL: [abstract]

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    Plasma. Reactions Weekly 1842, 308 (2021).

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