Antithrombin During Extracorporeal Membrane Oxygenation in Adults: National Survey and Retrospective Analysis
The impact of antithrombin replacement during extracorporeal membrane oxygenation (ECMO) in adults remains unclear. This work comprises a survey, showing that antithrombin is routinely supplemented in many Italian ECMO-Centers, and a retrospective analysis on 66 adults treated with veno-venous ECMO...
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| Veröffentlicht in: | ASAIO journal (1992) 2019-03, Vol.65 (3), p.257-263 |
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| container_title | ASAIO journal (1992) |
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| creator | Iapichino, Giacomo E Protti, Alessandro Andreis, Davide T Panigada, Mauro Artoni, Andrea Novembrino, Cristina Pesenti, Antonio Gattinoni, Luciano |
| description | The impact of antithrombin replacement during extracorporeal membrane oxygenation (ECMO) in adults remains unclear. This work comprises a survey, showing that antithrombin is routinely supplemented in many Italian ECMO-Centers, and a retrospective analysis on 66 adults treated with veno-venous ECMO and unfractionated heparin at our Institution. Twenty-four to 72 h after the beginning of ECMO, antithrombin activity was ≤70% in 47/66 subjects and activated partial thromboplastin time (aPTT) ratio was |
| doi_str_mv | 10.1097/MAT.0000000000000806 |
| format | Article |
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This work comprises a survey, showing that antithrombin is routinely supplemented in many Italian ECMO-Centers, and a retrospective analysis on 66 adults treated with veno-venous ECMO and unfractionated heparin at our Institution. Twenty-four to 72 h after the beginning of ECMO, antithrombin activity was ≤70% in 47/66 subjects and activated partial thromboplastin time (aPTT) ratio was <1.5 in 20/66 subjects. Activated partial thromboplastin time ratio <1.5 was associated not with lower antithrombin activity (61 ± 17 vs. 63 ± 22%; p = 0.983) but with higher circulating level of C-reactive protein (23 ± 8 vs. 11 ± 9 mg/dl; p < 0.001). In 34 subjects who received antithrombin concentrate, antithrombin activity increased (from 54 ± 9 to 84 ± 13%; p < 0.001); the proportion of subjects with aPTT ratio ≥1.5 increased (from 21/34 [62%] to 31/34 [91%]; p = 0.004); heparin dosage remained constant (from 19 ± 7 to 19 ± 6 IU/kg/h; p = 0.543); and C-reactive protein decreased (from 17 ± 10 to 13 ± 9 mg/dl; p = 0.013). Among those with aPTT ratio <1.5, aPTT ratio remained <1.5 in 3 out of 13 subjects. Antithrombin is frequently supplemented during veno-venous ECMO although low antithrombin activity does not constantly impede, and antithrombin replacement does not constantly ensure, reaching the target aPTT ratio. Inflammation possibly affects the individual response to heparin.]]></description><identifier>ISSN: 1058-2916</identifier><identifier>EISSN: 1538-943X</identifier><identifier>DOI: 10.1097/MAT.0000000000000806</identifier><identifier>PMID: 29746315</identifier><language>eng</language><publisher>United States: Copyright by the American Society for Artificial Internal Organs</publisher><subject>Adult ; Anticoagulants - therapeutic use ; Antithrombins - blood ; Antithrombins - therapeutic use ; Extracorporeal Membrane Oxygenation - adverse effects ; Female ; Heparin - therapeutic use ; Humans ; Male ; Partial Thromboplastin Time ; Retrospective Studies ; Thrombosis - etiology ; Thrombosis - prevention & control</subject><ispartof>ASAIO journal (1992), 2019-03, Vol.65 (3), p.257-263</ispartof><rights>Copyright © 2019 by the American Society for Artificial Internal Organs</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4226-943dc8c4475eb2eb6c281afc07f33d60c2826543a49aae12a1cbbeedeb0029423</citedby><cites>FETCH-LOGICAL-c4226-943dc8c4475eb2eb6c281afc07f33d60c2826543a49aae12a1cbbeedeb0029423</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29746315$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iapichino, Giacomo E</creatorcontrib><creatorcontrib>Protti, Alessandro</creatorcontrib><creatorcontrib>Andreis, Davide T</creatorcontrib><creatorcontrib>Panigada, Mauro</creatorcontrib><creatorcontrib>Artoni, Andrea</creatorcontrib><creatorcontrib>Novembrino, Cristina</creatorcontrib><creatorcontrib>Pesenti, Antonio</creatorcontrib><creatorcontrib>Gattinoni, Luciano</creatorcontrib><title>Antithrombin During Extracorporeal Membrane Oxygenation in Adults: National Survey and Retrospective Analysis</title><title>ASAIO journal (1992)</title><addtitle>ASAIO J</addtitle><description><![CDATA[The impact of antithrombin replacement during extracorporeal membrane oxygenation (ECMO) in adults remains unclear. This work comprises a survey, showing that antithrombin is routinely supplemented in many Italian ECMO-Centers, and a retrospective analysis on 66 adults treated with veno-venous ECMO and unfractionated heparin at our Institution. Twenty-four to 72 h after the beginning of ECMO, antithrombin activity was ≤70% in 47/66 subjects and activated partial thromboplastin time (aPTT) ratio was <1.5 in 20/66 subjects. Activated partial thromboplastin time ratio <1.5 was associated not with lower antithrombin activity (61 ± 17 vs. 63 ± 22%; p = 0.983) but with higher circulating level of C-reactive protein (23 ± 8 vs. 11 ± 9 mg/dl; p < 0.001). In 34 subjects who received antithrombin concentrate, antithrombin activity increased (from 54 ± 9 to 84 ± 13%; p < 0.001); the proportion of subjects with aPTT ratio ≥1.5 increased (from 21/34 [62%] to 31/34 [91%]; p = 0.004); heparin dosage remained constant (from 19 ± 7 to 19 ± 6 IU/kg/h; p = 0.543); and C-reactive protein decreased (from 17 ± 10 to 13 ± 9 mg/dl; p = 0.013). Among those with aPTT ratio <1.5, aPTT ratio remained <1.5 in 3 out of 13 subjects. Antithrombin is frequently supplemented during veno-venous ECMO although low antithrombin activity does not constantly impede, and antithrombin replacement does not constantly ensure, reaching the target aPTT ratio. Inflammation possibly affects the individual response to heparin.]]></description><subject>Adult</subject><subject>Anticoagulants - therapeutic use</subject><subject>Antithrombins - blood</subject><subject>Antithrombins - therapeutic use</subject><subject>Extracorporeal Membrane Oxygenation - adverse effects</subject><subject>Female</subject><subject>Heparin - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Partial Thromboplastin Time</subject><subject>Retrospective Studies</subject><subject>Thrombosis - etiology</subject><subject>Thrombosis - prevention & control</subject><issn>1058-2916</issn><issn>1538-943X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtPAjEQgBujEUT_gTE9egH72pe3DeIjAUkUE2-bbneA1X1g2-Xx7y2Cxniwl3Y630ynH0LnlPQoiYKrUTzpkd8rJP4BalOPh91I8NdDdyZe2GUR9VvoxJg3QlyS02PUYlEgfE69NirjyuZ2rusyzSt80-i8muHB2mqpar2oNcgCj6BMtawAj9ebGVTS5nWFHR1nTWHNNX78unHgc6OXsMGyyvATWF2bBSibLwHHLrsxuTlFR1NZGDjb7x30cjuY9O-7w_HdQz8edpVgzN-On6lQCRF4kDJIfcVCKqeKBFPOM5-4kPme4FJEUgJlkqo0BcggJYRFgvEOutz1Xej6owFjkzI3CorC_aJuTMIID1lABeEOFTtUuXmNhmmy0Hkp9SahJNmKTpzo5K9oV3axf6FJS8h-ir7NOiDcAau6sKDNe9GsQCdzJ9TO_-_9CYEri_k</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Iapichino, Giacomo E</creator><creator>Protti, Alessandro</creator><creator>Andreis, Davide T</creator><creator>Panigada, Mauro</creator><creator>Artoni, Andrea</creator><creator>Novembrino, Cristina</creator><creator>Pesenti, Antonio</creator><creator>Gattinoni, Luciano</creator><general>Copyright by the American Society for Artificial Internal Organs</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201903</creationdate><title>Antithrombin During Extracorporeal Membrane Oxygenation in Adults: National Survey and Retrospective Analysis</title><author>Iapichino, Giacomo E ; Protti, Alessandro ; Andreis, Davide T ; Panigada, Mauro ; Artoni, Andrea ; Novembrino, Cristina ; Pesenti, Antonio ; Gattinoni, Luciano</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4226-943dc8c4475eb2eb6c281afc07f33d60c2826543a49aae12a1cbbeedeb0029423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Anticoagulants - therapeutic use</topic><topic>Antithrombins - blood</topic><topic>Antithrombins - therapeutic use</topic><topic>Extracorporeal Membrane Oxygenation - adverse effects</topic><topic>Female</topic><topic>Heparin - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Partial Thromboplastin Time</topic><topic>Retrospective Studies</topic><topic>Thrombosis - etiology</topic><topic>Thrombosis - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iapichino, Giacomo E</creatorcontrib><creatorcontrib>Protti, Alessandro</creatorcontrib><creatorcontrib>Andreis, Davide T</creatorcontrib><creatorcontrib>Panigada, Mauro</creatorcontrib><creatorcontrib>Artoni, Andrea</creatorcontrib><creatorcontrib>Novembrino, Cristina</creatorcontrib><creatorcontrib>Pesenti, Antonio</creatorcontrib><creatorcontrib>Gattinoni, Luciano</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>ASAIO journal (1992)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iapichino, Giacomo E</au><au>Protti, Alessandro</au><au>Andreis, Davide T</au><au>Panigada, Mauro</au><au>Artoni, Andrea</au><au>Novembrino, Cristina</au><au>Pesenti, Antonio</au><au>Gattinoni, Luciano</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antithrombin During Extracorporeal Membrane Oxygenation in Adults: National Survey and Retrospective Analysis</atitle><jtitle>ASAIO journal (1992)</jtitle><addtitle>ASAIO J</addtitle><date>2019-03</date><risdate>2019</risdate><volume>65</volume><issue>3</issue><spage>257</spage><epage>263</epage><pages>257-263</pages><issn>1058-2916</issn><eissn>1538-943X</eissn><abstract><![CDATA[The impact of antithrombin replacement during extracorporeal membrane oxygenation (ECMO) in adults remains unclear. This work comprises a survey, showing that antithrombin is routinely supplemented in many Italian ECMO-Centers, and a retrospective analysis on 66 adults treated with veno-venous ECMO and unfractionated heparin at our Institution. Twenty-four to 72 h after the beginning of ECMO, antithrombin activity was ≤70% in 47/66 subjects and activated partial thromboplastin time (aPTT) ratio was <1.5 in 20/66 subjects. Activated partial thromboplastin time ratio <1.5 was associated not with lower antithrombin activity (61 ± 17 vs. 63 ± 22%; p = 0.983) but with higher circulating level of C-reactive protein (23 ± 8 vs. 11 ± 9 mg/dl; p < 0.001). In 34 subjects who received antithrombin concentrate, antithrombin activity increased (from 54 ± 9 to 84 ± 13%; p < 0.001); the proportion of subjects with aPTT ratio ≥1.5 increased (from 21/34 [62%] to 31/34 [91%]; p = 0.004); heparin dosage remained constant (from 19 ± 7 to 19 ± 6 IU/kg/h; p = 0.543); and C-reactive protein decreased (from 17 ± 10 to 13 ± 9 mg/dl; p = 0.013). Among those with aPTT ratio <1.5, aPTT ratio remained <1.5 in 3 out of 13 subjects. Antithrombin is frequently supplemented during veno-venous ECMO although low antithrombin activity does not constantly impede, and antithrombin replacement does not constantly ensure, reaching the target aPTT ratio. Inflammation possibly affects the individual response to heparin.]]></abstract><cop>United States</cop><pub>Copyright by the American Society for Artificial Internal Organs</pub><pmid>29746315</pmid><doi>10.1097/MAT.0000000000000806</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Anticoagulants - therapeutic use Antithrombins - blood Antithrombins - therapeutic use Extracorporeal Membrane Oxygenation - adverse effects Female Heparin - therapeutic use Humans Male Partial Thromboplastin Time Retrospective Studies Thrombosis - etiology Thrombosis - prevention & control |
| title | Antithrombin During Extracorporeal Membrane Oxygenation in Adults: National Survey and Retrospective Analysis |
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