1
|
Kelly DP, Grandin EW, O'Brien KL. How we manage blood product support and coagulation in the adult patient requiring extracorporeal membrane oxygenation. Transfusion 2022; 62:741-750. [PMID: 35170768 DOI: 10.1111/trf.16830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
Use of extracorporeal membrane oxygenation (ECMO) is increasing among critically ill adults with cardiac and/or respiratory failure. Use of ECMO is associated with hemostatic alterations requiring use of anticoagulation and blood product support. There are limited guidelines to direct transfusion management in the adult patient supported with ECMO. The objective of this article is to describe (1) the role of the transfusion service in providing transfusion support and current understanding of transfusion thresholds, (2) the complexities of monitoring anticoagulation, and (3) the consideration regarding additional factor concentrates and antifibrinolytics within the context of ECMO support. The information provided should assist ECMO care teams in informing transfusion and anticoagulation practice while highlighting key areas for future research and collaboration.
Collapse
Affiliation(s)
- Daniel P Kelly
- Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Edward Wilson Grandin
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kerry L O'Brien
- Division of Laboratory Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
2
|
A Novel Turn on Fluorescence Sensor for Determination Enoxaparin, a Low Molecular Weight Heparin. J Fluoresc 2020; 30:1591-1599. [PMID: 32897495 DOI: 10.1007/s10895-020-02616-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/25/2020] [Indexed: 01/09/2023]
Abstract
A sensor system was designed for the detection of Enoxaparin (Enox), a low molecular weight heparin (LMWH) that was run over the fluorescence quenching mechanism of fluorescein (FL) dye. At nanomolar concentrations, FL probe was subjected to fluorescence quenching by Fe(III). Fluorescence quenching mechanism of FL by Fe(III) was examined using various analytical techniques such as UV-vis absorption, fluorescence, and Fourier transform Infrared spectroscopy techniques, as well as with scanning electron microscope. The results indicated that photoinduced electron transfer process occurred between FL and Fe and that FL was quenched both statically and dynamically. Thermodynamic parameters showed that the interactions between them were predominantly hydrophobic interactions. Enox caused FL to recover its lost fluorescence properties and an increase was observed in the intensity of the fluorescence. Enox was detected successfully with the turn on fluorescence sensor. The developed Enox biosensor exhibited linearity in the range of 0-1.1 μg/ml. For Enox detection, the limit of detection was measured as 255 ng/mL. Enox biosensor was presented as a practical, simple, and applicable sensor system with high sensitivity and good selectivity. Enox is a medication usually monitored indirectly over anticoagulation. This study was presented as an alternative method for monitoring Enox directly. HIGHLIGHTS: Fluorescence quenching of Fluorescein dye by Fe(III) was studied in detail. The presence of enoxaparin enhanced the fluorescence properties of the fluorescein dye. A sensitive, simple and effective sensor system for determination of Enoxaparin, a low molecular weight heparin was shaped in the aqueous media. It was presented as a new method for Enoxaparin to be followed directly.
Collapse
|
3
|
Lessire S, Douxfils J, Baudar J, Bailly N, Dincq AS, Gourdin M, Dogné JM, Chatelain B, Mullier F. Is Thrombin Time useful for the assessment of dabigatran concentrations? An in vitro and ex vivo study. Thromb Res 2015; 136:693-6. [PMID: 26251077 DOI: 10.1016/j.thromres.2015.07.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/13/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Sarah Lessire
- Department of Anesthesiology, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU Dinant Godinne UcL Namur, Belgium; Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
| | - Jonathan Douxfils
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
| | - Justine Baudar
- Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU Dinant Godinne UcL Namur, Belgium
| | - Nicolas Bailly
- Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU Dinant Godinne UcL Namur, Belgium
| | - Anne-Sophie Dincq
- Department of Anesthesiology, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU Dinant Godinne UcL Namur, Belgium
| | - Maximilien Gourdin
- Department of Anesthesiology, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU Dinant Godinne UcL Namur, Belgium
| | - Jean-Michel Dogné
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium
| | - Bernard Chatelain
- Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU Dinant Godinne UcL Namur, Belgium
| | - François Mullier
- Department of Pharmacy, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), University of Namur, Namur, Belgium; Hematology Laboratory, Namur Thrombosis and Hemostasis Center (NTHC), Namur Research Institute for Life Sciences (NARILIS), CHU Dinant Godinne UcL Namur, Belgium.
| |
Collapse
|
4
|
Kessler M, Moureau F, Nguyen P. Anticoagulation in Chronic Hemodialysis: Progress Toward an Optimal Approach. Semin Dial 2015; 28:474-89. [PMID: 25913603 DOI: 10.1111/sdi.12380] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Appropriate anticoagulation for hemodialysis (HD) requires a subtle balance between under- and over-heparinization to prevent extracorporeal circuit (ECC) clotting and bleeding, respectively. We discuss five key issues relating to anticoagulation therapy for chronic HD in adults following a review of relevant literature published since 2002: (i) options for standardization of anticoagulation in HD settings. The major nephrology societies have issued low evidence level recommendations on this subject. Interventional studies have generally investigated novel low-molecular weight heparins and provided data on safety of dosing regimens that cannot readily be extrapolated to clinical practice; (ii) identification of clinical and biological parameters to aid individualization of anticoagulation treatment. We find that use of clinical and biological monitoring of anticoagulation during HD sessions is currently not clearly defined in routine clinical practice; (iii) role of ECC elements (dialysis membrane and blood lines), dialysis modalities, and blood flow in clotting development; (iv) options to reduce or suppress systemic heparinization during HD sessions. Alternative strategies have been investigated, especially when the routine mode of anticoagulation was not suitable in patients at high risk of bleeding or was contraindicated; (v) optimization of anticoagulation therapy for the individual patient. We conclude by proposing a standardized approach to deliver anticoagulation treatment for HD based on an individualized prescription prepared according to the patient's profile and needs.
Collapse
Affiliation(s)
- Michèle Kessler
- Department of Nephrology, University Hospital, Vandœuvre-les-Nancy, France
| | | | - Philippe Nguyen
- Department of Hematology, University Hospital, Reims, France
| |
Collapse
|
5
|
Bhatty S, Ali A, Shetty R, Sumption KF, Topaz O, Jovin IS. Contemporary anticoagulation therapy in patients undergoing percutaneous intervention. Expert Rev Cardiovasc Ther 2014; 12:451-61. [PMID: 24506409 DOI: 10.1586/14779072.2014.885839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The proper use of anticoagulants is crucial for ensuring optimal patient outcomes post percutaneous interventions in the cardiac catheterization laboratory. Anticoagulant agents such as unfractionated heparin, a thrombin inhibitor; low-molecular weight heparins, predominantly Factor Xa inhibitors; fondaparinux, a Factor Xa inhibitor and bivalirudin, a direct thrombin inhibitor have been developed to target various steps in the coagulation cascade to prevent formation of thrombin. Optimal anticoagulation achieves the correct balance between thrombosis and bleeding and is related to optimal outcomes with minimal complications. This review will discuss the mechanisms and appropriate use of current and emerging anticoagulant therapies used during percutaneous interventions.
Collapse
Affiliation(s)
- Shaun Bhatty
- Department of Internal Medicine, Cardiovascular Division, Virginia Commonwealth University Health System/Medical College of Virginia, Richmond, VA, USA
| | | | | | | | | | | |
Collapse
|
6
|
Pauwels R, Devreese K, Van Biesen W, Eloot S, Glorieux G, Vanholder R, Dhondt A. Bedside monitoring of anticoagulation in chronic haemodialysis patients treated with tinzaparin. Nephrol Dial Transplant 2013; 29:1092-6. [DOI: 10.1093/ndt/gft508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
7
|
Inchiosa MA, Pothula S, Kubal K, Sanchala VT, Navarro I. Rapid point-of-care assay of enoxaparin anticoagulant efficacy in whole blood. J Vis Exp 2012:3852. [PMID: 23093300 PMCID: PMC3490316 DOI: 10.3791/3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the low-molecular-weight-heparin (LMWH), enoxaparin. There are also urgent clinical situations where it would be important if this could be determined rapidly. The present assay is designed to accomplish this. We only assayed human blood samples that were spiked with known concentrations of enoxaparin. The essential feature of the present assay is the quantification of the efficacy of enoxaparin in a patient's blood sample by degrading it to complete inactivity with heparinase. Two blood samples were drawn into Vacutainer tubes (Becton-Dickenson; Franklin Lakes, NJ) that were spiked with enoxaparin; one sample was digested with heparinase for 5 min at 37 °C, the other sample represented the patient's baseline anticoagulated status. The percent shortening of clotting time in the heparinase-treated sample, as compared to the baseline state, yielded the anticoagulant contribution of enoxaparin. We used the portable, battery operated Hemochron 801 apparatus for measurements of clotting times (International Technidyne Corp., Edison, NJ). The apparatus has 2 thermostatically controlled (37 °C) assay tube wells. We conducted the assays in two types of assay cartridges that are available from the manufacturer of the instrument. One cartridge was modified to increase its sensitivity. We removed the kaolin from the FTK-ACT cartridge by extensive rinsing with distilled water, leaving only the glass surface of the tube, and perhaps the detection magnet, as activators. We called this our minimally activated assay (MAA). The use of a minimally activated assay has been studied by us and others. (2-4) The second cartridge that was studied was an activated partial thromboplastin time (aPTT) assay (A104). This was used as supplied from the manufacturer. The thermostated wells of the instrument were used for both the heparinase digestion and coagulation assays. The assay can be completed within 10 min. The MAA assay showed robust changes in clotting time after heparinase digestion of enoxaparin over a typical clinical concentration range. At 0.2 anti-Xa I.U. of enoxaparin per ml of blood sample, heparinase digestion caused an average decrease of 9.8% (20.4 sec) in clotting time; at 1.0 I.U. per ml of enoxaparin there was a 41.4% decrease (148.8 sec). This report only presents the experimental application of the assay; its value in a clinical setting must still be established.
Collapse
|