Effect of Initial Anticoagulation Targets on Bleeding and Thrombotic Complications for Patients With Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation

Association of coagulation function with the risk of in-hospital mortality in patients with severe acute respiratory distress syndrome

BACKGROUND

To evaluate the association of coagulation disorder score with the risk of in-hospital mortality in acute respiratory distress syndrome (ARDS) patients.

METHODS

In this cohort study, 7,001 adult patients with ARDS were identified from the Medical Information Mart for Intensive Care Database-IV (MIMIC-IV). Univariate and multivariate Logistic stepwise regression models were used to explore the associations of coagulation-associated biomarkers with the risk of in-hospital mortality in patients with ADRS. Restricted cubic spline (RCS) was plotted to explore the association between coagulation disorder score and in-hospital mortality of ARDS patients.

RESULTS

The follow-up time for in-hospital death was 7.15 (4.62, 13.88) days. There were 1,187 patients died and 5,814 people survived in hospital. After adjusting for confounding factors, increased risk of in-hospital mortality in ARDS patients was observed in those with median coagulation disorder score [odds ratio (OR) = 1.22, 95% confidence interval (CI): 1.01-1.47) and high coagulation disorder score (OR = 1.38, 95% CI: 1.06-1.80). The results of RCS indicated that when the coagulation disorder score >2, the trend of in-hospital mortality rose gradually, and OR was >1.

CONCLUSIONS

Poor coagulation function was associated with increased risk of in-hospital mortality in ARDS patients. The findings implied that clinicians should regularly detect the levels of coagulation-associated biomarkers for the management of ARDS patients.

Evaluation of an aPTT guided versus a multimodal heparin monitoring approach in patients on extra corporeal membrane oxygenation: A retrospective cohort study

INTRODUCTION

Bleeding and thrombotic complications are common in extracorporeal membrane oxygenation (ECMO) patients and are associated with increased mortality and morbidity. The optimal anticoagulation monitoring protocol in these patients is unknown. This study aims to compare the incidence of thrombotic and hemorrhagic complications before and after a protocol change. In addition, the association between hemostatic complications, coagulation tests and risk factors is evaluated.

METHODS

This is a retrospective single center cohort study of adult ECMO patients. We collected demographics, ECMO parameters and coagulation test results. Outcomes of the aPTT guided and multimodal protocol, including aPTT, anti-Xa assay and rotational thromboelastometry were compared and the association between coagulation tests, risk factors and hemostatic complications was determined using a logistic regression analysis for repeated measurements.

RESULTS

In total, 250 patients were included, 138 in the aPTT protocol and 112 in the multimodal protocol. The incidence of thrombosis (aPTT: 14%; multimodal: 12%) and bleeding (aPTT: 36%; multimodal: 40%), did not significantly differ between protocols. In the aPTT guided protocol, the aPTT was associated with thrombosis (Odds Ratio [OR] 1.015; 95% confidence interval [CI] 1.004-1.027). In both protocols, surgical interventions were risk factors for bleeding and thrombotic complications (aPTT: OR 93.2, CI 39.9-217.6; multimodal OR 17.5, CI 6.5-46.9).

DISCUSSION

The incidence of hemostatic complications was similar between both protocols and surgical interventions were a risk factor for hemostatic complications. Results from this study help to elucidate the role of coagulation tests and risk factors in predicting hemostatic complications in patients undergoing ECMO support.