Monitoring Unfractionated Heparin in Adult Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO): ACT, APTT, or ANTI-XA?

• Published in: Critical care research and practice Vol. 2021; pp. 5579936 - 7
• Main Authors: Nguyen, Tung Phi, Phan, Xuan Thi, Huynh, Dai Quang, Viet Truong, Ha Thi, Hai Le, Yen Nguyen, Nguyen, Tuan Manh, Minh Du, Quan Quoc, Le, Thao Phuong, Truong, Hai Ngoc, Ho, Thi Thi, Ngoc Pham, Thao Thi
• Format: Journal Article
• Language: English
• Published: Egypt Hindawi 04.05.2021; Hindawi Limited; Wiley
• Subjects: Heparin; Medical law; Medical research; Medicine, Experimental
• ISSN: 2090-1305; 2090-1313
• DOI: 10.1155/2021/5579936

Background. During ECMO, anticoagulants, in particular, unfractionated heparin (UFH), are commonly used and monitored by laboratory tests, including ACT, APTT, and anti-Xa level. Method. A single-center retrospective observational study was conducted on adult patients undergoing ECMO between January 2019 and January 2020 at a tertiary hospital. The correlations between ACT, APTT, anti-Xa, antithrombin, and UFH dose were assessed. Results. 129 sets of measurements from 37 patients were obtained including ACT, APTT, anti-Xa, antithrombin, and UFH dose measured simultaneously. 102 out of 129 sets of values were interpreted as antithrombin deficiencies. The correlation coefficient between APTT and anti-Xa; ACT and anti-Xa are 0.72 and 0.33, respectively, p<0.001. The patients with normal antithrombin levels exhibited a significant correlation between APTT and anti-Xa (r = 0.80, p<0.001). ACT, on the other hand, was poorly correlated with UFH dose, whether there is AT deficiency or not. Anti-Xa and APTT are only moderately correlated with UFH dose in the group without antithrombin deficiency, with correlation coefficients of 0.62 and 0.57, respectively, p<0.05. Conclusion. APTT value is strongly correlated with anti-Xa value, particularly in patients with normal antithrombin levels. However, the ACT value was poorly correlated with anti-Xa and not with the UFH dose. In groups without antithrombin deficiency, APTT and anti-Xa values only moderately correlated with UFH dose.