Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study

• Published in: Critical care (London, England) Vol. 25; no. 1; pp. 127 - 11
• Main Authors: Descamps, Richard, Moussa, Mouhamed D, Besnier, Emmanuel, Fischer, Marc-Olivier, Preau, Sébastien, Tamion, Fabienne, Daubin, Cédric, Cousin, Nicolas, Vincentelli, André, Goutay, Julien, Du Cheyron, Damien
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02.04.2021; BioMed Central; BMC
• Subjects: Acute respiratory distress syndrome (ARDS); Anti-Xa; Anticoagulants; Blood clotting; Blood oxygenation, Extracorporeal; Blood products; Cardiomyopathy; Chronic obstructive pulmonary disease; Cohort analysis; Complications and side effects; Critical care; Data collection; Drug dosages; Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation; Extracorporeal membrane oxygenation (ECMO); Health aspects; Hemoglobin; Hemorrhage; Hospitals; Life Sciences; Mortality; Patient outcomes; Patients; Risk factors; Surgical apparatus & instruments; Thrombocytopenia; France; Anti-Xa; Acute respiratory distress syndrome (ARDS); Hemorrhage; Extracorporeal life support (ECLS); Extracorporeal membrane oxygenation (ECMO)
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-021-03554-0

Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring. We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding. Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29-0.67] vs 0.33 [0.22-0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47-1.46] vs 0.66 [0.36-0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan-Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006). In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.