A monocentric observational study evaluates the accuracy of anticoagulation monitoring in critically ill patients on ECLS (extracorporeal life support) using new markers of the effect of direct thrombin inhibitors and also the accuracy of anticoagulation monitoring in patients on unfractionated heparin using anti-Xa. A more accurate setting of anticoagulation may lead to a reduction in the number of serious bleeding and thrombotic complications in these patients.
Anticoagulation using a direct thrombin inhibitor, argatroban, is one of the modern options for anticoagulation in patients on VV (veno-venous) ECMO (extracorporeal membrane oxygenation) support, and in 2021 the ECMO center of the University Hospital Ostrava changed the standard anticoagulation using UHF (unfractionated heparin) to anticoagulation using Argatroban as a new standard of routine care. Argatroban shows more stable levels and has a short half-life, and a number of foreign ECMO centers have been using Argatroban for a long time also as basic anticoagulation in all ECMO patients. To monitor the effect of direct thrombin inhibitors, it is possible to use monitoring of anti-FIIa activity, which directly assesses the effect of the anticoagulant on thrombin activity. Anticoagulation with Argatroban may reduce the risk of serious bleeding complications. Target values of aPTT (Activated Partial Thromboplastin Time) and anti-FIIa can be determined according to ELSO (Extracorporeal Life Support Organization) guidelines.
Study Type
OBSERVATIONAL
Enrollment
100
Argatroban will be administered to the study subjects in this group in order to achieve anticoagulation.
Heparin will be administered to the study subjects in this group in order to achieve anticoagulation.
University Hospital Ostrava
Ostrava, Moravian-Silesian Region, Czechia
Comparison of aPTT values with anti-IIa and Argatroban dose in patients on VV ECMO
Comparison of correlation of aPTT and anti-IIa with dynamics of D dimer, FDP (fibrin degradation product) and acute phase reactants of ferritin, CRP (C-reactive protein) Correlation of bleeding complications with aPTT, anti-IIa, platelets
Time frame: up to 2 weeks
Comparison of apt and anti-Xa values and heparin dose in patients on VV ECMO
Comparison of correlation of aPTT and anti-Xa with dynamics of D dimer, FDP and acute phase reactants of ferritin, CRP
Time frame: up to 2 weeks
Frequency and severity of bleeding complications
Comparison of frequency and severity of bleeding complications in patients on anticoagulation with Argatroban and heparin
Time frame: up to 2 weeks
Frequency and severity of thrombotic complications
Comparison of frequency and severity of thrombotic complications in patients anticoagulated with Argatroban and heparin
Time frame: up to 2 weeks
Consumption of blood products (in ml)
The consumption of blood products (volume in ml) in patients on Argatroban and heparin
Time frame: up to 2 weeks
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