Effects Of Different Anticoagulation Monitoring Indexes On Anticoagulation And Clinical Prognosis Of Adult Veno-arterial Extracorporeal Membrane Oxygenation

Objective Veno-arterial extracorporeal membrane oxygenation(VA-ECMO)is an effective treatment for patients with end-stage cardiopulmonary failure,but bleeding or thrombus complications during ECMO seriously threaten the prognosis of patients,and the best anticoagulation regimen during ECMO is still unclear.Objective to investigate the correlation between different anticoagulation monitoring indexes and the dose of unfractionated heparin(UNFH)during adult VA-ECMO and its effect on clinical prognosis.Methods Adult VA-ECMO patients from January 2017 to December 2019 were excluded:age<18 years old;ECMO running time<48h;ECMO patients transferred from other hospitals;patients without anti-Xa activity were excluded,a total of 51 cases were included.Activated whole blood clotting time(ACT),bedside activated partial thromboplastin time(POC aPTT)were detected every 3 hours,anti-Xa activity and laboratory aPTT(LAB aPTT)were detected with the same blood sample once a day,the main end point was to compare the correlation between ACT,aPTT,anti-Xa activity and heparin dose,and the secondary end point was the effects of ACT,aPTT and anti-Xa activity on bleeding,thrombotic complications and mortality.Results In adult VA-ECMO patients,the correlation between anti-Xa activity and UNFH dose(r=0.46)was better than that of LAB aPTT(r=0.22,P<0.01),POC aPTT was no correlation between heparin dose(r=0.996).There was a weak negative correlation between the dose of ACT and UNFH(r=0.29,P<0.01).There was a positive correlation between anti-Xa activity and LAB aPTT(r=0.39,P<0.001)and antithrombin(AT)(r=0.29,P<0.01).The bleeding rate was 29.4%,the thrombosis rate was 13.7%,and the discharge survival rate was 62.7%.In the unadjusted analysis,anti-Xa activity was not related to bleeding,thrombotic complications and mortality during ECMO.Conclusion In adult patients with VA-ECMO,the correlation between anti-Xa activity and heparin dose is better than that of ACT and aPTT,but there is no correlation between anti-Xa activity and bleeding,thrombotic complications and mortality.Therefore,comprehensive anticoagulation monitoring method should be adopted in the process of ECMO,which can not only reflect the anticoagulant effect of UNFH during ECMO,but also comprehensively evaluate the coagulation ability of patients.