Daniel Schwaiger MD , Lukas Schausberger MD , Benedikt Treml MD, MBA , Dragana Jadzic MD, PhD , Nicole Innerhofer MD , Christoph Oberleitner MD , Zoran Bukumiric MD, PhD , Sasa Rajsic MD, PhD
{"title":"激活凝血时间引导的抗凝与体外膜氧合支持期间并发症的关系：系统回顾与元分析》。","authors":"Daniel Schwaiger MD , Lukas Schausberger MD , Benedikt Treml MD, MBA , Dragana Jadzic MD, PhD , Nicole Innerhofer MD , Christoph Oberleitner MD , Zoran Bukumiric MD, PhD , Sasa Rajsic MD, PhD","doi":"10.1053/j.jvca.2024.09.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to reduce the risk of thromboembolic events. Despite its historic role, activated clotting time (ACT) remains a widely used heparin monitoring method. Systematic evidence on the association of ACT-guided monitoring with hemorrhagic or thromboembolic complications does not exist.</div></div><div><h3>Design</h3><div>Systematic literature review and meta-analysis (Scopus and PubMed, July 2023).</div></div><div><h3>Setting</h3><div>All cohort studies.</div></div><div><h3>Participants</h3><div>Patients receiving ECMO support.</div></div><div><h3>Intervention</h3><div>Anticoagulation monitoring with ACT.</div></div><div><h3>Measurements and Main Results</h3><div>We identified 3,177 publications, with 8 studies reporting the average ACT values for patients with and without bleeding. Meta-analysis revealed no significant difference in the compared groups (SMD = 0.69; 95% CI −0.05 to 1.43, p = 0.069; <em>I<sup>2</sup></em> = 87.4%). Three studies (n = 117 patients) reported on the average ACT values for patients with thrombosis, without significant differences in ACT between patients with and without thrombosis (SMD = 0.47; 95% CI −0.50 to 1.44, p = 0.342; <em>I<sup>2</sup></em> = 81.1%).</div></div><div><h3>Conclusions</h3><div>Even though ACT is a widely used heparin monitoring tool, the evidence on its association with hemorrhagic or thromboembolic events is still controversial and limited. Further studies are essential to elucidate the role of ACT in anticoagulation monitoring during ECMO support.</div></div>","PeriodicalId":15176,"journal":{"name":"Journal of cardiothoracic and vascular anesthesia","volume":"38 12","pages":"Pages 3034-3042"},"PeriodicalIF":2.6000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of Activated Clotting Time–Guided Anticoagulation with Complications during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis\",\"authors\":\"Daniel Schwaiger MD , Lukas Schausberger MD , Benedikt Treml MD, MBA , Dragana Jadzic MD, PhD , Nicole Innerhofer MD , Christoph Oberleitner MD , Zoran Bukumiric MD, PhD , Sasa Rajsic MD, PhD\",\"doi\":\"10.1053/j.jvca.2024.09.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to reduce the risk of thromboembolic events. Despite its historic role, activated clotting time (ACT) remains a widely used heparin monitoring method. Systematic evidence on the association of ACT-guided monitoring with hemorrhagic or thromboembolic complications does not exist.</div></div><div><h3>Design</h3><div>Systematic literature review and meta-analysis (Scopus and PubMed, July 2023).</div></div><div><h3>Setting</h3><div>All cohort studies.</div></div><div><h3>Participants</h3><div>Patients receiving ECMO support.</div></div><div><h3>Intervention</h3><div>Anticoagulation monitoring with ACT.</div></div><div><h3>Measurements and Main Results</h3><div>We identified 3,177 publications, with 8 studies reporting the average ACT values for patients with and without bleeding. Meta-analysis revealed no significant difference in the compared groups (SMD = 0.69; 95% CI −0.05 to 1.43, p = 0.069; <em>I<sup>2</sup></em> = 87.4%). Three studies (n = 117 patients) reported on the average ACT values for patients with thrombosis, without significant differences in ACT between patients with and without thrombosis (SMD = 0.47; 95% CI −0.50 to 1.44, p = 0.342; <em>I<sup>2</sup></em> = 81.1%).</div></div><div><h3>Conclusions</h3><div>Even though ACT is a widely used heparin monitoring tool, the evidence on its association with hemorrhagic or thromboembolic events is still controversial and limited. Further studies are essential to elucidate the role of ACT in anticoagulation monitoring during ECMO support.</div></div>\",\"PeriodicalId\":15176,\"journal\":{\"name\":\"Journal of cardiothoracic and vascular anesthesia\",\"volume\":\"38 12\",\"pages\":\"Pages 3034-3042\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of cardiothoracic and vascular anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1053077024005913\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiothoracic and vascular anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1053077024005913","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Association of Activated Clotting Time–Guided Anticoagulation with Complications during Extracorporeal Membrane Oxygenation Support: A Systematic Review and Meta-Analysis
Objective
Extracorporeal membrane oxygenation (ECMO) requires systemic anticoagulation to reduce the risk of thromboembolic events. Despite its historic role, activated clotting time (ACT) remains a widely used heparin monitoring method. Systematic evidence on the association of ACT-guided monitoring with hemorrhagic or thromboembolic complications does not exist.
Design
Systematic literature review and meta-analysis (Scopus and PubMed, July 2023).
Setting
All cohort studies.
Participants
Patients receiving ECMO support.
Intervention
Anticoagulation monitoring with ACT.
Measurements and Main Results
We identified 3,177 publications, with 8 studies reporting the average ACT values for patients with and without bleeding. Meta-analysis revealed no significant difference in the compared groups (SMD = 0.69; 95% CI −0.05 to 1.43, p = 0.069; I2 = 87.4%). Three studies (n = 117 patients) reported on the average ACT values for patients with thrombosis, without significant differences in ACT between patients with and without thrombosis (SMD = 0.47; 95% CI −0.50 to 1.44, p = 0.342; I2 = 81.1%).
Conclusions
Even though ACT is a widely used heparin monitoring tool, the evidence on its association with hemorrhagic or thromboembolic events is still controversial and limited. Further studies are essential to elucidate the role of ACT in anticoagulation monitoring during ECMO support.
期刊介绍：
The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.
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