Pediatric Critical Care Medicine, Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands.
Department of Pediatrics, Section of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Perfusion. 2021 Jul;36(5):501-512. doi: 10.1177/0267659120952982. Epub 2020 Aug 29.
The purpose was to compare time-based vs anti-Xa-based anticoagulation strategies in patients on ECMO. We conducted a systematic review and meta-analysis using multiple electronic databases and included studies from inception to July 19, 2019. The proportion of bleeding, thrombosis, and mortality were evaluated.Twenty-six studies (2,086 patients) were included. Bleeding occurred in 34.2% (95%CI 25.1;43.9) of the patients with anti-Xa-based versus 41.6% (95%CI 24.9;59.4) of the patients with time-based anticoagulation strategies. Thrombosis occurred in 32.6% (95%CI 19.1;47.7) of the patients with anti-Xa-based versus 38.4% (95%CI 22.2;56.1) of the patients with time-based anticoagulation strategies. And mortality rate was 35.4% (95%CI 28.9;42.1) of the patients with anti-Xa-based versus 42.9% (95%CI 36.9;48.9) of the patients with time-based anticoagulation strategies. Among the seven studies providing results from both anticoagulation strategies, significantly fewer bleeding events occurred in the anti-Xa-based anticoagulation strategy (adjusted OR 0.49 (95%CI 0.32;0.74), < 0.001) and a significantly lower mortality rate (adjusted OR 0.61 (95%CI 0.40;0.95), = 0.03). There was no significant difference in thrombotic events (adjusted OR 0.91 (95%CI 0.56;1.49), = 0.71). In these seven observational studies, only a small fraction of the patients were adults, and data were insufficient to analyze the effect of the type of ECMO.In this meta-analysis of observational studies of patients on ECMO, an anti-Xa-based anticoagulation strategy, when compared to a time-based strategy, was associated with fewer bleeding events and mortality rate, without an increase in thrombotic events.
目的是比较 ECMO 患者中基于时间的抗凝策略与基于抗 Xa 的抗凝策略。我们使用多个电子数据库进行了系统评价和荟萃分析，并纳入了从成立到 2019 年 7 月 19 日的研究。评估了出血、血栓形成和死亡率的比例。纳入了 26 项研究（2086 名患者）。基于抗 Xa 的抗凝策略组患者出血发生率为 34.2%（95%CI 25.1%；43.9%），基于时间的抗凝策略组患者出血发生率为 41.6%（95%CI 24.9%；59.4%）。基于抗 Xa 的抗凝策略组患者血栓形成发生率为 32.6%（95%CI 19.1%；47.7%），基于时间的抗凝策略组患者血栓形成发生率为 38.4%（95%CI 22.2%；56.1%）。基于抗 Xa 的抗凝策略组患者死亡率为 35.4%（95%CI 28.9%；42.1%），基于时间的抗凝策略组患者死亡率为 42.9%（95%CI 36.9%；48.9%）。在提供两种抗凝策略结果的七项研究中，基于抗 Xa 的抗凝策略显著减少了出血事件（调整后的 OR 0.49（95%CI 0.32；0.74），<0.001）和降低了死亡率（调整后的 OR 0.61（95%CI 0.40；0.95），=0.03）。血栓形成事件无显著差异（调整后的 OR 0.91（95%CI 0.56；1.49），=0.71）。在这七项观察性研究中，只有一小部分患者为成年人，并且数据不足以分析 ECMO 类型的影响。在这项对 ECMO 患者的观察性研究的荟萃分析中，与基于时间的策略相比，基于抗 Xa 的抗凝策略与出血事件和死亡率减少相关，而血栓形成事件没有增加。
