Wang Yan, Wang Liangshan, Fu Hongfu, Li Jin, Li Chenglong, Zhang Shuai, Hao Xing, Wang Hong, Du Zhongtao, Hou Xiaotong
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
BMC Anesthesiol. 2025 May 30;25(1):275. doi: 10.1186/s12871-025-03153-4.
Extracorporeal membrane oxygenation (ECMO) is increasingly used in patients after cardiac surgery; however, anticoagulation management has consistently been challenging. This study aimed to explore the feasibility of a low-anticoagulation strategy for post-cardiotomy ECMO (PC-ECMO).
A retrospective comparison was performed between two anticoagulation targets in adult patients undergoing veno-arterial ECMO after cardiac surgery at the Beijing Anzhen Hospital (Beijing, China) between January 2018 and November 2023. The low-anticoagulation (LAC) strategy group consisted of patients with an activated partial thromboplastin time (APTT) ratio of 1-1.5, whereas the conventional anticoagulation (CAC) strategy group included those with an APTT ratio of 1.5-2.5. The primary outcome was thrombotic complications associated with ECMO. Secondary outcomes included bleeding events, pulmonary infection, need for renal replacement therapy, in-hospital mortality rate, ECMO support duration, hours of mechanical ventilation, anticoagulation fraction, length of hospitalization, and transfusion volume(s).
The study included data from 203 patients, who were divided into two groups: LAC (n = 108 [53.2%]) and CAC (n = 95 [46.8%]). Propensity score matching was used to balance confounding variables. A total of 43 patient pairs were successfully matched, and no significant difference was observed in thrombotic complications between the LAC and CAC groups (30.2% versus [vs.] 25.3%, respectively; p = 0.810). Meanwhile, no significant differences were observed in secondary outcomes and subgroups within the matched cohort, except for ECMO support time, which was shorter in the LAC group (119.6 h vs. 146.0 h; p = 0.015).
The low-anticoagulation strategy was feasible for PC-ECMO support.
体外膜肺氧合（ECMO）在心脏手术后患者中的应用越来越广泛；然而，抗凝管理一直具有挑战性。本研究旨在探讨心脏术后ECMO（PC-ECMO）低抗凝策略的可行性。
对2018年1月至2023年11月在北京安贞医院（中国北京）接受心脏手术后静脉-动脉ECMO的成年患者的两个抗凝目标进行回顾性比较。低抗凝（LAC）策略组由活化部分凝血活酶时间（APTT）比值为1-1.5的患者组成，而传统抗凝（CAC）策略组包括APTT比值为1.5-2.5的患者。主要结局是与ECMO相关的血栓并发症。次要结局包括出血事件、肺部感染、肾脏替代治疗需求、住院死亡率、ECMO支持持续时间、机械通气小时数、抗凝分数、住院时间和输血量。
该研究纳入了203例患者的数据，这些患者被分为两组：LAC组（n = 108 [53.2%]）和CAC组（n = 95 [46.8%]）。采用倾向评分匹配来平衡混杂变量。共成功匹配了43对患者，LAC组和CAC组之间的血栓并发症无显著差异（分别为30.2%对[vs.]25.3%；p = 0.810）。同时，在匹配队列的次要结局和亚组中未观察到显著差异，但LAC组的ECMO支持时间较短（119.6小时对146.0小时；p = 0.015）。
低抗凝策略对PC-ECMO支持是可行的。
