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Viscoelastic Testing in the Management of Adult Patients on Mechanical Circulatory Support Devices with Focus on Extracorporeal Membrane Oxygenation.
Volod, Oksana; Wegner, Julie.
  • Volod O; Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California.
  • Wegner J; College of Health Professions, South University Online, Savannah, Georgia.
Semin Thromb Hemost ; 48(7): 814-827, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2028759
ABSTRACT
Thromboembolic and hemorrhagic complications continue to remain frequent complications that significantly impact the morbidity and mortality of patients implanted with mechanical circulatory support devices (MCSDs). The severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2) has resulted in a number of COVID-19 patients being supported by MCSDs, specifically extracorporeal membrane oxygenation (ECMO), which in turn has created a crucial need for rapid assessment of hemostatic status in these patients to avoid bleeding and thrombotic complications. Currently, conventional plasma-based coagulation assays such as prothrombin time and activated partial thromboplastin time (aPTT) are used to assess hemostasis, and the activated clotting time (ACT) and aPTT are the most common tests used to monitor heparin anticoagulation in patients on ECMO. Unfractionated heparin remains the mainstay anticoagulation therapy for patients on ECMO. Extracorporeal Life Support Organization (ELSO) offers little guidance on the subject but does state that each institution should create its internal anticoagulation protocols. Viscoelastic assays (VEAs) are increasingly recognized by ELSO and ECMO community for their potential to assess hemostatic derangements in patients implanted with MCSDs as well as guidance for appropriate hemostatic therapy. This review focuses on the evidence for the use of viscoelastic assays to assess overall hemostasis and to guide the treatment of adult patients connected to an ECMO circuit. Limitations of the use of conventional assays, ACT, and VEA are also discussed.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hemostatics / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Observational study Limits: Adult / Humans Language: English Journal: Semin Thromb Hemost Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hemostatics / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Observational study Limits: Adult / Humans Language: English Journal: Semin Thromb Hemost Year: 2022 Document Type: Article