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Anticoagulation Management in Severe Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation.
Guo, Zhen; Sun, Lin; Li, Bailing; Tian, Rui; Zhang, Xiaolin; Zhang, Zhongwei; Clifford, Sean P; Liu, Yuan; Huang, Jiapeng; Li, Xin.
  • Guo Z; Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
  • Sun L; Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
  • Li B; Department of Cardiovascular Surgery, Shanghai Changhai Hospital, The Second Military Medical University, Shanghai, China.
  • Tian R; Department of Emergency and Critical Care, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
  • Zhang X; Department of Intensive Care Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
  • Zhang Z; Department of Intensive Care Unit, Fudan University Shanghai Cancer Center, Shanghai, China.
  • Clifford SP; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY.
  • Liu Y; Department of Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
  • Huang J; Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY. Electronic address: jiapeng.huang@louisville.edu.
  • Li X; Department of Cardiovascular Surgery. Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: li.xin3@zs-hospital.sh.cn.
J Cardiothorac Vasc Anesth ; 35(2): 389-397, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-807039
ABSTRACT

OBJECTIVE:

To explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation (ECMO)-assisted patients with coronavirus disease 2019 (COVID-19).

DESIGN:

Single-center, retrospective observation of a series of patients.

PARTICIPANTS:

Laboratory-confirmed severe COVID-19 patients who received venovenous ECMO support from January 20-May 20, 2020.

INTERVENTIONS:

This study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support. MEASUREMENTS AND MAIN

RESULTS:

Eight of 667 confirmed COVID-19 patients received venovenous ECMO and had an elevated D-dimer level before and during ECMO support. An ECMO circuit pack (oxygenator and tubing) was replaced a total of 13 times in all 8 patients, and coagulation-related complications included oxygenator thrombosis (7/8), tracheal hemorrhage (5/8), oronasal hemorrhage (3/8), thoracic hemorrhage (3/8), bleeding at puncture sites (4/8), and cannulation site hemorrhage (2/8).

CONCLUSIONS:

Hypercoagulability and secondary hyperfibrinolysis during ECMO support in COVID-19 patients are common and possibly increase the propensity for thrombotic events and failure of the oxygenator. Currently, there is not enough evidence to support a more aggressive anticoagulation strategy.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Extracorporeal Membrane Oxygenation / COVID-19 / Anticoagulants Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Cardiothorac Vasc Anesth Journal subject: Anesthesiology / Cardiology Year: 2021 Document Type: Article Affiliation country: J.jvca.2020.08.067

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Extracorporeal Membrane Oxygenation / COVID-19 / Anticoagulants Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: J Cardiothorac Vasc Anesth Journal subject: Anesthesiology / Cardiology Year: 2021 Document Type: Article Affiliation country: J.jvca.2020.08.067