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dc.contributor.authorKanji, Rahim
dc.contributor.authorVandenbriele, Christophe
dc.contributor.authorArachchillage, Deepa R.J
dc.contributor.authorPrice, Susanna
dc.contributor.authorGorog, Diana
dc.date.accessioned2021-07-21T09:43:11Z
dc.date.available2021-07-21T09:43:11Z
dc.date.issued2021-05-13
dc.identifier.citationKanji , R , Vandenbriele , C , Arachchillage , D R J , Price , S & Gorog , D 2021 , ' Optimal tests to minimise bleeding and ischaemic complications in patients on extracorporeal membrane oxygenation ' , Thrombosis and haemostasis . https://doi.org/10.1055/a-1508-8230
dc.identifier.issn0340-6245
dc.identifier.otherPURE: 25181213
dc.identifier.otherPURE UUID: 1d6a0c3c-3bee-41b6-9f04-69bfb92023f3
dc.identifier.otherScopus: 85108815116
dc.identifier.urihttp://hdl.handle.net/2299/24873
dc.description© 2021. Thieme. All rights reserved. This is the accepted manuscript version of an article which has been published in final form at https://doi.org/10.1055/a-1508-8230
dc.description.abstractPatients supported with extracorporeal membrane oxygenation (ECMO) experience a very high frequency of bleeding and ischaemic complications, including stroke and systemic embolism. These patients require systemic anticoagulation, mainly with unfractionated heparin (UFH) to prevent clotting of the circuit and reduce the risk of arterial or venous thrombosis. Monitoring of UFH can be very challenging. Whilst most centres routinely monitor the activated clotting time and activated partial thromboplastin time (aPTT) to assess UFH, measurement of anti-Xa level best correlates with heparin dose, and appears predictive of circuit thrombosis, although aPTT may be a better predictor of bleeding. Although monitoring of prothrombin time, platelet count and fibrinogen is routinely undertaken to assess haemostasis, there is no clear guidance available regarding the optimal test. Additional tests, including antithrombin level and thromboelastography can be used for risk stratification of patients to try and predict the risks of thrombosis and bleeding. Each has their specific role, strengths and limitations. Increased thrombin generation may have a role in predicting thrombosis. Acquired von Willebrand syndrome is frequent with ECMO, contributing to bleeding risk and can be detected by assessing the von Willebrand factor activity to antigen ratio, whilst the Platelet Function Analyzer can be used in urgent situations to detect this, with high negative predictive value. Tests of platelet aggregation can aid the prediction bleeding. In order to personalise management, a selection of complementary tests to collectively assess heparin-effect, coagulation, platelet function and platelet aggregation is proposed, in order to optimise clinical outcomes in these high-risk patients.en
dc.format.extent12
dc.language.isoeng
dc.relation.ispartofThrombosis and haemostasis
dc.titleOptimal tests to minimise bleeding and ischaemic complications in patients on extracorporeal membrane oxygenationen
dc.contributor.institutionCentre for Health Services and Clinical Research
dc.contributor.institutionBasic and Clinical Science Unit
dc.contributor.institutionSchool of Life and Medical Sciences
dc.contributor.institutionDepartment of Clinical, Pharmaceutical and Biological Science
dc.description.statusPeer reviewed
dc.date.embargoedUntil2022-05-13
dc.relation.schoolSchool of Life and Medical Sciences
dcterms.dateAccepted2021-05-13
rioxxterms.versionAM
rioxxterms.versionofrecordhttps://doi.org/10.1055/a-1508-8230
rioxxterms.typeJournal Article/Review
herts.preservation.rarelyaccessedtrue


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