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Activated Partial Thromboplastin Time and Anti-IIa Monitoring in Argatroban Anticoagulation in COVID-19 Patients on Venovenous Extracorporeal Membrane Oxygenation
F. Burša, M. Frelich, P. Sklienka, S. Němcová, Z. Kučerová, O. Jor, T. Romanová, A. Kondé, J. Janošek, J. Sagan, J. Máca
Language English
Document type Journal Article, Observational Study
NLK
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from 2019
PubMed Central
from 2018
Europe PubMed Central
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ProQuest Central
from 1995-01-01
Medline Complete (EBSCOhost)
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Health & Medicine (ProQuest)
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- MeSH
- Anticoagulants * therapeutic use adverse effects administration & dosage MeSH
- Arginine analogs & derivatives MeSH
- COVID-19 * blood therapy mortality complications MeSH
- Adult MeSH
- COVID-19 Drug Treatment * MeSH
- Hemorrhage chemically induced MeSH
- Pipecolic Acids * therapeutic use administration & dosage adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation * methods MeSH
- Drug Monitoring methods MeSH
- Partial Thromboplastin Time MeSH
- SARS-CoV-2 MeSH
- Aged MeSH
- Sulfonamides MeSH
- Thrombosis prevention & control etiology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
Unfractionated heparin has long been considered the standard anticoagulation in ECMO, despite some pitfalls such as heparin resistance, heparin induced thrombocytopenia (HIT), etc Recently, some centres started to increasingly use argatroban for this purpose, typically using activated partial thromboplastin time (aPTT) for its monitoring. Direct monitoring of the efficacy of argatroban using Anti-IIa is not yet an established method, although it might be more appropriate as it targets the same pathway.An observational study was performed in adult veno-venous ECMO patients hospitalized with SARS-CoV-2 infection anticoagulated with argatroban to an aPTT target of 40-60 s and Anti-IIa target of 0.4-0.6 μg/mL. Bleeding and thrombotic complications were monitored.Forty-four VV ECMO patients were included, with an overall hospital mortality of approx. 50%. No life-threatening thrombotic events were recorded. The risk of bleeding complications significantly increased with aPTT above 52.7 s and with Anti-IIa values over 0.78 μg/mL. Using the above cut-offs for both the aPTT and Anti-IIa and their combination, the negative predictive value for bleeding was approximately 90%.It seems that the generally recommended limits for Anti-IIa of 1.5 μg/mL may be high. However, further data are needed to confirm lower limits.Trial Registration:retrospectively registered in ClinicalTrials.gov, NCT06038682.
References provided by Crossref.org
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