Systematic review and meta-analysis of the clinical effectiveness of point-of-care testing for anticoagulation management during ECMO - 14/06/21
, Dario Fina b, c, Roberto Lorusso b, Hugo ten Cate d, Mariusz Kowalewski b, e, Matteo Matteucci b, f, Raffaele Serra g, Pasquale Mastroroberto a, Giuseppe Filiberto Serraino aAbstract |
Study objective |
Viscoelastic point-of-care (POC) tests are commonly used to provide prompt diagnosis of coagulopathy and allow targeted treatments in bleeding patients on ECMO.
We evaluated the clinical effectiveness of point-of-care (POC) testing for anticoagulation management in patients on extracorporeal membrane oxygenation (ECMO).
Design |
Systematic review and meta-analysis. Eligible studies evaluating the use of thromboelastography- or thromboelastometry-guided algorithms, anti-factor Xa and platelet function testing were selected after screening the literature from July 1975 to January 2020.
Setting |
Patients on ECMO support.
Patients |
Anticoagulation management on ECMO patients.
Interventions |
Rotational thromboelastometry, thromboelastography, alone or combined with platelet function testing. Trials monitoring the anticoagulation effects during ECMO using an anti-factor Xa assay were included in the systematic review.
Measurements |
The primary outcomes were bleeding events, surgical revisions, thrombosis events and ECMO circuit change/failure. Secondary outcomes were blood-product transfusions, cerebrovascular accidents, mortality on ECMO, ECMO duration, intensive care unit and hospital discharge rates, and in-hospital mortality.
Main results |
Thirty-one trials enrolling 1684 participants were included in the systematic review. Four trials enrolling 547 subjects were included in the meta-analysis. The use of a POC testing device resulted in improved detection of surgical bleeding (RR: 0.68, 95% CI 0.49 to 0.94, I2 = 0%; χ2 test for heterogeneity, P = 0.02). The use of POC-guided algorithms did not affect bleeding (RR:0.78, 95% CI 0.58 to 1.04, I2 = 47%; χ2 test for heterogeneity, P = 0.09), thrombosis events (RR:1.35, 95% CI 0.86 to 2.12, I2 = 37%; χ2 test for heterogeneity, P = 0.19), or ECMO circuit/change (RR:0.90, 95% CI 0.48 to 1.71, I2 = 28%; χ2 test for heterogeneity, P = 0.75).
Conclusion |
Routine use of POC tests did not improve the main clinical outcomes beyond suggesting a diagnosis of surgical bleeding in ECMO patients.
Le texte complet de cet article est disponible en PDF.Highlights |
• | This meta-analysis evaluates POC tests for anticoagulation in ECMO. |
• | POC-guided algorithms did not affect bleeding, thrombosis, and ECMO circuit/change. |
• | Use of POC-guided algorithms resulted in a reduction in surgical revision. |
Keywords : Viscoelastic test, Anticoagulation, Point of care, Extracorporeal membrane oxygenation, Bleeding
Plan
Vol 73
Article 110330- octobre 2021 Retour au numéro
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