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CC BY-NC-ND 4.0 · Hamostaseologie 2023; 43(03): 171-178
DOI: 10.1055/a-1796-8652
Original Article

A Comparison of Activated Partial Thromboplastin Time and Activated Coagulation Time for Anticoagulation Monitoring during Extracorporeal Membrane Oxygenation Therapy

Ying Liu
1   Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
,
Zhiyong Yuan
1   Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
,
Xiaoning Han
1   Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
,
Kai Song
2   School of Mathematics and Statistics, Qingdao University, Qingdao, Shandong, People's Republic of China
,
Jinyan Xing
1   Department of Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
› Author Affiliations Funding This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Background Unfractionated heparin is used to prevent coagulation activation in patients undergoing extracorporeal membrane oxygenation (ECMO) support. We designed this study to determine the preferable indicator for anticoagulation monitoring.

Methods We conducted a retrospective study and divided the patients into an activated coagulation time (ACT)-target group and an activated partial thromboplastin time (aPTT)-target group. The correlations between ACT, aPTT, and the heparin dose were explored.

Results Thirty-six patients were included (19 aPTT-target and 17 ACT-target patients); a total of 555 matched pairs of ACT/aPTT results were obtained. The correlation between the ACT and aPTT measurements was Spearman's Rank Correlation Coefficient (rs) = 0.518 in all 555 pairs. The Bland–Altman plot showed data points outside the displayed range (51.2–127.7), suggesting that the agreement between ACT and aPTT was poor. The aPTT group had fewer heparin dose changes (2.12 ± 0.68 vs. 2.57 ± 0.64, p = 0.05) and a lower cumulative heparin dose (317.6 ± 108.5 vs. 396.3 ± 144.3, p = 0.00) per day than the ACT group. There was no difference in serious bleeding (9 vs. 5; p = 0.171) or embolism events (3 vs. 3; p = 1.0) or in the red blood cell and fresh frozen plasma transfusion volumes between the ACT- and aPTT-target groups. Similarly, there was no significant difference in the ECMO duration (9 [4–15] days vs. 4 [3–14] days; p = 0.124) or length of ICU hospitalization (17 [5–32] days vs. 13 [4–21] days; p = 0.451) between the groups.

Conclusion The correlation between ACT and aPTT and the heparin dose was poor. The aPTT group had fewer daily heparin dose changes and a lower cumulative heparin dose per day than the ACT group, with no more bleeding and thrombotic events. Therefore, we recommend aPTT rather than ACT to adjust heparin dose in the absence of better monitoring indicators.

Keywords

ECMO - thrombosis - bleeding - ACT - aPTT


Publication History

Received: 20 September 2021

Accepted: 11 March 2022

Article published online:
26 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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