ArticleAnnals of intensive care2018
Thromboelastography-based anticoagulation management during extracorporeal membrane oxygenation: a safety and feasibility pilot study.
Article in Annals of intensive care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 50 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Prospective Randomized Study Of Anticoagulation Monitoring With Thromboelastography Versus aPTT During Extracorporeal Membrane Oxygenation In Adults
Thrombo-Elastography Guided Management of ECMO
Anticoagulation-free VV ECMO for Acute Respiratory Failure: A Pilot Safety and Feasibility Randomized Clinical Trial
Who cites it
50 citing papers in PubMed, 3 syntheses or guidelines pooled it, 134 citations in OpenAlex.
- Venous thromboembolism in critically ill COVID-19 patients receiving prophylactic or therapeutic anticoagulation: a systematic review and meta-analysis.Journal of thrombosis and thrombolysis · 2020Pooled it
- Systematic review of interventions to improve safety and quality of anticoagulant prescribing for therapeutic indications for hospital inpatients.European journal of clinical pharmacology · 2019Pooled it
- Assessing Venous Thrombotic Risks in Extracorporeal Membrane Oxygenation-Supported Patients: A Systematic Review and Meta-Analysis.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisPooled it
- Effect of Unfractionated Heparin Dose on Complement Activation and Selected Extracellular Vesicle Populations during Extracorporeal Membrane Oxygenation.International journal of molecular sciences · 2024Trial
- Hemostasis, coagulation and thrombin in venoarterial and venovenous extracorporeal membrane oxygenation: the HECTIC study.Scientific reports · 2021Trial
- Identification of Coagulation Phenotypes Using Viscoelastic and Conventional Assays During Veno-Venous Extracorporeal Membrane Oxygenation: A Hierarchical Clustering Analysis.Artificial organs · 2026Observational
- Thrombin generation parameters provide independent information on plasma coagulation potential in pediatric patients on extracorporeal membrane oxygenation: a prospective, single-center pilot study.Research and practice in thrombosis and haemostasis · 2026Observational
- Alternate and Emerging Anticoagulation Strategies for Extracorporeal Membrane Oxygenation: A Scoping Review.Journal of clinical medicine · 2026Review
- Prolonged Thromboelastography R Time and Thrombocytopenia as Early Warning Indicators of Bleeding in ECMO Patients Who Developed Sepsis During Support: A Retrospective Cohort Study.Infection and drug resistance · 2026Article
- Anticoagulation during extracorporeal membrane oxygenation: questioning the current standards in balancing the risks of thrombosis and bleeding.British journal of anaesthesia · 2025Article
- Accelerometer-based vibration analysis and oxygenator thrombosis in venovenous ECMO: an experimental porcine model.Intensive care medicine experimental · 2025Article
- Anticoagulation Management During ECMO: Narrative Review.JHLT open · 2025Review
- Thromboelastography-based dynamic evaluation of perioperative coagulation changes and anticoagulant efficacy in lung cancer patients.Thrombosis journal · 2025Article
- Viscoelastic Hemostatic Assays are Associated With Mortality and Blood Transfusion in a Multicenter Cohort.Journal of the American College of Emergency Physicians open · 2025Article
- Review
- Anticoagulation in venovenous extracorporeal membrane oxygenation.Frontiers in medicine · 2025Review
- Thromboelastography versus thromboelastometry for unfractionated heparin monitoring in adult patients on extracorporeal membrane oxygenation.Perfusion · 2025Observational
- The role of extracorporeal COFrontiers in medicine · 2025Review
- Inferior vena cava thrombosis in patients undergoing extracorporeal membrane oxygenation: a case series and literature review.BMC anesthesiology · 2024Article
- Reply to Wendel-GarciaAmerican journal of respiratory and critical care medicine · 2024Article
Corrections and comments
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Authors and funding
12 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is no consensus on the management of anticoagulation during extracorporeal membrane oxygenation (ECMO). ECMO is currently burdened by a high rate of hemostatic complications, possibly associated with inadequate monitoring of heparin anticoagulation. This study aims to assess the safety and feasibility of an anticoagulation protocol for patients undergoing ECMO based on thromboelastography (TEG) as opposed to an activated partial thromboplastin time (aPTT)-based protocol.
methodsWe performed a multicenter, randomized, controlled trial in two academic tertiary care centers. Adult patients with acute respiratory failure treated with veno-venous ECMO were randomized to manage heparin anticoagulation using a TEG-based protocol (target 16-24 min of the R parameter, TEG group) or a standard of care aPTT-based protocol (target 1.5-2 of aPTT ratio, aPTT group). Primary outcomes were safety and feasibility of the study protocol.
resultsForty-two patients were enrolled: 21 were randomized to the TEG group and 21 to the aPTT group. Duration of ECMO was similar in the two groups (9 (7-16) days in the TEG group and 11 (4-17) days in the aPTT group, p = 0.74). Heparin dosing was lower in the TEG group compared to the aPTT group (11.7 (9.5-15.3) IU/kg/h vs. 15.7 (10.9-21.3) IU/kg/h, respectively, p = 0.03). Safety parameters, assessed as number of hemorrhagic or thrombotic events and transfusions given, were not different between the two study groups. As for the feasibility, the TEG-based protocol triggered heparin infusion rate adjustments more frequently (p < 0.01) and results were less frequently in the target range compared to the aPTT-based protocol (p < 0.001). Number of prescribed TEG or aPTT controls (according to study groups) and protocol violations were not different between the study groups.
conclusionsTEG seems to be safely used to guide anticoagulation management during ECMO. Its use was associated with the administration of lower heparin doses compared to a standard of care aPTT-based protocol. Trial registration ClinicalTrials.gov, October 22,2014. Identifier: NCT02271126.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.