SynthesisClinical cardiology2024
Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta-analysis.
Synthesis in Clinical cardiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.
- Association of anti-factor Xa-guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta-analysis.Clinical cardiology · 2024Pooled it
- A best evidence summary of anticoagulation management for extracorporeal membrane oxygenation in adults.Medicine · 2026Article
- ExtracorporeaL life support and Modification Of Hemostasis: the ELMOH trial: hemostatic changes during the first 48 h of VV- and VA-ECMO: a prospective multicenter cohort study.Critical care (London, England) · 2026Article
- Perioperative Veno-Venous Extracorporeal Membrane Oxygenation in Non-Elective Thoracic Surgery: A Propensity-Matched Bicentric Comparison With Medical Indication.Interdisciplinary cardiovascular and thoracic surgery · 2025Observational
- Anticoagulation Management During ECMO: Narrative Review.JHLT open · 2025Review
- Decreased bleeding and thrombotic complications on extracorporeal membrane oxygenation support following an updated anticoagulation protocol.JTCVS open · 2025Article
- Anticoagulation Monitoring During ECMO Support: Monitor or Flip a Coin?Clinical cardiology · 2024Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe use of extracorporeal membrane oxygenation (ECMO) is associated with complex hemostatic changes. Systemic anticoagulation is initiated to prevent clotting in the ECMO system, but this comes with an increased risk of bleeding. Evidence on the use of anti-Xa-guided monitoring to prevent bleeding during ECMO support is limited. Therefore, we aimed to analyze the association between anti-factor Xa-guided anticoagulation and hemorrhage during ECMO.
methodsA systematic review and meta-analysis was performed (up to August 2023). PROSPERO: CRD42023448888.
resultsTwenty-six studies comprising 2293 patients were included in the analysis, with six works being part of the meta-analysis. The mean anti-Xa values did not show a significant difference between patients with and without hemorrhage (standardized mean difference -0.05; 95% confidence interval [CI]: -0.19; 0.28, p = .69). We found a positive correlation between anti-Xa levels and unfractionated heparin dose (UFH; pooled estimate of correlation coefficients 0.44; 95% CI: 0.33; 0.55, p < .001). The most frequent complications were any type of hemorrhage (pooled 36%) and thrombosis (33%). Nearly half of the critically ill patients did not survive to hospital discharge (47%).
conclusionsThe most appropriate tool for anticoagulation monitoring in ECMO patients is uncertain. Our analysis did not reveal a significant difference in anti-Xa levels in patients with and without hemorrhagic events. However, we found a moderate correlation between anti-Xa and the UFH dose, supporting its utilization in monitoring UFH anticoagulation. Given the limitations of time-guided monitoring methods, the role of anti-Xa is promising and further research is warranted.
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