• Michael A Mazzeffi, Kenichi Tanaka, Alia Roberts, Raymond Rector, Jay Menaker, Zachary Kon, Kristopher B Deatrick, David Kaczorowski, Bartley Griffith, and Daniel Herr.
• University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, MD. Electronic address: mmazzeffi@som.umaryland.edu.
• J. Cardiothorac. Vasc. Anesth. 2019 May 1; 33 (5): 1216-1220.

ObjectiveTo compare the incidence of bleeding and thrombosis between adult venoarterial (VA) extracorporeal membrane oxygenation (ECMO) patients managed with an activated clotting time (ACT)-guided heparin anticoagulation protocol and activated partial thromboplastin time (aPTT) protocol.DesignRetrospective cohort study.SettingTertiary care, academic medical center.ParticipantsConsecutive adult VA ECMO patients during a 6-year period.InterventionsNone.Measurements And Main ResultsDemographic, medical, transfusion, and ECMO data were collected for all patients. Primary study outcomes were bleeding and thrombosis. Secondary outcomes were stroke and in-hospital mortality. One hundred twenty-one patients were included in the cohort. Fifty patients had ACT monitoring, and 71 had aPTT monitoring. There was no difference in the incidence of bleeding or thrombosis between the 2 groups (78.0% v 67.6% for bleeding [p = 0.21] and 16.0% v 19.7% for thrombosis [p = 1.0]). After adjusting for age and total ECMO days, patients managed with ACT received approximately 30% more red blood cell, fresh frozen plasma, and platelet transfusion (all p < 0.05).ConclusionThere is no apparent difference in the incidence rate of bleeding or thrombosis between VA ECMO patients managed with an ACT- or aPTT-guided heparin anticoagulation protocol. Patients managed with an ACT-guided protocol received more blood transfusion, which could reflect greater total bleeding. Future randomized controlled trials would help to elucidate optimal anticoagulation strategies for VA ECMO patients.Copyright © 2018 Elsevier Inc. All rights reserved.

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