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Anticoagulants in adult extracorporeal membrane oxygenation: alternatives to standardized anticoagulation with unfractionated heparin

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Abstract

Background

Extracorporeal membrane oxygenation (ECMO) is a vital technique for severe respiratory or heart failure patients. Bleeding and thrombotic events are common during ECMO and negatively impact patient outcomes. Unfractionated heparin is the primary anticoagulant, but its adverse effects limit its use, necessitating alternative anticoagulants.

Objective

Review available alternative anticoagulants for adult ECMO patients. Explore potential novel anticoagulants for future ECMO use. Aim to reduce complications (bleeding and thrombosis) and improve safety and efficacy for critically ill ECMO patients.

Methods

Comprehensive literature review of existing and emerging anticoagulants for ECMO.

Results

Identified a range of alternative anticoagulants beyond unfractionated heparin. Evaluated their potential utility in mitigating ECMO-related complications.

Conclusion

Diverse anticoagulant options are available and under investigation for ECMO. These alternatives may enhance patient safety and outcomes during ECMO support. Further research and clinical studies are warranted to determine their effectiveness and safety profiles.

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Availability of data and materials

All data generated or analyzed during this study are included in the published studies.

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Acknowledgements

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  1. Shu Tang and Liqing Xu contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Shu Tang, Liqing Xu, Hui Li & Zhanshen Wu

  2. Institute of Clinical Pharmacology, Zhengzhou University, Zhengzhou, China

    Qiang Wen

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Contributions

XLQ and LH conducted the literature search and source document search and wrote the paper. WZS was responsible for reviewing the data and drawing the figures for this article. TS was responsible for the design and full text review of this study; WQ was responsible for the full text review. XLQ and TS were responsible for revising the manuscript, and all authors read and approved the final version. XLQ and LH were responsible for downloading and processing the data in this paper and writing the paper. WZS was responsible for reviewing the data in this paper and drawing the graphs and tables. TS was responsible for the design of this study and reviewing the full text; WQ was responsible for reviewing the full text. All authors read and approved the final version.

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Tang, S., Xu, L., Li, H. et al. Anticoagulants in adult extracorporeal membrane oxygenation: alternatives to standardized anticoagulation with unfractionated heparin. Eur J Clin Pharmacol 79, 1583–1594 (2023). https://doi.org/10.1007/s00228-023-03568-3

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