LATE-BREAKING ABSTRACT: Feasibility of low dose anticoagulation protocol during extracorporeal membrane oxygenation

Introduction: The need for minimal anticoagulation strategy is increasing with the wide use of heparin-bonded ECMO devices. Aims and objectives: The study was to evaluate the feasibility of activated partial thrombopastin time (aPTT) driven low dose anticoagulation protocol during ECMO support. Methods: In this retrospective study, we reviewed 71 ECMO patients from December 2008 to July 2014. In the conventional group, anticoagulation targeted to maintain an ACT in between 180 and 220 seconds by a continuous infusion of unfractionated heparin. In the low dose group, anticoagulation targeted to aPTT in between 63 and 84 seconds. We examined the incidence of bleeding events, thromboembolic complications, transfusion requirements and change of ECMO circuit in each group. Results: A total of 71 patients (31 conventional group and 40 low dose group) were included in the analysis. Incidences of bleeding complications were significantly lower in the low dose group driven by aPTT (71.0 % vs 22.5 %, p p =0.018). The average daily transfusion doses of RBC unit, FFP and platelet were lower in the low dose group driven by aPTT (RBC: 2.7 vs 1.3 p =0.011, FFP: 1.4 vs 0.6 p =0.045, PLT: 5.5 vs 3.1 p =0.019). However, major thrombosis did not occur in the both groups. The 69 percent of the patients receiving ECMO therapy were successfully weaned and the overall mortality was 46.5 percent. Conclusions: In this study, low level of anticoagulation driven by aPTT showed acceptable results in limiting bleeding event, transfusion dose without serious thromboembolic complications in patients who underwent ECMO treatment.