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Anticoagulation Management in Severe Coronavirus Disease 2019 Patients on Extracorporeal Membrane Oxygenation

Zhen Guo1, Lin Sun1, Bailing Li2

  • 1Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.

Journal of Cardiothoracic and Vascular Anesthesia
|September 30, 2020
PubMed

Insights

COVID-19 patients on extracorporeal membrane oxygenation (ECMO) often experience hypercoagulability, leading to oxygenator thrombosis and bleeding complications. Current evidence does not support more aggressive anticoagulation strategies for these patients.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Infectious Diseases

Background:

  • Severe coronavirus disease 2019 (COVID-19) can necessitate extracorporeal membrane oxygenation (ECMO) for respiratory support.
  • Coagulation abnormalities are frequently observed in COVID-19 patients, posing challenges for anticoagulation management during ECMO.

Purpose of the Study:

  • To investigate the specific coagulation characteristics and anticoagulation management strategies in COVID-19 patients undergoing venovenous ECMO.
  • To identify the incidence of bleeding and thrombotic complications in this patient population.

Main Methods:

  • A retrospective observational study was conducted at a single center.
  • Data from laboratory-confirmed severe COVID-19 patients receiving venovenous ECMO between January and May 2020 were analyzed.
  • Anticoagulation management, monitoring, bleeding complications, and thrombotic events were assessed.

Main Results:

  • Eight out of 667 COVID-19 patients required venovenous ECMO, with elevated D-dimer levels noted before and during support.
  • ECMO circuit packs were replaced 13 times due to coagulation-related complications.
  • Common complications included oxygenator thrombosis (7/8), various hemorrhages (tracheal, oronasal, thoracic, puncture sites, cannulation sites).

Conclusions:

  • COVID-19 patients on ECMO exhibit common hypercoagulability and secondary hyperfibrinolysis.
  • These coagulation derangements may increase the risk of thrombotic events and oxygenator failure.
  • Insufficient evidence currently exists to advocate for more aggressive anticoagulation protocols in this cohort.
Abstract

Keywords:
COVID-19ECMOSARS-CoV-2anticoagulationcoronavirusextracorporeal membrane oxygenationsevere acute respiratory syndrome coronavirus 2thrombosis

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