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Incidence of heparin resistance and heparin failure in patients receiving extracorporeal membrane oxygenation: an exploratory retrospective analysis.

Publication ,  Journal Article
Nagler, B; Staudinger, T; Schellongowski, P; Knoebl, P; Brock, R; Kornfehl, A; Schwameis, M; Herkner, H; Levy, JH; Buchtele, N
Published in: J Thromb Haemost
October 2024

BACKGROUND: Unfractionated heparin (UFH) is used in most centers for extracorporeal membrane oxygenation (ECMO) anticoagulation. When standard doses do not achieve desired target values, heparin resistance is reported, most commonly defined as doses of UFH > 35 000 IU/d. OBJECTIVES: To study the incidence of heparin resistance and its association with thromboembolic complications in patients requiring ECMO support. METHODS: In this observational cohort study, we included adults who received venovenous, venoarterial ECMO and extracorporeal carbon dioxide removal between January 2010 and May 2022. Main risk factor was heparin resistance (UFH, > 35 000 IU/d or > 20 IU/kg/h); the outcome was thromboembolism. Multivariable Poisson regression was used to estimate the effects of heparin resistance, adjusted for several clinical variables on the thromboembolism rate per 100 ECMO patient-days. RESULTS: Of the 197 patients included, 33 (16.8%) required UFH > 35 000 IU/d and 14 (7.1%) required UFH > 20 IU/kg/h. Thromboembolic complications occurred at a rate of 5.89/100 ECMO d. Heparin resistance was not associated with thromboembolic events (incidence rate ratio [IRR], 0.93; 95% CI, 0.14-5.82), whereas COVID-19 (IRR, 2.33; 95% CI, 1.4-3.96; P < .001) and ECMO type (venoarterial ECMO: IRR, 2.29; 95% CI, 1.34-3.92; P = .002; extracorporeal carbon dioxide removal: IRR, 2.89; 95% CI, 1.46-5.59; P = .002; reference venovenous ECMO) were significantly associated with the risk of thromboembolic events. CONCLUSION: A significant proportion of patients fulfilled the common definition of heparin resistance. However, this did not influence the occurrence of thromboembolic events.

Duke Scholars

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

October 2024

Volume

22

Issue

10

Start / End Page

2773 / 2783

Location

England

Related Subject Headings

  • Thromboembolism
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Heparin
  • Female
  • Extracorporeal Membrane Oxygenation
 

Citation

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Nagler, B., Staudinger, T., Schellongowski, P., Knoebl, P., Brock, R., Kornfehl, A., … Buchtele, N. (2024). Incidence of heparin resistance and heparin failure in patients receiving extracorporeal membrane oxygenation: an exploratory retrospective analysis. J Thromb Haemost, 22(10), 2773–2783. https://doi.org/10.1016/j.jtha.2024.06.008
Nagler, Bernhard, Thomas Staudinger, Peter Schellongowski, Paul Knoebl, Roman Brock, Andrea Kornfehl, Michael Schwameis, Harald Herkner, Jerrold H. Levy, and Nina Buchtele. “Incidence of heparin resistance and heparin failure in patients receiving extracorporeal membrane oxygenation: an exploratory retrospective analysis.J Thromb Haemost 22, no. 10 (October 2024): 2773–83. https://doi.org/10.1016/j.jtha.2024.06.008.
Nagler B, Staudinger T, Schellongowski P, Knoebl P, Brock R, Kornfehl A, et al. Incidence of heparin resistance and heparin failure in patients receiving extracorporeal membrane oxygenation: an exploratory retrospective analysis. J Thromb Haemost. 2024 Oct;22(10):2773–83.
Nagler, Bernhard, et al. “Incidence of heparin resistance and heparin failure in patients receiving extracorporeal membrane oxygenation: an exploratory retrospective analysis.J Thromb Haemost, vol. 22, no. 10, Oct. 2024, pp. 2773–83. Pubmed, doi:10.1016/j.jtha.2024.06.008.
Nagler B, Staudinger T, Schellongowski P, Knoebl P, Brock R, Kornfehl A, Schwameis M, Herkner H, Levy JH, Buchtele N. Incidence of heparin resistance and heparin failure in patients receiving extracorporeal membrane oxygenation: an exploratory retrospective analysis. J Thromb Haemost. 2024 Oct;22(10):2773–2783.
Journal cover image

Published In

J Thromb Haemost

DOI

EISSN

1538-7836

Publication Date

October 2024

Volume

22

Issue

10

Start / End Page

2773 / 2783

Location

England

Related Subject Headings

  • Thromboembolism
  • Risk Factors
  • Retrospective Studies
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Heparin
  • Female
  • Extracorporeal Membrane Oxygenation