Evaluation of a pharmacy managed heparin protocol for extracorporeal membrane oxygenation patients

Kalliopi Fitousis, Robin Klasek, Phillip E. Mason, Faisal N. Masud

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Introduction: Unfractionated heparin is the preferred anticoagulant in extracorporeal membrane oxygenation (ECMO) patients. However, there is a lack of consensus on its titration and monitoring. The objective of this study was to describe the efficacy and safety of a pharmacy managed heparin protocol utilizing activated partial thromboplastin time (aPTT) in comparison to our standard physician-managed activated clotting time (ACT)-based anticoagulation in ECMO patients. Methods: Patients administered a heparin drip while on ECMO were included in the study. The primary endpoints were the incidence of hemorrhagic and thrombotic complications. Results: A total of 122 adult patients were identified who were on ECMO with heparin anticoagulation; sixty-one patients were managed with each of the physician-managed ACT and pharmacy managed aPTT protocols. No statistically significant difference was observed between the physician ACT and the pharmacy aPTT groups in overall hemorrhagic (69% vs 80%, p=0.145) or thrombotic complications (41% vs 39%, p=0.853). Conclusion: There was a similar rate of thrombotic and bleeding events between the two study groups. A pharmacy managed heparin protocol utilizing aPTT monitoring appears to be a safe and effective method of providing anticoagulation in adult ECMO patients.

Original languageEnglish (US)
Pages (from-to)238-244
Number of pages7
JournalPerfusion (United Kingdom)
Volume32
Issue number3
DOIs
StatePublished - 2017

Keywords

  • Activated clotting time
  • Activated partial thromboplastin time
  • Anticoagulation
  • ECMO
  • Heparin
  • Pharmacy protocol

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Safety Research
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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