Management of anticoagulation and bleeding with extracorporeal circuits
| Prior to commencing anticoagulation in ECMO measure . | Range . | Result . |
|---|---|---|
| • Hemoglobin | <70 g/L | Y/N |
| • Platelet count | >50 × 109/L | Y/N |
| • PT/INR | PT/INR <2.0 | Y/N |
| • aPTTr | aPTTr <2.0 | Y/N |
| • Anti-Xa level | Anti-Xa level <0.7 | Y/N |
| • Fibrinogen | >1 g/L | Y/N |
| • Triglycerides | <400 mg/dL | Y/N |
| • Bilirubin | <6 mg/dL | Y/N |
| • Active bleeding | Y/N | |
| • No CVA within last 4 weeks | Y/N | |
| Only commence anticoagulation if all the above answers are Y . | ||
| • If platelets <50 × 109/L, transfuse 1 pool of platelets and recheck • If INR >2 or aPTTr >2, transfuse 15 mL/kg FFP • If fibrinogen <1 g/L, transfuse 15 mL/kg | ||
| Starting dose of UFH 18 IU/kg/h using adjusted body weight . | ||
| • If total body weight is less than adjusted body weight, use the patient's ACTUAL weight • Dose is capped at 100 kg | ||
| Once 2 consecutive anti-Xa levels are within the therapeutic range, without a pause/interruption to the infusion or a dose adjustment being required, anti-Xa monitoring can be reduced to once daily. | ||
| Target anti-Xa 0.3 to 0.5 . | ||
| Daily bloods . | Range . | . |
| • Hemoglobin | <70 g/L | • Maintain hemoglobin >70 |
| • Platelet count | >50 × 109/L | • Maintain platelets >50 |
| • INR | INR <2.0 | |
| • aPTTr | aPTTr <2.0 | |
| • Anti-Xa level | Anti-Xa level <0.7 | • If >0.7, hold UFH infusion |
| • Fibrinogen | >1 g/L | • Maintain >1 g/L |
| • Triglycerides | <400 mg/dL | • Review sedation |
| • Bilirubin | <6 mg/dL | • Hemolysis screen |
| If anti-Xa in range and aPTTr <2, no change to anticoagulation | ||
| If anti-Xa in range and aPTTr >2, investigate for DIC, ensure fibrinogen >1 | ||
| Prior to commencing anticoagulation in ECMO measure . | Range . | Result . |
|---|---|---|
| • Hemoglobin | <70 g/L | Y/N |
| • Platelet count | >50 × 109/L | Y/N |
| • PT/INR | PT/INR <2.0 | Y/N |
| • aPTTr | aPTTr <2.0 | Y/N |
| • Anti-Xa level | Anti-Xa level <0.7 | Y/N |
| • Fibrinogen | >1 g/L | Y/N |
| • Triglycerides | <400 mg/dL | Y/N |
| • Bilirubin | <6 mg/dL | Y/N |
| • Active bleeding | Y/N | |
| • No CVA within last 4 weeks | Y/N | |
| Only commence anticoagulation if all the above answers are Y . | ||
| • If platelets <50 × 109/L, transfuse 1 pool of platelets and recheck • If INR >2 or aPTTr >2, transfuse 15 mL/kg FFP • If fibrinogen <1 g/L, transfuse 15 mL/kg | ||
| Starting dose of UFH 18 IU/kg/h using adjusted body weight . | ||
| • If total body weight is less than adjusted body weight, use the patient's ACTUAL weight • Dose is capped at 100 kg | ||
| Once 2 consecutive anti-Xa levels are within the therapeutic range, without a pause/interruption to the infusion or a dose adjustment being required, anti-Xa monitoring can be reduced to once daily. | ||
| Target anti-Xa 0.3 to 0.5 . | ||
| Daily bloods . | Range . | . |
| • Hemoglobin | <70 g/L | • Maintain hemoglobin >70 |
| • Platelet count | >50 × 109/L | • Maintain platelets >50 |
| • INR | INR <2.0 | |
| • aPTTr | aPTTr <2.0 | |
| • Anti-Xa level | Anti-Xa level <0.7 | • If >0.7, hold UFH infusion |
| • Fibrinogen | >1 g/L | • Maintain >1 g/L |
| • Triglycerides | <400 mg/dL | • Review sedation |
| • Bilirubin | <6 mg/dL | • Hemolysis screen |
| If anti-Xa in range and aPTTr <2, no change to anticoagulation | ||
| If anti-Xa in range and aPTTr >2, investigate for DIC, ensure fibrinogen >1 | ||
aPTTr, activated partial thromboplastin time ratio; CVA, cerebral vascular accident; INR, international normalised ratio; UFH, unfractionated heparin.