Whole-blood Point-of-Care Activated Partial Thromboplastin Time Ratio (APR) is not Accurate Enough to Monitor Heparin Therapy in Patients with Severe Respiratory Failure Secondary to SARS-Cov-2 Infection Supported with Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO)

Clinical and Applied Thrombosis/Hemostasis

卷:28

Original Manuscript

Daniel Aston ; Martin Besser ; Ben Goddard ; Nicholas Maggs ; Hassan Ahmed ; Florian Falter

[1] Division of Clinical Haematology and Blood Transfusion, Cambridge University Hospitals, Cambridge, UK

[2] Department of Anaesthesia and Critical Care, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK

[3] Department of Anaesthesia and Intensive Care, , Leeds, UK

[4] Department of Clinical Perfusion, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK

关键词: heparins;    anticoagulants;    coagulation;    SARS-CoV-2;   

DOI  :  10.1177/10760296221148162

 received in 2022-09-27, accepted in 2022-12-12,  发布年份 2022

来源: Sage Journals

【 摘 要 】

Support with VV-ECMO requires anticoagulation with unfractionated heparin to prevent thrombotic complications. This must be monitored due to bleeding risk. A point-of-care (POC) method of testing aPTT and APR was evaluated for agreement with laboratory methods. In a prospective observational study, patients supported on VV-ECMO as a result of severe respiratory failure secondary to Covid-19 infection were given heparin as part of standard therapy. The aPTT was measured (i) at the bedside using the Hemochron Signature Elite device and (ii) at the hospital laboratory. Duplicate results were compared. Agreement between the POC and laboratory tests was poor, as assessed using the Bland-Altman method. The maximum difference between POC and laboratory methods was 133% and the minimum was 0%. Overall bias was 7.3% and limits of agreement were between −43.8% and 58.5%. Correlation increased when results were normalised to platelet count and creatinine. This POC test is insufficiently accurate for use as the primary method of heparin monitoring in patients requiring VV-ECMO for Covid-19. Platelets and renal function may influence the result of this whole blood POC test.

【 授权许可】

CC BY-NC   
© The Author(s) 2022

【 图 表 】

Figure 5.

Figure 4.