The relationship between different anticoagulation monitoring indicators and heparin doses in adult patients with extracorporeal cardiopulmonary resuscitation

Objectives Achieving optimal systemic anticoagulation in patients undergoing extracorporeal membrane oxygenation (ECMO) requires precise titration, posing a significant clinical challenge. This study aims to explore the relationship between various anticoagulation monitoring parameters and heparin dosing in adult patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). Methods A retrospective analysis was conducted on 40 ECPR patients, who were categorized into either the activated clotting time (ACT)-target group or the activated partial thromboplastin time (aPTT)-target group. Anticoagulation monitoring parameters, including aPTT, corresponding ACT, and heparin doses, were collected. Continuous variables are expressed as mean ± SD and compared using Student's t -test. Pearson correlation analysis was performed to examine the relationships between ACT, aPTT, and heparin doses in both groups. Results Of the 40 patients, 16 (40%) died and 24 (60%) survived. Twelve patients (30%) experienced severe bleeding events, while five (12.5%) developed thrombotic complications. Compared with the ACT-target group, the aPTT-target group had higher platelet counts (PLT) and lower blood flow levels ( P < 0.001). Pearson correlation analysis revealed that heparin dose was positively correlated with aPTT ( r = 0.412, P < 0.001) and negatively correlated with blood flow ( r = −0.329, P < 0.001). ACT showed a weak correlation with aPTT ( r = 0.123, P < 0.001). Conclusion Heparin dosing exhibited a stronger correlation with aPTT than with ACT, and blood flow emerged as an important monitoring parameter. Comprehensive anticoagulation monitoring strategies should be employed to evaluate heparin efficacy in ECMO-treated ECPR patients.