Anti-Xa versus time-guided anticoagulation strategies in extracorporeal membrane oxygenation: a systematic review and meta-analysis

Figure 1.. PRIMSA diagram detailing the search and selection process applied during the systematic analysis.

Figure 2.. Meta-analysis of the proportion of bleeding according to the anticoagulation strategy (anti-Xa-guided vs time-guided). Overall, there were fewer bleeding events among anti-Xa-based anticoagulation series, bleeding occurring in 34.2% of the patients (Figure 2(a)) versus 41.6% of the patients in the time-guided studies (Figure 2(b)). Using a random-effect on the seven studies providing results from both strategies, there was significantly fewer bleeding events in the anti-Xa-based anticoagulation strategy (adjusted OR 0.49, p < 0.001), Figure 2(c)).

Figure 3.. Meta-analysis of the proportion of thrombosis according to the anticoagulation strategy (anti-Xa-guided vs time-guided). Overall, there were fewer thrombotic events among anti-Xa-based anticoagulation series, thrombosis occurring in 32.6% of the patients (Figure 3(a)) versus 38.4% of the patients in the time-guided studies (Figure 3(b)). Using a random-effect on the seven studies providing results from both strategies, there was no significant difference in thrombotic events (adjusted OR 0.91, p = 0.71, Figure 3(c)).

Figure 4.. Meta-analysis of the mortality rate according to the anticoagulation strategy (anti-Xa-guided vs time-guided). Overall, there was a lower mortality rate among anti-Xa-based anticoagulation series, bleeding occurring in 35.4% of the patients (Figure 4(a)) versus 42.9% of the patients in the time-guided studies (Figure 4(b)). Using a random-effect on the seven studies providing results from both strategies, there was significantly lower mortality rate in the anti-Xa-based anticoagulation strategy (adjusted OR 0.61, p < 0.03), Figure 4(c)).