Subcutaneous nadroparin was comparable to unfractionated heparin regarding bleeding events (34% vs 53%; P=0.12) and life-threatening bleeding (2.8% vs 9.3%; P=0.26) during venovenous ECMO.
Cohort
Yes
Does subcutaneous nadroparin reduce bleeding and thrombotic complications compared to unfractionated heparin in adults supported with venovenous extracorporeal membrane oxygenation?
Subcutaneous nadroparin appears to be a safe and feasible alternative to unfractionated heparin for anticoagulation during venovenous ECMO, with comparable rates of bleeding and thrombotic events.
Absolute Event Rate: 34% vs 53%
p-value: p=0.12
Extracorporeal membrane oxygenation (ECMO) requires constant management of coagulation. Whereas unfractionated heparin remains the anticoagulant of choice, experienced centers report high bleeding rates. Biocompatibility of the extracorporeal circuit enables management of anticoagulation with subcutaneous low-molecular-weight heparins only. The aim of this study was to evaluate the safety and feasibility of anticoagulation with subcutaneous nadroparin compared with unfractionated heparin during respiratory ECMO in patients. We assessed for thrombotic complications and number of bleeding and life-threatening bleeding events. Additionally, we evaluated the change in resistance to flow in the oxygenator and the number of transfused blood products. Nadroparin and unfractionated heparin were comparable in terms of number of bleeding (34 vs. 53%; p = 0.12), life-threatening bleeding (2.8 vs. 9.3%; p = 0.26) events, and daily red blood cell transfusion rates (0.79 units/patient/day vs. 0.71 units/patient/day in nadroparin group; p = 0.87) during respiratory ECMO. The relative change in resistance to flow in the oxygenator was similar between groups (8.03 vs. 11.6%; p = 0.27). Nadroparin seemed equivalent to unfractionated heparin in the number of thrombotic and hemorrhagic events as well as in the daily red blood cell transfusion rates during venovenus-ECMO.
Piwowarczyk et al. (2020) conducted a cohort in Venovenous extracorporeal membrane oxygenation (ECMO). Subcutaneous nadroparin vs. Unfractionated heparin was evaluated on Bleeding events (p=0.12). Subcutaneous nadroparin was comparable to unfractionated heparin regarding bleeding events (34% vs 53%; P=0.12) and life-threatening bleeding (2.8% vs 9.3%; P=0.26) during venovenous ECMO.