Low vs standardized dose anticoagulation regimens for extracorporeal membrane oxygenation: A meta-analysis

BACKGROUND: To compare the safety and efficacy of low-dose anticoagulation (LA) with that of standardized dose anticoagulation (SA) for patients supported with extracorporeal membrane oxygenation (ECMO). METHODS: PubMed, MEDLINE, the Cochrane Library, and Web of Science were screened for original articles. Screening was performed using predefined search terms to identify cohort studies reporting the comparison of LA with SA in patients supported with ECMO from Nov 1990 to Jun 2020. The effect size was determined by the odds ratio (OR) with the 95% confidence interval (CI). RESULTS: An analysis of 7 studies including a total of 553 patients was performed. LA (Low-heparin group) was administered to 255 patients, whereas the other 298 patients received SA (Full-heparin group). The incidence of gastrointestinal tract hemorrhage (OR 0.36, 95% CI 0.20-0.64) and surgical site hemorrhage (OR 0.43, 95% CI 0.20-0.94) were significantly lower in patients who underwent LA compared with that in those who underwent SA. The rates of hospital mortality (OR 0.81, 95% CI 0.42-1.56), successfully weaning off of ECMO (OR 0.80, 95% CI 0.30-2.14), pulmonary embolism (OR 0.79, 95% CI 0.24-2.65), intracardiac thrombus (OR 0.34, 95% CI 0.09-1.30), intracranial hemorrhage (OR 0.62, 95% CI 0.22-1.74), and pulmonary hemorrhage (OR 0.77, 95% CI 0.30-1.93) were similar between the two groups. CONCLUSIONS: This meta-analysis confirms that LA is a feasible and safe anticoagulation strategy in patients supported by ECMO. Future studies should focus on the long-term benefits of LA compared with SA.