From July 1, 2013 to February 28, 2022, there were 14 patients who admitted in the respiratory intensive care unit (RICU) of Beijing Chao-Yang Hospital received ECMO and used
argatroban for anticoagulation (
argatroban group). Two of them received
argatroban as the initial
anticoagulant. The remaining 12 patients used UFH at first, and then switched to
argatroban. UFH group included 28 patients who received UFH for anticoagulation after matching the demographic characteristics. Primary endpoint was the prevalence of ECMO-related thrombotic events. Secondary endpoints included the type of thrombotic events, prevalence of ECMO-related major
bleeding events,
bleeding sites, ICU mortality, mortality during ECMO, liver and kidney function, thrombelastogram,
blood transfusion, dosage of
argatroban, the dynamic changes of coagulation variables 4 days before and 7 days after
argatroban treatment.
RESULTS: In
argatroban group, there were 8 patients received veno-venous ECMO (VV-ECMO), 2 patients with veno-arterial ECMO (VA-ECMO), and 4 patients with veno-arterio-venous ECMO (VAV-ECMO). In UFH group, VV-ECMO was applied in 23 patients, VA-ECMO and VAV ECMO was established in 3 patients and 2 patients, respectively. In endpoint events, the incidence of ECMO related thrombotic events in
argatroban group was slightly higher than that in UFH group (28.6% vs. 21.4%). The ECMO running time in
argatroban group was slightly longer than that in UFH group [days: 16 (7, 21) vs. 13 (8, 17)]. The incidence of ECMO-related
bleeding events (28.6% vs. 32.1%) and mortality during ECMO (35.7% vs. 46.4%) in
argatroban group were slightly lower than those in UFH group. However, the differences were not statistically significant (all P < 0.05). The
platelet transfusion in
argatroban group was significantly higher than that in UFH group [U: 7.7 (0, 10.0) vs. 0.8 (0, 1.0)]. The coagulation reaction time (R value) in thrombelastography in
argatroban group was significantly longer than that in UFH group [minutes: 9.3 (7.2, 10.8) vs. 8.8 (6.3, 9.7)]. The maximum width value [MA value, mm: 48.4 (40.7, 57.9) vs. 52.6 (45.4, 61.5)] and
blood clot generation rate [α-Angle (deg): 54.1 (45.4, 62.0) vs. 57.9 (50.2, 69.0)] in the
argatroban group were significantly lower than those in the UFH group (all P < 0.05). The activated partial thromboplastin time (APTT) was prolonged after changing from UFH to
argatroban in the
argatroban group [seconds: 63.5 (58.4, 70.6) vs. 56.7 (53.1, 60.9)]. The PLT level showed a decreasing trend during UFH anticoagulation
therapy, and gradually increased after changing to
argatroban.
D-dimer level was 19.1 (7.0, 28.7) mg/L after switching to
argatroban, and then no longer showed an increasing trend. The level of
fibrinogen (FIB) showed a decreasing trend during the
anticoagulant therapy of UFH (the lowest was 23.6 g/L), and fluctuated between 16.8 and 26.2 g/L after changing to
argatroban. The median initial dose of
argatroban was 0.049 (0.029, 0.103) μg×kg-1×min-1, which the highest dose was in VV-ECMO patients of [0.092 (0.049, 0.165) μg×kg-1×min-1]. The initial dose of VAV-ECMO was the lowest [0.026 (0.013, 0.041) μg×kg-1×min-1], but without significant difference (P > 0.05). The maintenance dose of
argatroban was 0.033 (0.014, 0.090) μg×kg-1×min-1, VV-ECMO patients was significantly higher than those in VA-ECMO and VAV-ECMO patients [μg×kg-1×min-1: 0.102 (0.059, 0.127) vs. 0.036 (0.026, 0.060), 0.013 (0.004, 0.022), both P < 0.05].
CONCLUSIONS: