Unconventional anticoagulation strategies to reduce the occurrence of adverse events of extracorporeal membrane oxygenation:a Meta-analysis

Li Hongjuan; Huang Zhigang; Wang Yan; Yun Kezheng; Wang Baoyu

doi:10.3969/j.issn.1002-1949.2024.08.012

Abstract：Objective To compare the safety and efficacy between unconventional anticoagulation and conventional anticoagulation in the patients with extracorporeal membrane oxygenation(ECMO).Methods PubMed,EMbase,Cochrane Library,CNKI,VIP,Wanfang Medicine and other databases were screened for original articles.SCreening was performed by using predefined search terms to identify randomized controlled trials and cohort studies reporting the comparison of unconventional anticoagulation with conventional anticoagulation in the patients supported with ECMO from the establishment of the database to October 2023.Effect sizes were determined by the odds ratio(OR)and the 95％confidence interval(CI).Results A total of 14 studies(1 151 patients)were included.562 patients received unconventional anticoagulant therapy,and the remaining 589 patients received conventional anticoagulant therapy.The incidence of intracranial hemorrhage(OR=0.32,95％CI 0.17-0.59)and gastrointestinal bleeding(OR=0.37,95％CI 0.22-0.63)were significantly lower in the patients with unconventional anticoagulation compared with those with conventional anticoagulation.But there was no significant difference in surgical site bleeding(OR=0.65,95％CI 0.37-1.15)and thoracic bleeding(OR=0.50,95％CI 0.20-1.27).In thrombotic events,there was no significant difference in pulmonary embolism(OR=0.81,95％CI 0.21-3.05)and circuit thrombosis(OR=0.67,95％CI 0.29-1.58)between unconventional anticoagulation and conventional anticoagulation.In the mode of VA-ECMO,there was no significant difference in the hospital mortality(OR=0.85,95％CI 0.60-1.19)and successful weaning off of ECMO(OR=0.92,95％CI 0.85-1.44).In the mode of VV-ECMO,the rates of hospital mortality(OR=0.30,95％CI 0.09-0.93)and the rates of pipeline replacement(OR=0.28,95％CI 0.10-0.79)were significantly lower in the patients with unconventional anticoagulation than those with conventional anticoagulation.Conclusions For the patients received ECMO,unconventional anticoagulation can not only reduce the incidence of intracranial hemorrhage and gastrointestinal bleeding without increasing the probability of thrombotic events and hospital mortality,but also reduce the probability of pipeline replacement in VV-ECMO.It is a feasible and safe anticoagulation strategy.Limited by factors such as the quality and sample size of the included studies,future studies need to focus on whether unconventional anticoagulation can reduce in-hospital mortality and shorten the time on the machine.