Low intensity heparin strategy safe for patients on ECMO

The incidence of any bleeding or thrombotic events does not differ when using low or standard intensity heparin protocol in patients on extracorporeal membrane oxygenation (ECMO), reports a recent study.

Twenty-seven adult patients on venoarterial or venovenous ECMO and anticoagulated with low or standard intensity heparin protocols were included in this single-centre, retrospective cohort study.

The incidence of major bleeding served as the primary outcome. Secondary outcomes were as follows: incidence of minor bleeding, thrombotic complications, heparin-induced thrombocytopenia, in-hospital mortality, time in therapeutic range, anti-Xa correlation with activated partial thromboplastin time, intensive care unit and hospital lengths of stay, oxygenator exchanges, and protocol switching rate.

Of the 27 patients, 14 received low intensity heparin and 13 standard intensity heparin. Six major bleeding events occurred in the low intensity group and four in the standard intensity group (p=0.69). For minor bleeding, four and five events occurred in the respective groups (p=0.69).

Notably, seven patients on standard intensity heparin switched protocols, but none in the low intensity group did so (p=0.002). No differences were observed in any other outcomes.

“There was no difference in the incidence of any bleeding or thrombotic events when using a low vs standard intensity heparin protocol in patients on ECMO,” the authors said. “A low intensity heparin strategy for patients on ECMO may be feasible and safe.”