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Hemostasis and Anticoagulation Monitoring during Extracorporeal Membrane Oxygenation in Children

Wolff, Erin Lynn (2011) Hemostasis and Anticoagulation Monitoring during Extracorporeal Membrane Oxygenation in Children. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: Bleeding and thromboembolism continue to be the greatest cause of morbidity and mortality during extracorporeal membrane oxygenation (ECMO). The activated clotting time (ACT) remains a standard for heparin management in both ECMO and cardiopulmonary bypass (CPB), despite its weak correlation to the lower plasma heparin levels of ECMO. Furthermore, little is known about the hemostatic alterations related to ECMO versus CPB in children. We hypothesize that the hemostatic profile of ECMO patients differs significantly from those undergoing CPB, and furthermore that age-specific differences exist between neonatal and pediatric ECMO patients. Methods: A prospective observational study evaluating antithrombin III (ATIII), fibrinolysis, thrombin generation, platelet activation and platelet response to agonist during CPB and ECMO at baseline, 4 and 24 hrs. Differences between age groups (neonatal vs. pediatric) in the ECMO group were also compared at baseline, 4, 12, 24, 72, and 144 hrs respectively. Results: The ECMO group was younger, weighed less, and had a lower body surface index than the CPB group. There were significant differences in baseline ATIII levels, platelet functionality, D-Dimer, and F1+2 concentrations between groups. Dichotomization of the ECMO group revealed that D-Dimer and F1+2 generation increased with time in neonatal patients. Conclusions: ECMO generally had greater impact on the hemostatic system than CPB. Circulating platelets were less responsive and markers of fibrinolytic and coagulation activation were greater in the ECMO group at all 3 time points compared between the two therapies. Fibrinolytic and coagulation activation increased with time significantly in the neonatal ECMO population.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Wolff, Erin Lynnelw11@pitt.eduELW11
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairWagner, Williamwagnerwr@upmc.eduWAGNER
Committee MemberBorovetz, Harveyborovetzhs@upmc.eduBOROVETZ
Committee MemberWearden,
Date: 19 September 2011
Date Type: Completion
Defense Date: 18 July 2011
Approval Date: 19 September 2011
Submission Date: 15 July 2011
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: Swanson School of Engineering > Bioengineering
Degree: MSBeng - Master of Science in Bioengineering
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: anticoagulation; ECMO; hemostasis
Other ID:, etd-07152011-173425
Date Deposited: 10 Nov 2011 19:51
Last Modified: 19 Dec 2016 14:36


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