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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.

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    Abstract

    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
    ETD Committee:
    ETD Committee TypeCommittee MemberEmailORCID
    Committee ChairWagner, Williamwagnerwr@upmc.edu
    Committee MemberBorovetz, Harveyborovetzhs@upmc.edu
    Committee MemberWearden, Peterwearpd@upmc.edu
    Title: Hemostasis and Anticoagulation Monitoring during Extracorporeal Membrane Oxygenation in Children
    Status: Unpublished
    Abstract: 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.
    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; The work is available for access worldwide immediately.
    Patent pending: No
    Institution: University of Pittsburgh
    Thesis Type: Master's Thesis
    Refereed: Yes
    Degree: MSBeng - Master of Science in Bioengineering
    URN: etd-07152011-173425
    Uncontrolled Keywords: anticoagulation; ECMO; hemostasis
    Schools and Programs: Swanson School of Engineering > Bioengineering
    Date Deposited: 10 Nov 2011 14:51
    Last Modified: 10 Feb 2012 08:55
    Other ID: http://etd.library.pitt.edu/ETD/available/etd-07152011-173425/, etd-07152011-173425

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