• Sasa Rajsic, Robert Breitkopf, Benedikt Treml, Dragana Jadzic, Nicole Innerhofer, Christine Eckhardt, Christoph Oberleitner, Fariha Nawabi, and Zoran Bukumiric.
• Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, 6020, Innsbruck, Austria. Electronic address: sasa.rajsic@i-med.ac.at.
• J. Cardiothorac. Vasc. Anesth. 2024 Aug 1; 38 (8): 166216721662-1672.

ObjectiveThe initiation of extracorporeal membrane oxygenation (ECMO) triggers complex coagulation processes necessitating systemic anticoagulation. Therefore, anticoagulation monitoring is crucial to avoid adverse events such as thrombosis and hemorrhage. The main aim of this work was to analyze the association between anti-Xa levels and thrombosis occurrence during ECMO support.DesignSystematic literature review and meta-analysis (Scopus and PubMed, up to July 29, 2023).SettingAll retrospective and prospective studies.ParticipantsPatients receiving ECMO support.InterventionAnticoagulation monitoring during ECMO support.Measurements And Main ResultsA total of 16 articles with 1,968 patients were included in the review and 7 studies in the meta-analysis (n = 374). Patients with thrombosis had significantly lower mean anti-Xa values (standardized mean difference -0.36, 95% confidence interval [CI] -0.62 to -0.11, p < 0.01). Furthermore, a positive correlation was observed between unfractionated heparin infusion and anti-Xa levels (pooled estimate of correlation coefficients 0.31, 95% CI 0.19 to 0.43, p < 0.001). The most common adverse events were major bleeding (42%) and any kind of hemorrhage (36%), followed by thromboembolic events (30%) and circuit or oxygenator membrane thrombosis (19%). More than half of the patients did not survive to discharge (52%).ConclusionsThis work revealed significantly lower levels of anti-Xa in patients experiencing thromboembolic events and a positive correlation between anti-Xa and unfractionated heparin infusion. Considering the contemplative limitations of conventional monitoring tools, further research on the role of anti-Xa is warranted. New trials should be encouraged to confirm these findings and determine the most suitable monitoring strategy for patients receiving ECMO support.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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