• Cécile Aubron, Zoe McQuilten, Michael Bailey, Jasmin Board, Heidi Buhr, Bruce Cartwright, Mark Dennis, Carol Hodgson, Paul Forrest, David McIlroy, Deirdre Murphy, Lynne Murray, Vincent Pellegrino, David Pilcher, Jayne Sheldrake, Huyen Tran, Shirley Vallance, D James Cooper, and endorsed by the International ECMO Network (ECMONet).
• Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre (ANZICRC), Monash University, Melbourne, VIC, Australia.
• Crit. Care Med. 2019 Jul 1; 47 (7): e563-e571.

ObjectivesTo determine whether randomization of patients undergoing extracorporeal membrane oxygenation to either therapeutic or a low-dose anticoagulation protocol results in a difference in activated partial thromboplastin time and anti-Xa.DesignRandomized, controlled, unblinded study.SettingTwo ICUs of two university hospitals.PatientsPatients admitted to the ICU, who required extracorporeal membrane oxygenation (venovenous or venoarterial) and who did not have a preexisting indication for therapeutic anticoagulation.InterventionsTherapeutic anticoagulation with heparin (target activated partial thromboplastin time between 50 and 70 s) or lower dose heparin (up to 12,000 U/24 hr aiming for activated partial thromboplastin time < 45 s).Measurements And Main ResultsThirty-two patients were randomized into two study groups that were not significantly different in demographics and extracorporeal membrane oxygenation characteristics. There was a significant difference in the daily geometric mean heparin dose (11,742 U [95% CI, 8,601-16,031 U] vs 20,710 U [95% CI, 15,343-27,954 U]; p = 0.004), daily geometric mean activated partial thromboplastin time (48.1 s [95% CI, 43.5-53.2 s] vs 55.5 s [95% CI, 50.4-61.2 s]; p = 0.04), and daily geometric mean anti-Xa (0.11 international units/mL [95% CI, 0.07-0.18] vs 0.27 [95% CI, 0.17-0.42]; p = 0.01). We found similar results when considering only venovenous extracorporeal membrane oxygenation episodes; however, no difference in daily geometric mean activated partial thromboplastin time between groups when considering only venoarterial extracorporeal membrane oxygenation episodes.ConclusionsAllocating patients on extracorporeal membrane oxygenation to two different anticoagulation protocols led to a significant difference in mean daily activated partial thromboplastin time and anti-Xa levels between groups. When considering subgroups analyses, these results were consistent in patients on venovenous extracorporeal membrane oxygenation. Our results support the feasibility of a larger trial in patients undergoing venovenous extracorporeal membrane oxygenation to compare different anticoagulation protocols; however, this study does not provide evidence on the optimal anticoagulation protocol for patients undergoing extracorporeal membrane oxygenation.

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