Open AccessHeparin Resistance in ECMO and the Role of Direct Thrombin Inhibitors: A Case Report
Author(s) -
Mohsyn Imran Malik,
Roman Nepomuceno,
Dave Nagpal
Publication year - 2021
Publication title -
uwomj/medical journal
Language(s) - English
Resource type - Journals
eISSN - 2560-8274
pISSN - 0042-0336
DOI - 10.5206/uwomj.v89i2.10242
Subject(s) - medicine , extracorporeal membrane oxygenation , intensive care medicine , heparin , heparin induced thrombocytopenia , discovery and development of direct thrombin inhibitors , extracorporeal , direct thrombin inhibitor , critically ill , antithrombin , anticoagulant , anesthesia , thrombin , dabigatran , surgery , atrial fibrillation , platelet , cardiology , warfarin
Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving technology that can provide timely support to those failing to oxygenate their blood, either due to cardiac or respiratory related illnesses. However, ECMO also requires a careful hemostatic balance due to the thrombotic nature of the external circuit and the potential for bleeding events while anticoagulated. Current standard procedure for anticoagulating patients on ECMO is the use of unfractionated heparin. Despite its widespread use, many patients still face bleeding and/or clotting complications during their admission, some resulting in disastrous consequences. One possible etiology for this ineffectiveness is due to the mechanism by which heparin works via antithrombin (AT) and the AT deficiency of a critically ill patients. In this case study, we discuss the use of an alternative anticoagulant, a direct-thrombin inhibitor (DTI) in a patient cannulated to ECMO, which is independent of AT. The case study follows their course while on ECMO, focusing on relevant hemostatic measures. We further demonstrate the therapeutic potential for DTIs in place of UFH in ECMO patients, and the need for further research into anticoagulation strategies in critically ill patients.