title: Heparin-like effect in postcardiotomy extracorporeal membrane oxygenation patients.
abstract: BACKGROUND
  Unfractionated heparin (UFH) is the anticoagulant of choice for extracorporeal membrane oxygenation (ECMO), but bivalirudin can be used as an alternative. The purpose of the present study is to investigate the existence of a heparin-like effect (HLE) during heparin-free ECMO.
  
  
  METHODS
  This is a retrospective study on patients treated with ECMO and receiving bivalirudin as the sole anticoagulant. Thromboelastography (TEG) tests with and without heparinase were recorded during the ECMO duration. A total of 41 patients (22 pediatrics and 19 adults) treated with ECMO after cardiac surgery procedures and receiving only bivalirudin-based anticoagulation were studied. Based on the presence of a different reaction time (R-time) between the TEG test with heparinase or without heparinase we defined the presence of a HLE. Survival to hospital discharge, liver failure, sepsis, bleeding and transfusion rate were analyzed for association with HLE with univariate tests.
  
  
  RESULTS
  HLE was detected in 56.1% of the patients. R-times were significantly shorter in tests done with heparinase versus without heparinase during the first seven days on ECMO. Patients with HLE had a significantly (P = 0.046) higher rate of sepsis (30%) than patients without HLE (5.6%) at a Pearson's chi-square test.
  
  
  CONCLUSIONS
  A heparin-like effect is common during ECMO, and most likely due to a release of heparinoids from the glycocalyx and the mast cells, as a consequence of sepsis or of the systemic inflammatory reaction triggered by the contact of blood with foreign surfaces.
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Baryshnikova
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Isgrò
authors.forename: Concetta
authors.initials: C
authors.lastname: Carlucci
authors.forename: Mauro
authors.initials: M
authors.lastname: Cotza
authors.forename: Giovanni
authors.initials: G
authors.lastname: Carboni
authors.forename: Andrea
authors.initials: A
authors.lastname: Ballotta
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000494:pharmacology* / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006629:Hirudins / Q000494:pharmacology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010314:Partial Thromboplastin Time; D010446:Peptide Fragments / Q000494:pharmacology* / Q000627:therapeutic use; D011183:Postoperative Complications; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D006629:Hirudins; D010446:Peptide Fragments; D011994:Recombinant Proteins; C074619:bivalirudin