title: Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: a retrospective analysis.
abstract: BACKGROUND
  Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure.
  
  
  METHODS
  Retrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients.
  
  
  RESULTS
  Out of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings.
  
  
  CONCLUSIONS
  Venous thrombosis and thromboembolism following ECMO therapy are frequent. Quality of anticoagulation and ECMO runtime predicted thromboembolic events.
authors.affiliation: Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Franziska C
authors.initials: FC
authors.lastname: Trudzinski
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital of Saarland, Homburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Minko
authors.affiliation: Institutes for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rapp
authors.affiliation: Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fähndrich
authors.affiliation: Department of Cardiology, Kliniken Maria-Hilf GmbH, Mönchengladbach, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Haake
authors.affiliation: Department of Pathology, University Hospital of Saarland, Homburg, Germany.
authors.forename: Myriam
authors.initials: M
authors.lastname: Haab
authors.affiliation: Department of Pathology, University Hospital of Saarland, Homburg, Germany.
authors.forename: Rainer M
authors.initials: RM
authors.lastname: Bohle
authors.affiliation: Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Flaig
authors.affiliation: Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Kaestner
authors.affiliation: Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Bals
authors.affiliation: Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Heinrike
authors.initials: H
authors.lastname: Wilkens
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Ralf M
authors.initials: RM
authors.lastname: Muellenbach
authors.affiliation: Department of Internal Medicine III - Cardiology, and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Link
authors.affiliation: Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, University Hospital of Saarland, Homburg, Germany.
authors.forename: Heinrich V
authors.initials: HV
authors.lastname: Groesdonk
authors.affiliation: Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Lensch
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Langer
authors.affiliation: Department of Internal Medicine V - Pneumology and Critical Care Medicine, University Hospital of Saarland, Homburg, Germany. philipp.lepper@uks.eu.
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Lepper