title: Evaluation of a pharmacy managed heparin protocol for extracorporeal membrane oxygenation patients.
abstract: BACKGROUND
  Unfractionated heparin is the preferred anticoagulant in extracorporeal membrane oxygenation (ECMO) patients. However, there is a lack of consensus on its titration and monitoring. The objective of this study was to describe the efficacy and safety of a pharmacy managed heparin protocol utilizing activated partial thromboplastin time (aPTT) in comparison to our standard physician-managed activated clotting time (ACT)-based anticoagulation in ECMO patients.
  
  
  METHODS
  Patients administered a heparin drip while on ECMO were included in the study. The primary endpoints were the incidence of hemorrhagic and thrombotic complications.
  
  
  RESULTS
  A total of 122 adult patients were identified who were on ECMO with heparin anticoagulation; sixty-one patients were managed with each of the physician-managed ACT and pharmacy managed aPTT protocols. No statistically significant difference was observed between the physician ACT and the pharmacy aPTT groups in overall hemorrhagic (69% vs 80%, p=0.145) or thrombotic complications (41% vs 39%, p=0.853).
  
  
  CONCLUSIONS
  There was a similar rate of thrombotic and bleeding events between the two study groups. A pharmacy managed heparin protocol utilizing aPTT monitoring appears to be a safe and effective method of providing anticoagulation in adult ECMO patients.
authors.affiliation: 1 Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Fitousis
authors.affiliation: 1 Department of Pharmacy, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Klasek
authors.affiliation: 2 Department of Medicine, Anesthesia and Critical Care, Methodist Debakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.|3 Department of Medicine, San Antonio Military Medical Center, San Antonio, Texas, USA.
authors.forename: Phillip E
authors.initials: PE
authors.lastname: Mason
authors.affiliation: 2 Department of Medicine, Anesthesia and Critical Care, Methodist Debakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
authors.forename: Faisal
authors.initials: F
authors.lastname: Masud
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D014914:Whole Blood Coagulation Time
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: ECMO; activated clotting time; activated partial thromboplastin time; anticoagulation; heparin; pharmacy protocol