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Strategies for Anticoagulation During Venovenous ECMO

Moderate intensity titrated dose anticoagulation has been used in patients receiving extracorporeal membrane oxygenation (ECMO) to prevent thromboembolism and thrombotic mechanical complications. As technology has improved, however, the incidence of thromboembolic events has decreased, leading to re-evaluation of the risks of anticoagulation, particularly during venovenous (V-V) ECMO. Recent data suggest that bleeding complications during V-V ECMO may be more strongly associated with mortality than thromboembolic complications, and case series have suggested that V-V ECMO can be safely performed without moderate or high intensity anticoagulation. At present, there is significant variability between institutions in the approach to anticoagulation during V-V ECMO. A definitive randomized controlled trial is needed to compare the effects of a low intensity fixed dose anticoagulation (low intensity) versus moderate intensity titrated dose anticoagulation (moderate intensity) on clinical outcomes during V-V ECMO. Before such a trial can be conducted, however, additional data are needed to inform the feasibility of the future trial.

Stanford is currently accepting patients for this trial.

Stanford Investigator(s):

Intervention(s):

  • other: Low intensity anticoagulation
  • other: Moderate Intensity Anticoagulation

Eligibility


Inclusion Criteria:

   1. Patient receiving V-V ECMO

   2. Patient is located in a participating unit of the Vanderbilt University Medical Center
   (VUMC) adult hospital.

Exclusion Criteria:

   1. Patient is pregnant

   2. Patient is a prisoner

   3. Patient is < 18 years old

   4. Patient underwent ECMO cannulation greater than 24 hours prior to screening

   5. Presence of an indication for systemic anticoagulation:

      1. Ongoing receipt of systemic anticoagulation

      2. Planned administration of anticoagulation for an indication other than ECMO

      3. Presence of or plan to insert an arterial ECMO cannula

   6. Presence of a contraindication to anticoagulation:

      1. Active bleeding determined by treating clinicians to make anticoagulation unsafe

      2. Major surgery or trauma less than 72 hours prior to randomization

      3. Known history of a bleeding diathesis

      4. Ongoing severe thrombocytopenia (platelet count < 30,000)

      5. History of heparin-induced thrombocytopenia (HIT)

      6. Heparin allergy

   7. Positive SARS-CoV-2 test within prior 21 days or high clinical suspicion for COVID-19

   8. The treating clinician determines that the patient's risks of thromboembolism or
   bleeding necessitate a specific approach to anticoagulation management during V-V ECMO

Ages Eligible for Study

18 Years - N/A

Genders Eligible for Study

All

Now accepting new patients

Contact Information

Stanford University
School of Medicine
300 Pasteur Drive
Stanford, CA 94305
Recruiting