30, 42, 36
For Chapter 30, this is the demonstration of what granularity buys: a registry field recording which anticoagulant was used cannot represent a practice that changes daily, and only daily data showed that it does. Chapter 42 owns the anticoagulation content.
Within-cohort; before and after a first bleeding event
Martucci G, Giani M, Schmidt M, Tanaka K, Tabatabai A, Tuzzolino F, Agerstrand C, Riera J, Ramanan R, Grasselli G, Ait Hssain A, Gannon WD, Buabbas S, Gorjup V, Trethowan B, Rizzo M, Fanelli V, Jeon K, De Pascale G, Combes A, Ranieri MV, Duburcq T, Foti G, Chico JI, Balik M, Broman LM, Schellongowski P, Buscher H, Lorusso R, Brodie D, Arcadipane A. Am J Respir Crit Care Med 2024;209(4):417-426. DOI 10.1164/rccm.202305-0896OC
Anticoagulation recorded DAILY by type, dosage and monitoring strategy, with bleeding events reported by site, severity and impact on mortality
Observational; practice varied by centre and was not protocolised. Abstract only.
Unfractionated heparin was the initial anticoagulant in 77 percent and the most frequently used during the course (6,221 days; 73 percent). aPTT was the monitoring test on 86 percent of days; median 52 s (IQR 39-61), falling by 5.3 s (95 percent CI -7.4 to -3.2, p under 0.01) after the first bleeding event. Bleeding occurred on 1,202 days (16.5 percent); 342 patients (52.5 percent) had at least one bleeding event, one episode every 215 hours on ECMO, of which 10 (1.6 percent) were fatal. Higher aPTT was a potentially modifiable risk factor for a first bleed (HR 1.07 per 20-s increase). The authors describe anticoagulation as a dynamic process, frequently stopped for bleeding and restarted according to the clinical picture.
652 adults on venovenous ECMO in 41 centres, December 2018 to February 2021; 8,471 ECMO days analysed