Thrombohemorrhagic risk is one of the main limiting factors in extracorporeal circulation. We describe here our experience in managing some life-threatening hematological complications in 58 patients with acute respiratory failure treated with long-term extracorporeal assistance. These patients were studied by clinical and laboratory means to assess questions related to heparin monitoring, coagulation complications and bleeding incidence. We found that two clotting tests, activated partial thromboplastin time (APTT) and activated clotting time (ACT) can be easily used to assess the safety of anticoagulant treatment (therapeutic ranges: APTT from 55 to 95 sec and ACT from 170 to 220 sec). A certain degree of coagulation activation, despite heparin, was indicated by the constant finding of thrombin-antithrombin complexes, while fibrinolytic activation, measured as plasminogen activator activity, was confined to the time of bypass connection and was of no clinical consequence. Platelet function was always impaired without relation to the platelet loss. Disseminated intravascular coagulation (DIC) (13 episodes) and severe bleeding (11 episodes) were major complications. DIC was corrected with a good outcome for 8 of 13 patients, while severe bleeding was correlated with a poor outcome in 8 of the 11 patients, probably because of the severity of the underlying disease

Physiopathology and management of coagulation during long-term extracorporeal respiratory assistance / L. D. Uziel, M. Cugno, I. Fabrizi, A. Pesenti, L. Gattinoni, A. Agostoni. - In: INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS. - ISSN 0391-3988. - 13:5(1990 May), pp. 280-287.

Physiopathology and management of coagulation during long-term extracorporeal respiratory assistance

L. D. Uziel;M. Cugno;A. Pesenti;L. Gattinoni;A. Agostoni
1990-05

Abstract

Thrombohemorrhagic risk is one of the main limiting factors in extracorporeal circulation. We describe here our experience in managing some life-threatening hematological complications in 58 patients with acute respiratory failure treated with long-term extracorporeal assistance. These patients were studied by clinical and laboratory means to assess questions related to heparin monitoring, coagulation complications and bleeding incidence. We found that two clotting tests, activated partial thromboplastin time (APTT) and activated clotting time (ACT) can be easily used to assess the safety of anticoagulant treatment (therapeutic ranges: APTT from 55 to 95 sec and ACT from 170 to 220 sec). A certain degree of coagulation activation, despite heparin, was indicated by the constant finding of thrombin-antithrombin complexes, while fibrinolytic activation, measured as plasminogen activator activity, was confined to the time of bypass connection and was of no clinical consequence. Platelet function was always impaired without relation to the platelet loss. Disseminated intravascular coagulation (DIC) (13 episodes) and severe bleeding (11 episodes) were major complications. DIC was corrected with a good outcome for 8 of 13 patients, while severe bleeding was correlated with a poor outcome in 8 of the 11 patients, probably because of the severity of the underlying disease
Blood coagulation tests ; humans ; blood coagulation disorders ; child ; hemorrhage ; blood coagulation ; disseminated intravascular coagulation ; extracorporeal circulation ; respiratory insufficiency ; adult ; middle aged ; positive-pressure respiration ; intermittent positive-pressure ventilation ; adolescent ; heparin ; male ; female ; carbon dioxide
Settore MED/09 - Medicina Interna
Settore MED/41 - Anestesiologia
INTERNATIONAL JOURNAL OF ARTIFICIAL ORGANS
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/163285
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