Monitoring Unfractionated Heparin In Adult Patients Undergoing Extracorporeal Membrane Oxygenation (ECMO): ACT, APTT or Anti-Xa?

Abstract Background: During ECMO, anticoagulant, particularly unfractionated heparin (UFH) is commonly used and monitored by laboratory tests, including ACT, APTT, and anti-Xa level.Method: A single-center retrospective observational study was conducted on adult patients undergoing ECMO between January 2019 and January 2020 at a tertiary hospital. The correlations between ACT, APTT, anti-Xa, antithrombin, and UFH dose were assessed.Results: 129 sets of measurements from 37 patients were obtained including ACT, APTT, anti-Xa, antithrombin, and UFH dose measured simultaneously. 102 out of 129 sets of values were interpreted as antithrombin deficiencies. The correlation coefficient between APTT and anti-Xa; ACT and anti-Xa are 0.72 and 0.33, respectively, p <0.001. The patients with normal antithrombin levels exhibited a significant correlation between APTT and anti-Xa (r = 0.80, p <0.001). ACT, on the other hand, was poorly correlated with UFH dose. Anti-Xa and APTT are only moderately correlated with UFH dose in the group without antithrombin deficiency, with correlation coefficients of 0.62 and 0.57 respectively, p <0.05. Conclusion: APTT value is strongly correlated with anti-Xa value, particularly in patients with normal antithrombin levels. However, the ACT value was poorly correlated with anti-Xa and not with UFH dose. In groups without antithrombin deficiency, APTT and anti-Xa values only moderately correlated with UFH dose.