Monitoramento dos exames laboratoriais de coagulação como preditivo de eventos trombóticos no circuito da ECMO

Abstract

This research aims at the early identification of the thrombotic event in the extracorporeal membrane oxygenation (ECMO) support circuit through laboratory analysis. Its general objective was to verify whether laboratory tests that monitor the status of blood clotting are predictors of the development of thrombi in the ECMO circuit in adult patients. The specific objectives were: to review the laboratory tests used to map the blood clotting status of adult patients undergoing ECMO in a specialized center; to correlate the values of laboratory tests that monitor blood clotting status with the risk of thrombus formation in the ECMO circuit; to identify the outcome of patients undergoing ECMO who developed thrombosis in the circuit. Epidemiological, analytical, quantitative, retrospective, observational study. The population analyzed were adult patients who used ECMO in the veno-venous (VV) and and veno-arterial (VA) modalities, with or without a diagnosis of COVID-19, whether or not they developed thrombosis in the circuit. Data collection took place between January 2016 and December 2020. The results of this study are based on a sample of 36 cases of patients being treated with ECMO, of which 36.1% had thrombosis in the circuit. The occurrence of thrombosis was not related to the patient's sex. In both groups, the modal age range was 54 years or older and younger than 63 years, and the occurrence of thrombosis was not associated with the patient's age. The occurrence of thrombosis was significantly lower in the VA modality, it was observed in 15.38% of the analyzed sample. A correlation with the duration of ECMO was identified, patients who had thrombosis spent significantly more days on ECMO than patients who did not have thrombosis. The frequency of patients with circuit replacement is significantly higher in the group that had thrombosis. The frequency of patients who died is significantly higher in the group that did not have thrombosis in the circuit. Based on the data from this study, it cannot be said that the rates of Activated Partial Thromboplastin Time (aPTT), Prothrombin Time/International Normalized Ratio (PT/INR), PT/Activity, D-dimer, fibrinogen and antithrombin III (AT III) are associated with the occurrence of thrombosis, since these markers, in most of the observations carried out in this study, were not significantly different in the groups with and without thrombosis, or the data obtained were not sufficient to compare the two groups, however, in relation to the platelets there was a significant association on the 5th day (p<0.039), with patients with platelets within the reference range being 6.7 times more likely to have thrombosis compared to patients with values below the reference range.