Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation Collaborative Consensus Conference
Research article published in Pediatric critical care medicine (2024)
Abstract
OBJECTIVES: To derive systematic-review informed, modified Delphi consensus regarding anticoagulation monitoring assays and target levels in pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE. DATA SOURCES: A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021. STUDY SELECTION: Anticoagulation monitoring of pediatric patients on ECMO. DATA EXTRACTION: Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Evidence tables were constructed using a standardized data extraction form. DATA SYNTHESIS: Risk of bias was assessed using the Quality in Prognosis Studies tool or the revised Cochrane risk of bias for randomized trials, as appropriate and the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for clinical recommendations focused on anticoagulation monitoring and targets, using a web-based modified Delphi process to build consensus (defined as > 80% agreement). One weak recommendation, two consensus statements, and three good practice statements were developed and, in all, agreement greater than 80% was reached. We also derived some resources for anticoagulation monitoring for ECMO clinician use at the bedside. CONCLUSIONS: There is insufficient evidence to formulate optimal anticoagulation monitoring during pediatric ECMO, but we propose one recommendation, two consensus and three good practice statements. Overall, the available pediatric evidence is poor and significant gaps exist in the literature.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation Collaborative Consensus Conference.
Por qué esto importa para la hirudoterapia
Esta declaración de consenso fundamentada en una revisión sistemática, procedente del Pediatric ECMO Anticoagulation Collaborative, aborda los ensayos de monitorización de la anticoagulación y los niveles objetivo en la oxigenación por membrana extracorpórea pediátrica. A lo largo de dos años, 48 expertos elaboraron una recomendación débil, dos declaraciones de consenso y tres declaraciones de buena práctica mediante un proceso Delphi modificado (>80% de acuerdo). Los autores concluyeron que la evidencia es insuficiente para definir la monitorización óptima de la anticoagulación durante la ECMO pediátrica, con importantes lagunas en la bibliografía. La relevancia para la ASH y la hirudoterapia es únicamente indirecta: el resumen no menciona sanguijuelas, hirudina ni bivalirudina de forma específica, centrándose en cambio en el manejo general de la anticoagulación. Si bien la anticoagulación es conceptualmente adyacente a los terapéuticos derivados de la sanguijuela, este documento no aporta datos directos sobre agentes derivados de la sanguijuela y debe considerarse contexto de fondo más que literatura primaria sobre hirudoterapia.
Citación
Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation Collaborative Consensus Conference
Ozment CP et al. · Pediatric critical care medicine, 2024
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 27, 2026 · Última actualización del sitio: 18 de junio de 2026