SCCM Resource Library-Anticoagulation Controversies in Extracorporeal Life Support

Video Transcription

Video Summary

In this talk, Ryan Ravisecki, a clinical pharmacist, discusses controversies around anticoagulation for extracorporeal life support (ECLS). He highlights the delicate balance between bleeding and thrombotic complications in ECLS patients. He mentions that up to 40-60% of patients experience major bleeding complications during ECLS, while thrombosis is also common, occurring in around 20% of patients. The talk focuses on two controversies: the optimal anticoagulant for ECLS patients and whether anticoagulation is necessary for ECLS support. Ravisecki discusses studies comparing unfractionated heparin and bivalirudin as anticoagulants, noting mixed results. He also mentions studies that explore the possibility of anticoagulation-free ECLS but emphasizes that more research is needed, particularly for veno-arterial ECMO. Ravisecki concludes that bivalirudin appears to be safe and effective, but cost analysis and further studies are necessary. He also suggests that anticoagulation may not be necessary for certain ECLS patients, but caution is required.

Asset Subtitle

Pharmacology, Procedures, 2022

Asset Caption

Anticoagulation strategies and monitoring vary by institution. Laboratory monitoring protocols and applications in a variety of situations, including extracorporeal membrane oxygenation, will be reviewed. Quality assurance for this high-risk medication with continuous evaluation of protocols and areas of practice improvement will be highlighted though clinical cases.

Meta Tag

Content Type Presentation

Knowledge Area Pharmacology

Knowledge Area Procedures

Knowledge Level Advanced

Membership Level Select

Tag Anticoagulation

Tag Extracorporeal Membrane Oxygenation ECMO

Year 2022

Keywords

anticoagulation

extracorporeal life support

bleeding complications

thrombotic complications

unfractionated heparin

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