Table 3:
Patient Anticoagulation Management, Complications, and Mortality
| Imaging Findings, Anticoagulation Management, and Outcomes | VA-ECMO AIS (n=13) | VA-ECMO ICH (n=6) | VV-ECMO ICH (n=5) |
|---|---|---|---|
|
| |||
| HCT Characteristics & Findings | |||
| Time to AIS or ICH, days | 4 (1–11) | 6 (2–10) | 5 (1–13) |
| Intraventricular hemorrhage | -– | 2 (33) | 2 (40) |
| Stroke volume* | 9.8 (1–83.3) | SDH: 1.1 (1–1.5) IPH: 82 (1–164) |
SDH: -– IPH: 1.3 (1–2.5) |
| Stroke volumes for those with heparin discontinuation and subsequent resumption |
1 | SDH 1.1 (1–1.5) IPH: 1 |
SDH: -– IPH: 1.3 (1–2.5) |
| Anticoagulation at Stroke Identification | |||
| Antiplatelet agent | 5 (38) | 2 (33) | 1 (20) |
| Anticoagulation Heparin Bivalirudin+ None∇ |
9 (70) 2 (15) 2 (15) |
5 (83) 0 (0) 1 (17) |
5 (100) 0 (0) 0 (0) |
| aPTT, median | 39.2 (22.8–58.8) | 50.0 (27.4–57.3) | 60.9 (34.1–65.6) |
| Anticoagulation Cessation & Resumption | |||
| Protamine sulfate reversal | 0 (0) | 1 (17) | 0 (0) |
| No heparin cessation | 7 (85) | 0 (0) | 0 (0) |
| Heparin cessation | 2 (15) | 5 (83) | 5 (100) |
| Heparin resumption | 1 (8) | 4 (67) | 5 (100) |
| Duration of heparin discontinuation, hours | 96 (96) | 45 (30–96) | 33 (6–136) |
| Thromboembolic Events While Heparin Discontinued | |||
| Pulmonary embolism | 0 (0) | 0 (0) | 1 (20) |
| Deep venous thrombosis | 0 (0) | 0 (0) | 1 (20) |
| Intracardiac thrombus | 0 (0) | 0 (0) | 0 (0) |
| ECMO circuit clot | 0 (0) | 0 (0) | 1 (20) |
| Repeat HCT Findings | |||
| New AIS off anticoagulation | 0 (0) | 0 (0) | 0 (0) |
| ICH: hematoma expansion after resumption | -– | 0 (0) | 0 (0) |
| AIS: hemorrhagic conversion after resumption |
0 (0) | -– | -– |
| In-Hospital Mortality | |||
| In-hospital mortality | 11 (85) | 4 (67) | 2 (40) |
| In-hospital mortality if heparin discontinued |
1 (50) | 3 (60) | 2 (40) |
| In-hospital mortality if heparin resumed |
0 (0) | 2 (50) | 2 (40) |
*
Sizes of intracerebral and subdural hemorrhages calculated using ABC/2 method
+
Both patients on bivalirudin continued anticoagulation after stroke identification
∇
Reason for no anticoagulation: massive intraoperative bleeding (n=3)
Values are expressed as median (range) for continuous variables and absolute frequency (percentages) for categorical variables.
Abbreviations: AIS= acute ischemic stroke; aPTT= activated partial thromboplastin time; HCT= head computed tomography; ICH= intracranial hemorrhage; VA-ECMO= venoarterial extracorporeal membrane oxygenation; VV-ECMO= venovenous extracorporeal membrane oxygenation