{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T09:06:28Z","timestamp":1785488788274,"version":"3.56.0"},"reference-count":53,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The use of extracorporeal membrane oxygenation (ECMO) is associated with complex hemostatic changes. Systemic anticoagulation is initiated to prevent clotting in the ECMO system, but this comes with an increased risk of bleeding. Evidence on the use of anti\u2010Xa\u2010guided monitoring to prevent bleeding during ECMO support is limited. Therefore, we aimed to analyze the association between anti\u2010factor Xa\u2010guided anticoagulation and hemorrhage during ECMO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review and meta\u2010analysis was performed (up to August 2023). PROSPERO: CRD42023448888.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010six studies comprising 2293 patients were included in the analysis, with six works being part of the meta\u2010analysis. The mean anti\u2010Xa values did not show a significant difference between patients with and without hemorrhage (standardized mean difference \u22120.05; 95% confidence interval [CI]: \u22120.19; 0.28, <jats:italic>p<\/jats:italic>\u2009=\u2009.69). We found a positive correlation between anti\u2010Xa levels and unfractionated heparin dose (UFH; pooled estimate of correlation coefficients 0.44; 95% CI: 0.33; 0.55, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). The most frequent complications were any type of hemorrhage (pooled 36%) and thrombosis (33%). Nearly half of the critically ill patients did not survive to hospital discharge (47%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The most appropriate tool for anticoagulation monitoring in ECMO patients is uncertain. Our analysis did not reveal a significant difference in anti\u2010Xa levels in patients with and without hemorrhagic events. However, we found a moderate correlation between anti\u2010Xa and the UFH dose, supporting its utilization in monitoring UFH anticoagulation. Given the limitations of time\u2010guided monitoring methods, the role of anti\u2010Xa is promising and further research is warranted.<\/jats:p><\/jats:sec>","DOI":"10.1002\/clc.24273","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T07:05:10Z","timestamp":1714633510000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Association of anti\u2010factor Xa\u2010guided anticoagulation with hemorrhage during ECMO support: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6193-3662","authenticated-orcid":false,"given":"Sasa","family":"Rajsic","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine Medical University Innsbruck Innsbruck 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