{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:33:27Z","timestamp":1777916007803,"version":"3.51.4"},"reference-count":23,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>No clear guidelines exist for unfractionated heparin (UFH) monitoring in adult patients on veno-arterial extracorporeal life support (VA-ECLS) for refractory cardiogenic shock. In this study, we sought to compare outcomes between anti-factor Xa (FXa) and activated partial thromboplastin time (aPTT) strategies for UFH monitoring during VA-ECLS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This is a single-center, retrospective review of VA-ECLS patients who received UFH in the cardiothoracic intensive care unit between July 2019 and November 2023. Standard protocol for UFH titration was aPTT goal of 45-60 sec (\n                      <jats:italic>n<\/jats:italic>\n                      = 52) before September 2021, then transitioned to FXa goal of 0.1-0.2 U\/mL (\n                      <jats:italic>n<\/jats:italic>\n                      = 50) thereafter. Inverse probability of treatment weighting was used to balance baseline differences between cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In adjusted analyses, 89.3% of FXa patients and 76.0% of aPTT patients achieved goal range for their respective assay. Total UFH duration (4.0 vs 4.0 days,\n                      <jats:italic>p<\/jats:italic>\n                      = .239) and maximum weight-adjusted UFH dose (9.3 vs 9.4 U\/hr\/kg,\n                      <jats:italic>p<\/jats:italic>\n                      = .823) remained comparable between adjusted FXa and aPTT cohorts. Moreover, in-hospital mortality (50.3% vs 33.9%,\n                      <jats:italic>p<\/jats:italic>\n                      = .133), major bleeding events (20.6% vs 11.2%,\n                      <jats:italic>p<\/jats:italic>\n                      = .292), and thromboembolic events (30.1% vs 30.1%,\n                      <jats:italic>p<\/jats:italic>\n                      = .998) were not significantly different. Extracorporeal circuit thrombosis and cannula site bleeding were the most frequent events in both groups. Multivariate logistic regression found the FXa strategy was not a significant risk factor for the composite outcome of major bleeding or thromboembolism (OR [95% CI]: 1.539 [0.575, 4.116],\n                      <jats:italic>p<\/jats:italic>\n                      = .393).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In adult VA-ECLS patients at our institution, bleeding and thromboembolic complications occurred at a similar rate regardless of which UFH monitoring strategy was utilized. Further studies in larger and more institutionally diverse cohorts are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591241309500","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T18:39:37Z","timestamp":1735238377000},"page":"1575-1584","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Unfractionated heparin monitoring by anti-factor Xa versus activated partial thromboplastin time strategies during venoarterial extracorporeal life support"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6494-126X","authenticated-orcid":false,"given":"Iris","family":"Feng","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanner R.","family":"Powley","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2945-4586","authenticated-orcid":false,"given":"Christine G.","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Kurlansky","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA"},{"name":"Center of Innovation and Outcomes Research, Department of Surgery, Columbia University, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren D.","family":"Sutherland","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M.","family":"Hastie","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Kaku","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin A.","family":"Fried","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-1911","authenticated-orcid":false,"given":"Koji","family":"Takeda","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, 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