GLOBAL AND EXTENDED COAGULATION MONITORING DURING EXTRACORPOREAL LUNGASSIST WITH HEPARIN-COATED SYSTEMS IN ARDS PATIENTS

Heparin-coated systems for extracorporeal lung-assist (ECLA) were deve loped to reduce hemorrhagic risk by lowering the systemic heparinizati on, monitored by global tests, e.g. activated coagulation time (ACT) a nd activated partial thromboplastin time (APTT). Since this strategy g ives no insight into procoagulant states five ARDS patients receiving ECLA with heparin-coated systems were investigated for changes in coag ulation using both global and extended tests. During ECLA onset the AP TT and ACT were within or near normal ranges, platelets decreased 76.5 % within 48h, fibrinogen decreased 28.7%, thrombin-antithrombin-III co mplexes were elevated before ECLA (53 mu g/L), but demonstrated an add itional peak (238 mu g/L), plasminogen-activator-inhibitor-I increased 12-fold, and the C1-inhibitor dropped 14.1%. In conclusion, after the onset of ECLA from a previous prethrombotic state, the precoagulant, anticoagulant, fibrinolytic and complement systems were activated in a similar way to that reported for non-heparinized systems with high-do se heparin. This was however only monitored by an extended test panel which was unable to predict thromboembolic events during ECLA.