Venoarterial ECMO is increasingly used for mechanical circulatory support during lung transplant. Optimal intensity of intraoperative anticoagulation would be expected to mitigate thromboembolism without increasing bleeding and blood product transfusions. Yet, the optimal intensity of intraoperative anticoagulation is unknown. We performed a retrospective cohort study of 163 patients who received a bilateral lung transplant at a single center. We categorized intensity of anticoagulation into four groups (very low to high) based on the bolus dose of unfractionated heparin given during lung transplant and compared the rates of intraoperative blood transfusions and the occurrence of thromboembolism between groups. When compared to the very low intensity group, each higher intensity group was associated with higher red blood cell, fresh frozen plasma, and platelet transfusions. The occurrence of thromboembolism was similar across groups. These preliminary data suggest that lower intensity anticoagulation may reduce the rate of intraoperative blood transfusions although further study is needed.

中文翻译：

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肺移植期间抗凝强度对静脉动脉体外膜氧合输血的影响

静脉动脉 ECMO 越来越多地用于肺移植期间的机械循环支持。术中抗凝的最佳强度有望在不增加出血和血液制品输注的情况下减轻血栓栓塞。然而，术中抗凝的最佳强度尚不清楚。我们对 163 名在单一中心接受双侧肺移植的患者进行了回顾性队列研究。我们根据肺移植期间给予普通肝素的推注剂量将抗凝强度分为四组（极低到高），并比较各组之间的术中输血率和血栓栓塞的发生率。与极低强度组相比，每个较高强度组都与较高的红细胞、新鲜冰冻血浆和血小板输注相关。各组之间血栓栓塞的发生率相似。这些初步数据表明，较低强度的抗凝可能会降低术中输血率，但还需要进一步研究。