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Objectives :This systematic review and meta-analysis aimed to evaluate clinical outcomes associated with different systemic heparin protocols, conservative versus standard intensity, during ECMO support.Included studies comprised both venovenous (VV) and venoarterial (VA) ECMO modalities. Design:A systematic review and meta-analysis were conducted per PRISMA guidelines.PubMed, Cochrane, and Scopus were searched until 15/11/2024 for studies comparing conservative (no or low-target aPTT 40-60, anticoagulation monitoring) versus standard anticoagulation (standard heparin targets aPTT 60-80) Setting:Studies were conducted in intensive care units across multiple international centers. Participants:Eight studies (601 patients: 280 conservative vs. 321 standard) were included in the meta-analysis. Interventions:conservative (no or low-target aPTT 40-60, anticoagulation monitoring) versus standard anticoagulation (standard heparin targets aPTT 60-80) Measurements secondary outcomes were stroke, limb ischemia, and circuit thrombosis.Random-effects models assessed outcomes, with heterogeneity evaluated using the Q test and I.A total of 698 studies were identified (PubMed: 461, Cochrane: 94, Scopus: 143).After removing duplicates, 358 records were screened, and 245 were excluded.27 studies underwent full-text review, with 13 meeting the inclusion criteria.Eight studies (601 patients: 280 conservative vs. 321 standard) were included in the meta-analysis.Mortality was similar between groups (conservative: 131/280 46.8% vs. standard: 159/321 49.5%;OR 1.04 95% CI 0.53-2.05,I = 64%).Thrombotic events were assessed in 4 studies (26/123 21.1% vs. 47/178 26.4%;OR 0.60 95% CI 0.33-1.09,I = 0%).Stroke (5/127 vs. 5/178), limb ischemia (10/87 vs. 20/147), and circuit thrombosis (15/141 vs. 15/191) were similarly unaffected.However, major bleeding significantly favored conservative strategies (74/251 29.5% vs. 157/297 52.9%;OR 0.40 95% CI 0.18-0.91,p = 0.03, I = 72%; 7 studies).Conclusions: Findings from this systematic review and meta-analysis indicate a potential association between conservative anticoagulation strategies during ECMO and reduced bleeding events without increasing mortality or thrombotic complications, including stroke, limb ischemia, and circuit thrombosis.Given the low event rates, wide confidence intervals, and absence of a formal power calculation, these null findings should not be interpreted as evidence of equivalence
Rahhal et al. (Wed,) studied this question.