TY - JOUR
T1 - Target for Anticoagulation in the Management of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock
T2 - Rationale and Design for a Pilot Randomized Controlled Trial
AU - Kazama, Shingo
AU - Kondo, Toru
AU - Hiroaki, Hiraiwa
AU - Morimoto, Ryota
AU - Okumura, Takahiro
AU - Honda, Junta
AU - Tanaka, Taku
AU - Higashi, Michiko
AU - Yamamoto, Takanori
AU - Numaguchi, Atsushi
AU - Kuwatsuka, Yachiyo
AU - Ando, Masahiko
AU - Yamaguchi, Shogo
AU - Uemura, Yusuke
AU - Sawamura, Akinori
AU - Watanabe, Naoki
AU - Morishima, Itsuro
AU - Haga, Tomoaki
AU - Shinoda, Masanori
AU - Murohara, Toyoaki
AU - Kasugai, Daisuke
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025/12
Y1 - 2025/12
N2 - Background: Bleeding and thromboembolic complications are significant challenges in the treatment of patients with cardiogenic shock (CS) who require venoarterial extracorporeal membrane oxygenation (VA-ECMO). Anticoagulation strategies that target higher activated partial thromboplastin time (aPTT) may exacerbate bleeding and lead to poor outcomes. However, there is a lack of sufficient randomized trials to determine the optimal aPTT target for this patient population. Research Question: Does anticoagulation management with a lower aPTT target range improve outcomes compared with a higher aPTT target range in patients with CS who are treated with VA-ECMO? Study Design and Methods: The Target for Anticoagulation in the Management of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock (TARGET-ECMO) trial is a multicenter, randomized controlled trial designed to evaluate the impact of different aPTT target ranges on outcomes in patients with CS who are treated with VA-ECMO. Patients are randomized into 1 of 2 groups: a lower aPTT target group (aPTT, 1.5 to1.8 times) or a higher aPTT target group (aPTT, 2.2 to 2.5 times). Results: The primary end point is a hierarchic composite outcome assessed at 7 days that consists of (1) death from any cause, (2) major bleeding, (3) thromboembolic events, and (4) total transfusion of RBC concentrates, which are evaluated with the use of a win ratio. Interpretation: Anticoagulation targets in VA-ECMO management typically are determined at the discretion of individual centers and clinicians. The Target for Anticoagulation in the Management of Venoarterial Extracorporeal Membrane Oxygenation for CS trial aims to improve the prognosis of patients with CS who are treated with VA-ECMO by exploring optimal aPTT target range for anticoagulation management. Clinical Trial Registration: Certified Review Board of Nagoya University Hospital (approval number: 2024-0166) and the Japan Registry of Clinical Trials (jRCT1041240069).
AB - Background: Bleeding and thromboembolic complications are significant challenges in the treatment of patients with cardiogenic shock (CS) who require venoarterial extracorporeal membrane oxygenation (VA-ECMO). Anticoagulation strategies that target higher activated partial thromboplastin time (aPTT) may exacerbate bleeding and lead to poor outcomes. However, there is a lack of sufficient randomized trials to determine the optimal aPTT target for this patient population. Research Question: Does anticoagulation management with a lower aPTT target range improve outcomes compared with a higher aPTT target range in patients with CS who are treated with VA-ECMO? Study Design and Methods: The Target for Anticoagulation in the Management of Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock (TARGET-ECMO) trial is a multicenter, randomized controlled trial designed to evaluate the impact of different aPTT target ranges on outcomes in patients with CS who are treated with VA-ECMO. Patients are randomized into 1 of 2 groups: a lower aPTT target group (aPTT, 1.5 to1.8 times) or a higher aPTT target group (aPTT, 2.2 to 2.5 times). Results: The primary end point is a hierarchic composite outcome assessed at 7 days that consists of (1) death from any cause, (2) major bleeding, (3) thromboembolic events, and (4) total transfusion of RBC concentrates, which are evaluated with the use of a win ratio. Interpretation: Anticoagulation targets in VA-ECMO management typically are determined at the discretion of individual centers and clinicians. The Target for Anticoagulation in the Management of Venoarterial Extracorporeal Membrane Oxygenation for CS trial aims to improve the prognosis of patients with CS who are treated with VA-ECMO by exploring optimal aPTT target range for anticoagulation management. Clinical Trial Registration: Certified Review Board of Nagoya University Hospital (approval number: 2024-0166) and the Japan Registry of Clinical Trials (jRCT1041240069).
KW - anticoagulation management
KW - bleeding and thromboembolic complications
KW - cardiogenic shock
KW - venoarterial extracorporeal membrane oxygenation
UR - https://www.scopus.com/pages/publications/105018486286
UR - https://www.scopus.com/pages/publications/105018486286#tab=citedBy
U2 - 10.1016/j.chstcc.2025.100198
DO - 10.1016/j.chstcc.2025.100198
M3 - Article
AN - SCOPUS:105018486286
SN - 2949-7884
VL - 3
JO - CHEST Critical Care
JF - CHEST Critical Care
IS - 4
M1 - 100198
ER -