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Dr. Vikram Fielding-Singh is a Clinical Assistant Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University. He obtained his medical degree from Stanford University and completed residency training at the University of California, San Francisco. He then pursued dual cardiac anesthesia and critical care training at the University of California, Los Angeles. He holds a juris doctorate from Yale Law School. Dr. Fielding-Singh’s research interests include improving perioperative care of patients with end stage kidney disease, using biomarkers to aid early diagnosis of acute kidney injury, and evaluating the performance of risk prediction models in perioperative medicine.
I am a clinical investigator interested in improving perioperative care of patients with end stage kidney disease, using biomarkers to aid early diagnosis of acute kidney injury, optimizing care for high-risk cardiac surgical patients and those on mechanical circulatory support, and evaluating the performance of risk prediction models in perioperative medicine.
Strategies for Anticoagulation During Venovenous ECMO
Moderate intensity titrated dose anticoagulation has been used in patients receiving
extracorporeal membrane oxygenation (ECMO) to prevent thromboembolism and thrombotic
mechanical complications. As technology has improved, however, the incidence of
thromboembolic events has decreased, leading to re-evaluation of the risks of
anticoagulation, particularly during venovenous (V-V) ECMO. Recent data suggest that bleeding
complications during V-V ECMO may be more strongly associated with mortality than
thromboembolic complications, and case series have suggested that V-V ECMO can be safely
performed without moderate or high intensity anticoagulation. At present, there is
significant variability between institutions in the approach to anticoagulation during V-V
ECMO. A definitive randomized controlled trial is needed to compare the effects of a low
intensity fixed dose anticoagulation (low intensity) versus moderate intensity titrated dose
anticoagulation (moderate intensity) on clinical outcomes during V-V ECMO. Before such a
trial can be conducted, however, additional data are needed to inform the feasibility of the
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