Platelet Count Trends and Prevalence of Heparin-Induced Thrombocytopenia in a Cohort of Extracorporeal Membrane Oxygenator Patients

Sokolovic, Mladen; Pratt, Alexandra; Vukićević, Vladimir; Sarumi, Molly; Johnson, Laura S.; Shah, N Sarita

doi:10.1097/ccm.0000000000001869

Cited by 41 publications

(62 citation statements)

References 30 publications

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“…The percentage of decreasing of the platelet count was mentioned in 7 papers [6-8, 16, 28, 29, 31]. Thrombocytopenia in V-A ECMO patients has been reported in 6 studies [8,24,25,31,36,40]. The I 2 test result showed high heterogeneity also in this sub-group analysis.…”

Section: • Thrombocytopeniamentioning

confidence: 73%

“…There were 6.698 V-A ECMO patients, of whom 459 were post-cardiotomy. In 6 studies, authors did not report about the ECMO setting (post-cardiotomy, post-acute myocardial infarction, or other aetiologies) [8,16,25,26,28,39]. V-V ECMO was present in 477 patients.…”

Section: Study Descriptionmentioning

confidence: 99%

“…Severe thrombocytopenia was reported only in 6 studies, and its prevalence ranged from 6.3 to 26.6% [8,24,32,35,37,40]. Five studies reported the timeline of platelet count after ECMO start [7,8,16,24,29]. The time to lowest platelet count varied from 2 to 7 days after ECMO initiation.…”

Section: • Thrombocytopeniamentioning

confidence: 99%

“…The contact with foreign circuit surfaces and the high shear stress, during ECMO treatment, have been shown to cause enhanced platelet activation, which may lead to an increased thrombotic predisposition [6][7][8]. On the other side, high shear stress has also been shown to cause loss of platelet surface receptors, important for platelet adhesion, as well as loss of high-molecular-weight von Willebrand factor (vWF) multimers, resulting in decreased binding of vWF to platelets [8,9]. Moreover, anticoagulant therapy, necessary to preserve the patency of the circuit and to avoid thrombotic complications, plays as a contributing factor to haemorrhagic complications [10].…”

Section: Introductionmentioning

confidence: 99%

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Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

et al. 2020

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Despite increasing improvement in extracorporeal membrane oxygenation (ECMO) technology and knowledge, thrombocytopenia and impaired platelet function are usual findings in ECMO patients and the underlying mechanisms are only partially elucidated. The purpose of this meta-analysis and systematic review was to thoroughly summarize and discuss the existing knowledge of platelet profile in adult ECMO population. All studies meeting the inclusion criteria (detailed data about platelet count and function) were selected, after screening literature from July 1975 to August 2019. Twenty-one studies from 1.742 abstracts were selected. The pooled prevalence of thrombocytopenia in ECMO patients was 21% (95% CI 12.9-29.0; 14 studies). Thrombocytopenia prevalence was 25.4% (95% CI 10.6-61.4; 4 studies) in veno-venous ECMO, whereas it was 23.2% (95% CI 11.8-34.5; 6 studies) in veno-arterial ECMO. Heparin-induced thrombocytopenia prevalence was 3.7% (95% CI 1.8-5.5; 12 studies). Meta-regression revealed no significant association between ECMO duration and thrombocytopenia. Platelet function impairment was described in 7 studies. Impaired aggregation was shown in 5 studies, whereas loss of platelet receptors was found in one trial, and platelet activation was described in 2 studies. Platelet transfusions were needed in up to 50% of the patients. Red blood cell transfusions were administered from 46 to 100% of the ECMO patients. Bleeding events varied from 16.6 to 50.7%, although the cause and type of haemorrhage was not consistently reported. Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations.

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Section: • Thrombocytopeniamentioning

confidence: 73%

Section: Study Descriptionmentioning

confidence: 99%

Section: • Thrombocytopeniamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

et al. 2020

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“…Sokolovic et al reported that in a cohort of adult ECMO patients, eight of 96 patients were positive for HIT (positive SRA or H/PF4 ELISA with OD >1) and seven of those patients had documented thrombotic events (HITT) based on predefined criteria (HIT and HITT incidence in the study group of 8.3% and 7.3%, respectively). HIT‐positive patients were significantly younger and had a trend toward higher average HIT ELISA OD.…”

Section: Hit and Ecmomentioning

confidence: 99%

Heparin‐induced thrombocytopenia complicating extracorporeal membrane oxygenation support: Review of the literature and alternative anticoagulants

Pollak

2019

Journal of Thrombosis and Haemostasis

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Heparin‐induced thrombocytopenia (HIT) is a life‐threatening prothrombotic, immune‐mediated complication of unfractionated heparin and low molecular weight heparin therapy. HIT is characterized by moderate thrombocytopenia 5‐10 days after initial heparin exposure, detection of platelet‐activating anti‐platelet factor 4/heparin antibodies and an increased risk of venous and arterial thrombosis. Extracorporeal membrane oxygenation (ECMO) is a form of mechanical circulatory support used in critically ill patients with respiratory or cardiac failure. Systemic anticoagulation is used to alleviate the thrombotic complications that may occur when blood is exposed to artificial surfaces within the ECMO circuit. Therefore, when HIT complicates patients on ECMO support, it is associated with a high thrombotic morbidity and mortality. The risk for HIT correlates with the accumulative dosage of heparin exposure. In ECMO patients receiving continuous infusion of heparin for circuit patency, the risk for HIT is not neglected and must be thought of in the differential diagnosis of the appropriate clinical and laboratory circumstances. The following article reviews the current knowledge in HIT complicating ECMO patients and the alternative anticoagulation options in the presence of HIT.

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Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study

et al. 2018

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Platelet Count Trends and Prevalence of Heparin-Induced Thrombocytopenia in a Cohort of Extracorporeal Membrane Oxygenator Patients

Cited by 41 publications

References 30 publications

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

Heparin‐induced thrombocytopenia complicating extracorporeal membrane oxygenation support: Review of the literature and alternative anticoagulants

Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study

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