Transplantation in a patient on extracorporeal membrane oxygenation with infective endocarditis, pericarditis and heparin-induced thrombocytopenia

Chen, Eunise; Clarke, Nicholas S.; Huffman, Lynn C.; Peltz, Matthias

doi:10.1093/icvts/ivw359

Cited by 9 publications

(19 citation statements)

References 5 publications

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“…No significant bleeding was mentioned. Chen et al reported a 55‐year‐old man who developed HIT while on ECMO because of cardiogenic shock. After HIT was suspected (and later confirmed), anticoagulation with bivalirudin was initiated without any adverse effects.…”

Section: Treatment Of Hitmentioning

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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Section: Treatment Of Hitmentioning

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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“…H-PF4 antibody enzyme-linked immunosorbent assay (ELISA) was performed as a screening test for HIT (13,14), where optical density (OD) values of equal to or greater than 0.4 was considered positive. Following a positive screening test, the diagnosis was usually confirmed by either functional assays, such as serotonin release assay (SRA) (6,8,(15)(16)(17) or heparin induced platelet aggregation assay (HIPA) (5,18,19), or a strong clinical suspicion of HIT with subsequent recovery of thrombocytopenia following heparin discontinuation (8,10,(20)(21)(22)(23)(24). High positive ELISA test result (e.g., OD >1.0) alone was sometimes considered sufficient to confirm the diagnosis of HIT (6,25).…”

Section: Definitionsmentioning

confidence: 99%

Heparin-induced thrombocytopenia during extracorporeal life support: incidence, management and outcomes

Choi

Luc

Weber

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Heparin-induced thrombocytopenia (HIT) is a severe antibody-mediated reaction leading to transient prothrombosis. However, its incidence in patients on extracorporeal life support (ECLS) is not well described. The aim of this systematic review was to report the incidence of HIT in patients on ECLS, as well as compare the characteristics and outcomes of HIT in patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and veno-venous ECMO (VV-ECMO). Methods: An electronic search was performed to identify all studies in the English literature examining outcomes of patients with HIT on ECLS. All identified articles were systematically assessed using specific inclusion and exclusion criteria. Random effects meta-analysis as well as univariate analysis was performed. Results: Of 309 patients from six retrospective studies undergoing ECLS, 83% were suspected, and 17% were confirmed to have HIT. Due to the sparsity of relevant retrospective data regarding patients with confirmed HIT on ECLS, patient-based data was subsequently collected on 28 patients from case reports and case series. Out of these 28 patients, 53.6% and 46.4% of them underwent VA-ECMO and VV-ECMO, respectively. Patients on VA-ECMO had a lower median platelet count nadir (VA-ECMO: 26.0 vs. VV-ECMO: 45.0 per µL, P=0.012) and were more likely to experience arterial thromboembolism (VA-ECMO: 53.3% vs. VV-ECMO: 0.0%, P=0.007), though there was a trend towards decreased likelihood of experiencing ECLS circuit oxygenator thromboembolism (VA-ECMO: 0.0% vs. VV-ECMO: 30.8%, P=0.075) and thromboembolism necessitating ECLS device or circuit exchange (VA-ECMO: 13.3% vs. VV-ECMO 53.8%, P=0.060). Kaplan-Meier survival plots including time from ECLS initiation reveal no significant differences in survival in patients supported on VA-ECMO as compared to VV-ECMO (P=0.300). Conclusions: Patients who develop HIT on VA-ECMO are more likely to experience more severe thrombocytopenia and arterial thromboembolism than those on VV-ECMO. Further research in this area and development of standardized protocols for the monitoring, diagnosis and management of HIT in patients on ECLS support are warranted.

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“…Nineteen unique cases of heart transplantation in the setting of active IE derived from 14 publications were included in our analysis . The median age was 44 years (23‐64 years).…”

Section: Resultsmentioning

confidence: 99%

“…The other patient had undergone prior HT . One patient had a nonischemic cardiomyopathy and coexisting heparin‐induced thrombocytopenia . Finally, one patient had a history of a valved conduit for aortic stenosis, an ascending aortic aneurysm complicated by decreased systolic function, and complete heart block requiring pacemaker placement.…”

Section: Resultsmentioning

confidence: 99%

Heart transplantation for infective endocarditis: Viable option for a limited few?

Murphy

Vikram

2018

Transplant Infectious Dis

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Active infection in the recipient is considered a relative contraindication for solid organ transplantation. However, heart transplantation (HT) can be curative in patients with ventricular assist device infections. For patients with infective endocarditis (IE), valve replacement is part of the management strategy based on emergent, acute, or elective indications. HT has been utilized as an uncommon and sporadic treatment option for carefully selected patients with refractory or recurrent IE after all other surgical treatment options have been exhausted or are not feasible. Herein, we review 19 published cases of IE in whom HT was undertaken in the setting of ongoing active infection with reported good outcomes. We attempt to propose general criteria for HT in the setting of IE and discuss challenges and hurdles that clinicians might encounter when considering HT for active IE in the absence of robust data or clearly defined criteria. K E Y W O R D S endocarditis, heart, transplant, transplantation, ventricular assist device Number Reference Pathogen at time of HT Prior pathogens Prior valve culture Antimicrobial treatment for IE pre-HT Blood cultures at HT Peripheral embolic sites of infection Duration of antimicrobial treatment pre-HT (Approx.) Pathology of explanted heart Explanted heart culture Antimicrobials post-HT Duration antimicrobial treatment post-HT

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Transplantation in a patient on extracorporeal membrane oxygenation with infective endocarditis, pericarditis and heparin-induced thrombocytopenia

Cited by 9 publications

References 5 publications

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

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

Heparin-induced thrombocytopenia during extracorporeal life support: incidence, management and outcomes

Heart transplantation for infective endocarditis: Viable option for a limited few?

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