TY - JOUR
T1 - The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation
T2 - a multicenter observational study
AU - Raasveld, Senta Jorinde
AU - van den Oord, Claudia
AU - Schenk, Jimmy
AU - van den Bergh, Walter M
AU - Oude Lansink-Hartgring, Annemieke
AU - van der Velde, Franciska
AU - Maas, Jacinta J
AU - van de Berg, Pablo
AU - Lorusso, Roberto
AU - Delnoij, Thijs S R
AU - Dos Reis Miranda, Dinis
AU - Scholten, Erik
AU - Taccone, Fabio Silvio
AU - Dauwe, Dieter F
AU - De Troy, Erwin
AU - Hermans, Greet
AU - Pappalardo, Federico
AU - Fominskiy, Evgeny
AU - Ivancan, Višnja
AU - Bojcic, Robert
AU - de Metz, Jesse
AU - van den Bogaard, Bas
AU - Donker, Dirk W
AU - Meuwese, Christiaan L
AU - De Bakker, Martin
AU - Reddi, Benjamin
AU - Henriques, José P S
AU - Broman, Lars Mikael
AU - Dongelmans, Dave A
AU - Vlaar, Alexander P J
PY - 2023/8/21
Y1 - 2023/8/21
N2 - BACKGROUND: Thrombocytopenia, hemorrhage and platelet transfusion are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). However, current literature is limited to small single-center experiences with high degrees of heterogeneity. Therefore, we aimed to ascertain in a multicenter study the course and occurrence rate of thrombocytopenia, and to assess the association between thrombocytopenia, hemorrhage and platelet transfusion during VA ECMO. METHODS: This was a sub-study of a multicenter (N?=?16) study on transfusion practices in patients on VA ECMO, in which a retrospective cohort (Jan-2018-Jul-2019) focusing on platelets was selected. The primary outcome was thrombocytopenia during VA ECMO, defined as mild (100-150·10 /L), moderate (50-100·10 /L) and severe (<?50·10 /L). Secondary outcomes included the occurrence rate of platelet transfusion, and the association between thrombocytopenia, hemorrhage and platelet transfusion, assessed through mixed-effect models. RESULTS: Of the 419 patients included, median platelet count at admission was 179·10 /L. During VA ECMO, almost all (N?=?398, 95%) patients developed a thrombocytopenia, of which a significant part severe (N?=?179, 45%). One or more platelet transfusions were administered in 226 patients (54%), whereas 207 patients (49%) suffered a hemorrhagic event during VA ECMO. In non-bleeding patients, still one in three patients received a platelet transfusion. The strongest association to receive a platelet transfusion was found in the presence of severe thrombocytopenia (adjusted OR 31.8, 95% CI 17.9-56.5). After including an interaction term of hemorrhage and thrombocytopenia, this even increased up to an OR of 110 (95% CI 34-360). CONCLUSIONS: Thrombocytopenia has a higher occurrence than is currently recognized. Severe thrombocytopenia is strongly associated with platelet transfusion. Future studies should focus on the etiology of severe thrombocytopenia during ECMO, as well as identifying indications and platelet thresholds for transfusion in the absence of bleeding. TRIAL REGISTRATION: This study was registered at the Netherlands Trial Registry at February 26th, 2020 with number NL8413 and can currently be found at https://trialsearch.who.int/Trial2.aspx?TrialID=NL8413.
AB - BACKGROUND: Thrombocytopenia, hemorrhage and platelet transfusion are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). However, current literature is limited to small single-center experiences with high degrees of heterogeneity. Therefore, we aimed to ascertain in a multicenter study the course and occurrence rate of thrombocytopenia, and to assess the association between thrombocytopenia, hemorrhage and platelet transfusion during VA ECMO. METHODS: This was a sub-study of a multicenter (N?=?16) study on transfusion practices in patients on VA ECMO, in which a retrospective cohort (Jan-2018-Jul-2019) focusing on platelets was selected. The primary outcome was thrombocytopenia during VA ECMO, defined as mild (100-150·10 /L), moderate (50-100·10 /L) and severe (<?50·10 /L). Secondary outcomes included the occurrence rate of platelet transfusion, and the association between thrombocytopenia, hemorrhage and platelet transfusion, assessed through mixed-effect models. RESULTS: Of the 419 patients included, median platelet count at admission was 179·10 /L. During VA ECMO, almost all (N?=?398, 95%) patients developed a thrombocytopenia, of which a significant part severe (N?=?179, 45%). One or more platelet transfusions were administered in 226 patients (54%), whereas 207 patients (49%) suffered a hemorrhagic event during VA ECMO. In non-bleeding patients, still one in three patients received a platelet transfusion. The strongest association to receive a platelet transfusion was found in the presence of severe thrombocytopenia (adjusted OR 31.8, 95% CI 17.9-56.5). After including an interaction term of hemorrhage and thrombocytopenia, this even increased up to an OR of 110 (95% CI 34-360). CONCLUSIONS: Thrombocytopenia has a higher occurrence than is currently recognized. Severe thrombocytopenia is strongly associated with platelet transfusion. Future studies should focus on the etiology of severe thrombocytopenia during ECMO, as well as identifying indications and platelet thresholds for transfusion in the absence of bleeding. TRIAL REGISTRATION: This study was registered at the Netherlands Trial Registry at February 26th, 2020 with number NL8413 and can currently be found at https://trialsearch.who.int/Trial2.aspx?TrialID=NL8413.
KW - Hemorrhage
KW - Platelet transfusion
KW - Thrombocytopenia
KW - Venoarterial extracorporeal membrane oxygenation
KW - Humans
KW - Platelet Transfusion/adverse effects
KW - Extracorporeal Membrane Oxygenation/adverse effects
KW - Retrospective Studies
KW - Hemorrhage/etiology therapy
KW - Thrombocytopenia/complications therapy
U2 - 10.1186/s13054-023-04612-5
DO - 10.1186/s13054-023-04612-5
M3 - Article
SN - 1364-8535
VL - 27
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 321
ER -