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The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study

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 asc...

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Autores principales: Raasveld, Senta Jorinde, van den Oord, Claudia, Schenk, Jimmy, van den Bergh, Walter M., Oude Lansink - Hartgring, Annemieke, van der Velde, Franciska, Maas, Jacinta J., van de Berg, Pablo, Lorusso, Roberto, Delnoij, Thijs S. R., Dos Reis Miranda, Dinis, Scholten, Erik, Taccone, Fabio Silvio, Dauwe, Dieter F., De Troy, Erwin, Hermans, Greet, Pappalardo, Federico, Fominskiy, Evgeny, Ivancan, Višnja, Bojčić, Robert, de Metz, Jesse, van den Bogaard, Bas, Donker, Dirk W., Meuwese, Christiaan L., De Bakker, Martin, Reddi, Benjamin, Henriques, José P. S., Broman, Lars Mikael, Dongelmans, Dave A., Vlaar, Alexander P. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10441744/
https://www.ncbi.nlm.nih.gov/pubmed/37605277
http://dx.doi.org/10.1186/s13054-023-04612-5
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author Raasveld, Senta Jorinde
van den Oord, Claudia
Schenk, Jimmy
van den Bergh, Walter M.
Oude Lansink - Hartgring, Annemieke
van der Velde, Franciska
Maas, Jacinta J.
van de Berg, Pablo
Lorusso, Roberto
Delnoij, Thijs S. R.
Dos Reis Miranda, Dinis
Scholten, Erik
Taccone, Fabio Silvio
Dauwe, Dieter F.
De Troy, Erwin
Hermans, Greet
Pappalardo, Federico
Fominskiy, Evgeny
Ivancan, Višnja
Bojčić, Robert
de Metz, Jesse
van den Bogaard, Bas
Donker, Dirk W.
Meuwese, Christiaan L.
De Bakker, Martin
Reddi, Benjamin
Henriques, José P. S.
Broman, Lars Mikael
Dongelmans, Dave A.
Vlaar, Alexander P. J.
author_facet Raasveld, Senta Jorinde
van den Oord, Claudia
Schenk, Jimmy
van den Bergh, Walter M.
Oude Lansink - Hartgring, Annemieke
van der Velde, Franciska
Maas, Jacinta J.
van de Berg, Pablo
Lorusso, Roberto
Delnoij, Thijs S. R.
Dos Reis Miranda, Dinis
Scholten, Erik
Taccone, Fabio Silvio
Dauwe, Dieter F.
De Troy, Erwin
Hermans, Greet
Pappalardo, Federico
Fominskiy, Evgeny
Ivancan, Višnja
Bojčić, Robert
de Metz, Jesse
van den Bogaard, Bas
Donker, Dirk W.
Meuwese, Christiaan L.
De Bakker, Martin
Reddi, Benjamin
Henriques, José P. S.
Broman, Lars Mikael
Dongelmans, Dave A.
Vlaar, Alexander P. J.
author_sort Raasveld, Senta Jorinde
collection PubMed
description 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(9)/L), moderate (50–100·10(9)/L) and severe (< 50·10(9)/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(9)/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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-023-04612-5.
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spelling pubmed-104417442023-08-22 The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study Raasveld, Senta Jorinde van den Oord, Claudia Schenk, Jimmy van den Bergh, Walter M. Oude Lansink - Hartgring, Annemieke van der Velde, Franciska Maas, Jacinta J. van de Berg, Pablo Lorusso, Roberto Delnoij, Thijs S. R. Dos Reis Miranda, Dinis Scholten, Erik Taccone, Fabio Silvio Dauwe, Dieter F. De Troy, Erwin Hermans, Greet Pappalardo, Federico Fominskiy, Evgeny Ivancan, Višnja Bojčić, Robert de Metz, Jesse van den Bogaard, Bas Donker, Dirk W. Meuwese, Christiaan L. De Bakker, Martin Reddi, Benjamin Henriques, José P. S. Broman, Lars Mikael Dongelmans, Dave A. Vlaar, Alexander P. J. Crit Care Research 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(9)/L), moderate (50–100·10(9)/L) and severe (< 50·10(9)/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(9)/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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-023-04612-5. BioMed Central 2023-08-21 /pmc/articles/PMC10441744/ /pubmed/37605277 http://dx.doi.org/10.1186/s13054-023-04612-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Raasveld, Senta Jorinde
van den Oord, Claudia
Schenk, Jimmy
van den Bergh, Walter M.
Oude Lansink - Hartgring, Annemieke
van der Velde, Franciska
Maas, Jacinta J.
van de Berg, Pablo
Lorusso, Roberto
Delnoij, Thijs S. R.
Dos Reis Miranda, Dinis
Scholten, Erik
Taccone, Fabio Silvio
Dauwe, Dieter F.
De Troy, Erwin
Hermans, Greet
Pappalardo, Federico
Fominskiy, Evgeny
Ivancan, Višnja
Bojčić, Robert
de Metz, Jesse
van den Bogaard, Bas
Donker, Dirk W.
Meuwese, Christiaan L.
De Bakker, Martin
Reddi, Benjamin
Henriques, José P. S.
Broman, Lars Mikael
Dongelmans, Dave A.
Vlaar, Alexander P. J.
The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
title The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
title_full The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
title_fullStr The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
title_full_unstemmed The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
title_short The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
title_sort interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10441744/
https://www.ncbi.nlm.nih.gov/pubmed/37605277
http://dx.doi.org/10.1186/s13054-023-04612-5
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