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Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation

Background: Heparin-induced thrombocytopenia (HIT) is a serious, immune-mediated adverse drug reaction to unfractionated heparin (UFH) affecting also patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). Although the association between VA-ECMO support and the development o...

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Autores principales: Lüsebrink, Enzo, Scherer, Clemens, Binzenhöfer, Leonhard, Hoffmann, Sabine, Höpler, Julia, Kellnar, Antonia, Thienel, Manuela, Joskowiak, Dominik, Peterß, Sven, Petzold, Tobias, Deseive, Simon, Hein, Ralph, Brunner, Stefan, Kääb, Stefan, Braun, Daniel, Theiss, Hans, Hausleiter, Jörg, Hagl, Christian, Massberg, Steffen, Orban, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9821297/
https://www.ncbi.nlm.nih.gov/pubmed/36615162
http://dx.doi.org/10.3390/jcm12010362
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author Lüsebrink, Enzo
Scherer, Clemens
Binzenhöfer, Leonhard
Hoffmann, Sabine
Höpler, Julia
Kellnar, Antonia
Thienel, Manuela
Joskowiak, Dominik
Peterß, Sven
Petzold, Tobias
Deseive, Simon
Hein, Ralph
Brunner, Stefan
Kääb, Stefan
Braun, Daniel
Theiss, Hans
Hausleiter, Jörg
Hagl, Christian
Massberg, Steffen
Orban, Martin
author_facet Lüsebrink, Enzo
Scherer, Clemens
Binzenhöfer, Leonhard
Hoffmann, Sabine
Höpler, Julia
Kellnar, Antonia
Thienel, Manuela
Joskowiak, Dominik
Peterß, Sven
Petzold, Tobias
Deseive, Simon
Hein, Ralph
Brunner, Stefan
Kääb, Stefan
Braun, Daniel
Theiss, Hans
Hausleiter, Jörg
Hagl, Christian
Massberg, Steffen
Orban, Martin
author_sort Lüsebrink, Enzo
collection PubMed
description Background: Heparin-induced thrombocytopenia (HIT) is a serious, immune-mediated adverse drug reaction to unfractionated heparin (UFH) affecting also patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). Although the association between VA-ECMO support and the development of thrombocytopenia has long been known and discussed, HIT as one underlying cause is still insufficiently understood. Therefore, the purpose of this study was to further investigate the epidemiology, mortality, diagnosis, and clinical management of HIT occurring in VA-ECMO patients treated with UFH. Methods: We conducted a retrospective single-center study including adult patients (≥18 years) with VA-ECMO support in the cardiac intensive care unit (ICU) of the University Hospital of Munich (LMU) between January 2013 and May 2022, excluding patients with a known history of HIT upon admission. Differences in baseline characteristics and clinical outcome between excluded HIT (positive anti-platelet factor 4 (PF4)/heparin antibody test but negative functional assay) and confirmed HIT (positive anti-PF4/heparin antibody test and positive functional assay) VA-ECMO patients as well as diagnosis and clinical management of HIT were analysed. Results: Among the 373 patients included, anti-PF4/heparin antibodies were detected in 53/373 (14.2%) patients. Functional HIT testing confirmed HIT in 13 cases (3.5%) and excluded HIT in 40 cases (10.7%), corresponding to a prevalence of confirmed HIT of 13/373 (3.5%) [1.6, 5.3] and a positive predictive value (PPV) of 24.5% for the antibody screening test. The platelet course including platelet recovery following argatroban initiation was similar between all groups. One-month mortality in patients with excluded HIT was 14/40 (35%) and 3-month mortality 17/40 (43%), compared to 5/13 (38%) (p > 0.999), and 6/13 (46%) (p > 0.999) in patients with confirmed HIT. Neurological outcome in both groups measured by the cerebral performance category of survivors on hospital discharge was similar, as well as adverse events during VA-ECMO therapy. Conclusions: With a prevalence of 3.5%, HIT is a non-frequent complication in patients on VA-ECMO and was not associated with a higher mortality rate. HIT was ultimately excluded by functional essay in 75% of VA-ECMO patients with clinical suspicion of HIT and positive anti-PF4/heparin antibody test. Argatroban seems to be an appropriate and safe therapeutic option for confirmed HIT-positive patients on VA-ECMO support.
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spelling pubmed-98212972023-01-07 Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation Lüsebrink, Enzo Scherer, Clemens Binzenhöfer, Leonhard Hoffmann, Sabine Höpler, Julia Kellnar, Antonia Thienel, Manuela Joskowiak, Dominik Peterß, Sven Petzold, Tobias Deseive, Simon Hein, Ralph Brunner, Stefan Kääb, Stefan Braun, Daniel Theiss, Hans Hausleiter, Jörg Hagl, Christian Massberg, Steffen Orban, Martin J Clin Med Article Background: Heparin-induced thrombocytopenia (HIT) is a serious, immune-mediated adverse drug reaction to unfractionated heparin (UFH) affecting also patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). Although the association between VA-ECMO support and the development of thrombocytopenia has long been known and discussed, HIT as one underlying cause is still insufficiently understood. Therefore, the purpose of this study was to further investigate the epidemiology, mortality, diagnosis, and clinical management of HIT occurring in VA-ECMO patients treated with UFH. Methods: We conducted a retrospective single-center study including adult patients (≥18 years) with VA-ECMO support in the cardiac intensive care unit (ICU) of the University Hospital of Munich (LMU) between January 2013 and May 2022, excluding patients with a known history of HIT upon admission. Differences in baseline characteristics and clinical outcome between excluded HIT (positive anti-platelet factor 4 (PF4)/heparin antibody test but negative functional assay) and confirmed HIT (positive anti-PF4/heparin antibody test and positive functional assay) VA-ECMO patients as well as diagnosis and clinical management of HIT were analysed. Results: Among the 373 patients included, anti-PF4/heparin antibodies were detected in 53/373 (14.2%) patients. Functional HIT testing confirmed HIT in 13 cases (3.5%) and excluded HIT in 40 cases (10.7%), corresponding to a prevalence of confirmed HIT of 13/373 (3.5%) [1.6, 5.3] and a positive predictive value (PPV) of 24.5% for the antibody screening test. The platelet course including platelet recovery following argatroban initiation was similar between all groups. One-month mortality in patients with excluded HIT was 14/40 (35%) and 3-month mortality 17/40 (43%), compared to 5/13 (38%) (p > 0.999), and 6/13 (46%) (p > 0.999) in patients with confirmed HIT. Neurological outcome in both groups measured by the cerebral performance category of survivors on hospital discharge was similar, as well as adverse events during VA-ECMO therapy. Conclusions: With a prevalence of 3.5%, HIT is a non-frequent complication in patients on VA-ECMO and was not associated with a higher mortality rate. HIT was ultimately excluded by functional essay in 75% of VA-ECMO patients with clinical suspicion of HIT and positive anti-PF4/heparin antibody test. Argatroban seems to be an appropriate and safe therapeutic option for confirmed HIT-positive patients on VA-ECMO support. MDPI 2023-01-02 /pmc/articles/PMC9821297/ /pubmed/36615162 http://dx.doi.org/10.3390/jcm12010362 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lüsebrink, Enzo
Scherer, Clemens
Binzenhöfer, Leonhard
Hoffmann, Sabine
Höpler, Julia
Kellnar, Antonia
Thienel, Manuela
Joskowiak, Dominik
Peterß, Sven
Petzold, Tobias
Deseive, Simon
Hein, Ralph
Brunner, Stefan
Kääb, Stefan
Braun, Daniel
Theiss, Hans
Hausleiter, Jörg
Hagl, Christian
Massberg, Steffen
Orban, Martin
Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation
title Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation
title_full Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation
title_fullStr Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation
title_full_unstemmed Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation
title_short Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation
title_sort heparin-induced thrombocytopenia in patients undergoing venoarterial extracorporeal membrane oxygenation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9821297/
https://www.ncbi.nlm.nih.gov/pubmed/36615162
http://dx.doi.org/10.3390/jcm12010362
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