In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 8 ( 2022-8-8), p. e0272577-
Abstract:
Unfractionated heparin (UFH) is the commonly used anticoagulant to prevent clotting of the ECMO circuit and thrombosis of the cannulated vessels. A side effect of UFH is heparin-induced thrombocytopenia (HIT). Little is known about HIT during ECMO and the impact of changing anticoagulation in ECMO patients with newly diagnosed HIT. The aim of the study was to determine the prevalence, complications, impact of switching anticoagulation to argatroban and outcomes of patients developing heparin-induced thrombocytopenia (HIT) during either veno-venous (VV) or veno-arterial (VA) ECMO. Methods Retrospective observational single centre study of prospectively collected data of consecutive patients receiving VV ECMO therapy for severe respiratory failure and VA ECMO for circulatory failure from January 2006 to December 2016 of the Medical intensive care unit (ICU) of the University Hospital of Regensburg. Treatment of HIT on ECMO was done with argatroban. Results 507 patients requiring ECMO were included. Further HIT-diagnostic was conducted if HIT-4T-score was ≥4. The HIT-confirmed group had positive HIT-enzyme-linked-immunosorbent-assay (ELISA) and positive heparin-induced-platelet-activation (HIPA) test, the HIT-suspicion group a positive HIT-ELISA and missing HIPA but remained on alternative anticoagulation until discharge and the HIT-excluded group a negative or positive HIT-ELISA, however negative HIPA. These were compared to group ECMO-control without any HIT suspicion. The prevalence of HIT-confirmed was 3.2%, of HIT-suspicion 2.0% and HIT-excluded 10.8%. Confirmed HIT was trendwise more frequent in VV than in VA (3.9 vs. 1.7% p = 0.173). Compared to the ECMO control group, patients with confirmed HIT were longer on ECMO (median 13 vs. 8 days, p = 0.002). Different types of complications were higher in the HIT-confirmed than in the ECMO-control group, but in-hospital mortality was not different (31% vs. 41%, p = 0.804). Conclusion HIT is rare on ECMO, should be suspected, if platelets are decreasing, but seems not to increase mortality if treated promptly.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0272577
DOI:
10.1371/journal.pone.0272577.g001
DOI:
10.1371/journal.pone.0272577.g002
DOI:
10.1371/journal.pone.0272577.g003
DOI:
10.1371/journal.pone.0272577.t001
DOI:
10.1371/journal.pone.0272577.t002
DOI:
10.1371/journal.pone.0272577.s001
DOI:
10.1371/journal.pone.0272577.s002
DOI:
10.1371/journal.pone.0272577.s003
DOI:
10.1371/journal.pone.0272577.s004
DOI:
10.1371/journal.pone.0272577.s005
DOI:
10.1371/journal.pone.0272577.s006
DOI:
10.1371/journal.pone.0272577.s007
DOI:
10.1371/journal.pone.0272577.s008
DOI:
10.1371/journal.pone.0272577.s009
DOI:
10.1371/journal.pone.0272577.s010
DOI:
10.1371/journal.pone.0272577.s011
DOI:
10.1371/journal.pone.0272577.s012
DOI:
10.1371/journal.pone.0272577.s013
DOI:
10.1371/journal.pone.0272577.s014
DOI:
10.1371/journal.pone.0272577.s015
DOI:
10.1371/journal.pone.0272577.s016
DOI:
10.1371/journal.pone.0272577.s017
DOI:
10.1371/journal.pone.0272577.s018
DOI:
10.1371/journal.pone.0272577.r001
DOI:
10.1371/journal.pone.0272577.r002
DOI:
10.1371/journal.pone.0272577.r003
DOI:
10.1371/journal.pone.0272577.r004
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3
Bookmarklink