The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study
Abstract 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 aime...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-08-01
|
| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04612-5 |
| _version_ | 1797736430811742208 |
|---|---|
| author | Senta Jorinde Raasveld Claudia van den Oord Jimmy Schenk Walter M. van den Bergh Annemieke Oude Lansink - Hartgring Franciska van der Velde Jacinta J. Maas Pablo van de Berg Roberto Lorusso Thijs S. R. Delnoij Dinis Dos Reis Miranda Erik Scholten Fabio Silvio Taccone Dieter F. Dauwe Erwin De Troy Greet Hermans Federico Pappalardo Evgeny Fominskiy Višnja Ivancan Robert Bojčić Jesse de Metz Bas van den Bogaard Dirk W. Donker Christiaan L. Meuwese Martin De Bakker Benjamin Reddi José P. S. Henriques Lars Mikael Broman Dave A. Dongelmans Alexander P. J. Vlaar |
| author_facet | Senta Jorinde Raasveld Claudia van den Oord Jimmy Schenk Walter M. van den Bergh Annemieke Oude Lansink - Hartgring Franciska van der Velde Jacinta J. Maas Pablo van de Berg Roberto Lorusso Thijs S. R. Delnoij Dinis Dos Reis Miranda Erik Scholten Fabio Silvio Taccone Dieter F. Dauwe Erwin De Troy Greet Hermans Federico Pappalardo Evgeny Fominskiy Višnja Ivancan Robert Bojčić Jesse de Metz Bas van den Bogaard Dirk W. Donker Christiaan L. Meuwese Martin De Bakker Benjamin Reddi José P. S. Henriques Lars Mikael Broman Dave A. Dongelmans Alexander P. J. Vlaar |
| author_sort | Senta Jorinde Raasveld |
| collection | DOAJ |
| description | Abstract 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 (100–150·109/L), moderate (50–100·109/L) and severe (< 50·109/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 179·109/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. |
| first_indexed | 2024-03-12T13:13:46Z |
| format | Article |
| id | doaj.art-bea9fbe3542b4c99a1aa9dbb4e8fd887 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-12T13:13:46Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-bea9fbe3542b4c99a1aa9dbb4e8fd8872023-08-27T11:19:43ZengBMCCritical Care1364-85352023-08-0127111210.1186/s13054-023-04612-5The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational studySenta Jorinde Raasveld0Claudia van den Oord1Jimmy Schenk2Walter M. van den Bergh3Annemieke Oude Lansink - Hartgring4Franciska van der Velde5Jacinta J. Maas6Pablo van de Berg7Roberto Lorusso8Thijs S. R. Delnoij9Dinis Dos Reis Miranda10Erik Scholten11Fabio Silvio Taccone12Dieter F. Dauwe13Erwin De Troy14Greet Hermans15Federico Pappalardo16Evgeny Fominskiy17Višnja Ivancan18Robert Bojčić19Jesse de Metz20Bas van den Bogaard21Dirk W. Donker22Christiaan L. Meuwese23Martin De Bakker24Benjamin Reddi25José P. S. Henriques26Lars Mikael Broman27Dave A. Dongelmans28Alexander P. J. Vlaar29Department of Critical Care, Amsterdam University Medical CentersDepartment of Critical Care, Amsterdam University Medical CentersDepartment of Critical Care, Amsterdam University Medical CentersDepartment of Critical Care, University Medical Center Groningen, University of GroningenDepartment of Critical Care, University Medical Center Groningen, University of GroningenAdult Intensive Care Unit, Leiden University Medical CenterAdult Intensive Care Unit, Leiden University Medical CenterAdult Intensive Care Unit, Catharina Hospital EindhovenCardiothoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CARIM)Department of Cardiology, Maastricht University Medical CenterAdult Intensive Care Unit, Erasmus University Medical CenterDepartment of Intensive Care, St. Antonius HospitalDepartment of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme BruxellesSurgical Intensive Care Unit, Department of Intensive Care Medicine, University Hospital LeuvenSurgical Intensive Care Unit, Department of Intensive Care Medicine, University Hospital LeuvenMedical Intensive Care Unit, Department of General Internal Medicine, University Hospitals LeuvenDepartment of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare ArrigoDepartment of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific InstituteDepartment of Anesthesia and Intensive Care, University Hospital Centre ZagrebDepartment of Anesthesia and Intensive Care, University Hospital Centre ZagrebDepartment of Intensive Care, OLVGDepartment of Intensive Care, OLVGIntensive Care Center, University Medical Center Utrecht (UMCU)Adult Intensive Care Unit, Erasmus University Medical CenterDepartment of Critical Care, Royal Adelaide HospitalDepartment of Critical Care, Royal Adelaide HospitalDepartment of Cardiology, Amsterdam University Medical CentersECMO Center Karolinska, Karolinska University HospitalDepartment of Critical Care, Amsterdam University Medical CentersDepartment of Critical Care, Amsterdam University Medical CentersAbstract 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 (100–150·109/L), moderate (50–100·109/L) and severe (< 50·109/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 179·109/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.https://doi.org/10.1186/s13054-023-04612-5ThrombocytopeniaPlatelet transfusionHemorrhageVenoarterial extracorporeal membrane oxygenation |
| spellingShingle | Senta Jorinde Raasveld Claudia van den Oord Jimmy Schenk Walter M. van den Bergh Annemieke Oude Lansink - Hartgring Franciska van der Velde Jacinta J. Maas Pablo van de Berg Roberto Lorusso Thijs S. R. Delnoij Dinis Dos Reis Miranda Erik Scholten Fabio Silvio Taccone Dieter F. Dauwe Erwin De Troy Greet Hermans Federico Pappalardo Evgeny Fominskiy Višnja Ivancan Robert Bojčić Jesse de Metz Bas van den Bogaard Dirk W. Donker Christiaan L. Meuwese Martin De Bakker Benjamin Reddi José P. S. Henriques Lars Mikael Broman Dave A. Dongelmans Alexander P. J. Vlaar The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study Critical Care Thrombocytopenia Platelet transfusion Hemorrhage Venoarterial extracorporeal membrane oxygenation |
| 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 | Thrombocytopenia Platelet transfusion Hemorrhage Venoarterial extracorporeal membrane oxygenation |
| url | https://doi.org/10.1186/s13054-023-04612-5 |
| work_keys_str_mv | AT sentajorinderaasveld theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT claudiavandenoord theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT jimmyschenk theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT waltermvandenbergh theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT annemiekeoudelansinkhartgring theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT franciskavandervelde theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT jacintajmaas theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT pablovandeberg theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT robertolorusso theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT thijssrdelnoij theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT dinisdosreismiranda theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT erikscholten theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT fabiosilviotaccone theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT dieterfdauwe theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT erwindetroy theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT greethermans theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT federicopappalardo theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT evgenyfominskiy theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT visnjaivancan theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT robertbojcic theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT jessedemetz theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT basvandenbogaard theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT dirkwdonker theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT christiaanlmeuwese theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT martindebakker theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT benjaminreddi theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT josepshenriques theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT larsmikaelbroman theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT daveadongelmans theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT alexanderpjvlaar theinteractionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT sentajorinderaasveld interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT claudiavandenoord interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT jimmyschenk interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT waltermvandenbergh interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT annemiekeoudelansinkhartgring interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT franciskavandervelde interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT jacintajmaas interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT pablovandeberg interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT robertolorusso interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT thijssrdelnoij interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT dinisdosreismiranda interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT erikscholten interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT fabiosilviotaccone interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT dieterfdauwe interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT erwindetroy interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT greethermans interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT federicopappalardo interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT evgenyfominskiy interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT visnjaivancan interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT robertbojcic interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT jessedemetz interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT basvandenbogaard interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT dirkwdonker interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT christiaanlmeuwese interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT martindebakker interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT benjaminreddi interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT josepshenriques interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT larsmikaelbroman interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT daveadongelmans interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy AT alexanderpjvlaar interactionofthrombocytopeniahemorrhageandplatelettransfusioninvenoarterialextracorporealmembraneoxygenationamulticenterobservationalstudy |