Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study

Intensive Care Med. 2018 Sep;44(9):1460-1469. doi: 10.1007/s00134-018-5346-y. Epub 2018 Aug 22.

Abstract

Purpose: Thrombocytopenia is a frequent and serious adverse event in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. Similarly to postcardiac surgery patients, heparin-induced thrombocytopenia (HIT) could represent the causative underlying mechanism. However, the epidemiology as well as related mortality regarding HIT and VA-ECMO remains largely unknown. We aimed to define the prevalence and associated 90-day mortality of HIT diagnosed under VA-ECMO.

Methods: This retrospective study included patients under VA-ECMO from 20 French centers between 2012 and 2016. Selected patients were hospitalized for more than 3 days with high clinical suspicion of HIT and positive anti-PF4/heparin antibodies. Patients were classified according to results of functional tests as having either Confirmed or Excluded HIT.

Results: A total of 5797 patients under VA-ECMO were screened; 39/5797 met the inclusion criteria, with HIT confirmed in 21/5797 patients (0.36% [95% CI] [0.21-0.52]). Fourteen of 39 patients (35.9% [20.8-50.9]) with suspected HIT were ultimately excluded because of negative functional assays. Drug-induced thrombocytopenia tended to be more frequent in Excluded HIT at the time of HIT suspicion (p = 0.073). The platelet course was similar between Confirmed and Excluded HIT (p = 0.65). Mortality rate was 33.3% [13.2-53.5] in Confirmed and 50% [23.8-76.2] in Excluded HIT (p = 0.48).

Conclusions: Prevalence of HIT among patients under VA-ECMO is extremely low at 0.36% with an associated mortality rate of 33.3%, which appears to be in the same range as that observed in patients treated with VA-ECMO without HIT. In addition, HIT was ultimately ruled out in one-third of patients with clinical suspicion of HIT and positive anti-PF4/heparin antibodies.

Keywords: ECLS; Immuno-allergic heparin-induced thrombocytopenia; Thrombocytopenia.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / adverse effects*
  • Arginine / analogs & derivatives
  • Critical Care / statistics & numerical data
  • Diagnosis, Differential
  • Extracorporeal Membrane Oxygenation / adverse effects*
  • Extracorporeal Membrane Oxygenation / mortality
  • Female
  • France / epidemiology
  • Heparin / adverse effects*
  • Humans
  • Male
  • Middle Aged
  • Pipecolic Acids / therapeutic use
  • Platelet Aggregation Inhibitors / therapeutic use
  • Platelet Count
  • Prevalence
  • Retrospective Studies
  • Shock, Cardiogenic / mortality
  • Shock, Cardiogenic / therapy
  • Sulfonamides
  • Thrombocytopenia / chemically induced*
  • Thrombocytopenia / drug therapy
  • Thrombocytopenia / mortality
  • Treatment Outcome

Substances

  • Anticoagulants
  • Pipecolic Acids
  • Platelet Aggregation Inhibitors
  • Sulfonamides
  • Heparin
  • Arginine
  • argatroban