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The following is a summary of “Bleeding complications, coagulation disorders, and their management in acute myocardial infarction-related cardiogenic shock rescued by veno-arterial ECMO: A retrospective cohort study,” published in the August 2024 issue of Critical Care by Masi et al.

Managing dual antiplatelet therapy (DAPT) in patients on the venoarterial-extracorporeal membrane (VA-ECMO) after acute myocardial infarction (AMI) is challenging.

Researchers conducted a retrospective study to characterize the frequency, management, and outcomes of severe bleeding complications in patients on VA-ECMO after AMI and to determine their occurrence risk factors.

They examined patients with post-AMI cardiogenic shock requiring VA-ECMO. Severe bleeding was defined by the Bleeding Academic Research Consortium classification. Multivariable Fine-Gray models were calculated to assess factors associated with the risk of severe bleeding.

The results showed that from January 2015 to July 2019, 176 patients received VA-ECMO after AMI, with 132 included in the analysis. Among them, 65 patients (49%) died, and severe bleeding occurred in 39% of cases. Severe thrombocytopenia (<50 G/L) affected 31%, while hypofibrinogenemia (<1.5 g/L) was seen in 19%, DAPT and anticoagulation were stopped in 32%, resulting in a 6% stent thrombosis rate. In 39% of patients, anticoagulation was discontinued. Factors like female sex, time on ECMO, troponin at admission, and Impella® use were linked to severe bleeding.

The concluded bleeding complications and coagulation disorders were frequent and severe in patients on VA-ECMO after AMI, leading to the withdrawal of DAPT. 

Source: sciencedirect.com/science/article/pii/S0883944124002582