The following is a summary of “Interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study,” published in the August 2023 issue of Critical Care by Raasveld et al.
Thrombocytopenia, bleeding, and platelet transfusion are common in venoarterial extracorporeal membrane oxygenation (VA ECMO) patients, but current literature comes from small, heterogeneous single-center experiences.
Researchers conducted a retrospective study to examine thrombocytopenia’s course and frequency, alongside evaluating its connection to bleeding and platelet transfusion during VA ECMO in a multicenter setting.
They conducted a sub-study within a multicenter (N = 16) investigation concerning transfusion practices in VA ECMO patients. Thrombocytopenia severity was the critical focus, classified as mild (100-150·109/L), moderate (50-100·109/L), and severe (< 50·109/L) during VA ECMO. Secondary outcomes included platelet transfusion frequency and the interaction among thrombocytopenia, bleeding, and platelet transfusion. Mixed-effect models were employed for these assessments.
The results showed 419 patients, and the median admission platelet count was 179·109/L. During VA ECMO, 95% (N=398) developed thrombocytopenia, with 45% (N=179) experiencing severe cases. Platelet transfusions were given to 226 patients (54%), while 207 (49%) encountered hemorrhagic events during VA ECMO. Remarkably, even non-bleeding patients had one in three receiving platelet transfusions. The most vital link to receiving these transfusions was found with severe thrombocytopenia (adjusted OR 31.8, 95% CI 17.9–56.5). The association was amplified by adding a hemorrhage-thrombocytopenia interaction term, resulting in an OR of 110 (95% CI 34-360).
They concluded platelet transfusion has a higher occurrence of severe thrombocytopenia, requiring future studies on etiology and transfusion thresholds.
Source: ccforum.biomedcentral.com/articles/10.1186/s13054-023-04612-5
