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SHR Neuro Cancer Cardio Lipid Metab Microb

Buchtele, N; Tanaka, K; Tuzzolino, F; Agerstrand, C; Ait, Hssain, A; Riera, J; Schellongowski, P; Schmidt, M; Ramanan, R; Balik, M; Broman, LM; Rizzitello, N; Szułdrzyński, K; Gannon, WD; Fanelli, V; Trethowan, B; Buscher, H; Alfoudri, H; Giani, M; Combes, A; Grasselli, G; Lorusso, R; Arcadipane, A; Brodie, D; Martucci, G, , PROTECMO, Study, group.
Incidence, kinetics, and clinical impact of thrombocytopenia in venovenous ECMO: insights from the multicenter observational PROTECMO study.
Crit Care. 2025; 29(1): 349 Doi: 10.1186/s13054-025-05569-3 [OPEN ACCESS]
Web of Science PubMed PUBMED Central FullText FullText_MUG

 

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Abstract:
BACKGROUND: Thrombocytopenia is a recognized risk factor for bleeding during extracorporeal membrane oxygenation (ECMO). This study determines the incidence, risk factors, and clinical relevance of thrombocytopenia and platelet transfusions during venovenous (VV) ECMO. METHODS: The multicenter, prospective observational PROTECMO study included 652 adult patients who received VV ECMO for respiratory failure. Thrombocytopenia was classified as mild (100-149·109/L), moderate (50-99·109/L), or severe (< 50·109/L). Bleeding events were evaluated using a modified Bleeding Academy Research Consortium score. Cox proportional hazards and logistic regression analyses were done to identify predictors, and quantify the association between platelet counts and bleeding risk. RESULTS: A total of 182 patients (27.9%) had thrombocytopenia at baseline (mild in 14.7%, moderate in 8.7%, and severe in 4.4%). Thrombocytopenia during ECMO, at least once in 80.2% of patients, was mild in 21.3% of cases, moderate in 32.2%, and severe in 26.7%. A 10·109/L decrease in platelet count was associated with a 3.7% (95% CI: 2.4-5.0%) increase in risk of bleeding. There was no strong evidence of nonlinear relationship within the platelet count range between 25,000 and 300,000. This relation remained consistent across all ECMO weeks. Mild thrombocytopenia increased the risk of experiencing a bleeding event by 61% (hazard ratio (HR) 1.611, 95% CI 1.230-2.109, p = 0.0005), while moderate and severe thrombocytopenia increased the risk by roughly 90% (moderate: HR 1.944 (CI 1.484-2.545), p < 0.0001; severe: HR 1.876 (CI 1.275-2.7680), p = 0.0014). The risk for thrombocytopenia < 100·109/L during ECMO significantly increased with ICU days prior to ECMO start, postoperative admission, immunocompromised state, renal replacement therapy, septic shock, low hemoglobin, and circuit exchange. CONCLUSIONS: Thrombocytopenia is highly prevalent in VV ECMO, and associated with a significant increase in the risk of bleeding, and a reduction in 6-month survival, particularly at platelet counts below 100·109/L. Further research is needed to better define the outcomes associated with specific thresholds for transfusion of platelets.
Find related publications in this database (using NLM MeSH Indexing)
Humans - administration & dosage
Thrombocytopenia - epidemiology, etiology
Extracorporeal Membrane Oxygenation - adverse effects, methods
Female - administration & dosage
Male - administration & dosage
Middle Aged - administration & dosage
Prospective Studies - administration & dosage
Incidence - administration & dosage
Adult - administration & dosage
Risk Factors - administration & dosage
Platelet Count - methods
Hemorrhage - etiology, epidemiology
Aged - administration & dosage
Platelet Transfusion - administration & dosage

Find related publications in this database (Keywords)
Thrombocytopenia
VV ECMO
Bleeding
Platelet kinetics
Intensive care
Anticoagulation
Predictors
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