Decreased maximum clot firmness in rotational thromboelastometry (ROTEM®) is associated with bleeding during extracorporeal mechanical circulatory support

Laine, Antti; Niemi, Tomi; Suojaranta-Ylinen, Raili; Raivio, Peter; Soininen, Leena; Lemström, Karl; Hämmäinen, Pekka; Schramko, Alexey

doi:10.1177/0267659116647473

Cited by 32 publications

(45 citation statements)

References 27 publications

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“…Seven studies analysed the platelet function during ECMO (Table 3) [7,16,27,30,33,35,38]. Platelet aggregometry was tested in 5 studies, platelet receptor quantification was assessed in one trial, and testing for monoclonal antibodies, expression of impaired platelet granule secretion, was performed in one study [7,16,27,30,38]. Impaired platelet activation, assessed through PF4 and ß-thromboglobulin secretion, was tested only in one investigation [35].…”

Section: Study Descriptionmentioning

confidence: 99%

“…Severe thrombocytopenia was reported only in 6 studies, and its prevalence ranged from 6.3 to 26.6% [8,24,32,35,37,40]. Five studies reported the timeline of platelet count after ECMO start [7,8,16,24,29]. The time to lowest platelet count varied from 2 to 7 days after ECMO initiation.…”

Section: • Thrombocytopeniamentioning

confidence: 99%

“…• Platelet dysfunction Seven studies assessed the platelet function in ECMO patients [7,16,27,28,33,35,38]. Platelet aggregation tests were performed in 5 studies, showing a substantial reduction in platelet function [7,16,27,30,38]. One study reported reduced levels of adhesion receptors for collagen and vWF (GPVI and GPIbα) on circulating platelets during ECMO assistance [33].…”

Section: • Thrombocytopeniamentioning

confidence: 99%

“…Bleeding events were reported only in 6 studies [7, 24-26, 35, 37]. The lowest and the highest prevalence of bleeding was 16.6% and 50.7%, respectively [7,24]. One study, comparing ECMO patients primarily supported with bivalirudin versus heparin, showed that bivalirudin patients experienced fewer bleeding events than the heparin patients [26].…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…Platelet activation and aggregation play a major role in this context. The contact with foreign circuit surfaces and the high shear stress, during ECMO treatment, have been shown to cause enhanced platelet activation, which may lead to an increased thrombotic predisposition [6][7][8]. On the other side, high shear stress has also been shown to cause loss of platelet surface receptors, important for platelet adhesion, as well as loss of high-molecular-weight von Willebrand factor (vWF) multimers, resulting in decreased binding of vWF to platelets [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

et al. 2020

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Despite increasing improvement in extracorporeal membrane oxygenation (ECMO) technology and knowledge, thrombocytopenia and impaired platelet function are usual findings in ECMO patients and the underlying mechanisms are only partially elucidated. The purpose of this meta-analysis and systematic review was to thoroughly summarize and discuss the existing knowledge of platelet profile in adult ECMO population. All studies meeting the inclusion criteria (detailed data about platelet count and function) were selected, after screening literature from July 1975 to August 2019. Twenty-one studies from 1.742 abstracts were selected. The pooled prevalence of thrombocytopenia in ECMO patients was 21% (95% CI 12.9-29.0; 14 studies). Thrombocytopenia prevalence was 25.4% (95% CI 10.6-61.4; 4 studies) in veno-venous ECMO, whereas it was 23.2% (95% CI 11.8-34.5; 6 studies) in veno-arterial ECMO. Heparin-induced thrombocytopenia prevalence was 3.7% (95% CI 1.8-5.5; 12 studies). Meta-regression revealed no significant association between ECMO duration and thrombocytopenia. Platelet function impairment was described in 7 studies. Impaired aggregation was shown in 5 studies, whereas loss of platelet receptors was found in one trial, and platelet activation was described in 2 studies. Platelet transfusions were needed in up to 50% of the patients. Red blood cell transfusions were administered from 46 to 100% of the ECMO patients. Bleeding events varied from 16.6 to 50.7%, although the cause and type of haemorrhage was not consistently reported. Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations.

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Section: Study Descriptionmentioning

confidence: 99%

Section: • Thrombocytopeniamentioning

confidence: 99%

Section: • Thrombocytopeniamentioning

confidence: 99%

Section: Secondary Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

et al. 2020

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Use of rotational thromboelastometry to predict hemostatic complications in pediatric patients undergoing extracorporeal membrane oxygenation: A retrospective cohort study

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Erdem

Wildschut

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Background The incidence of hemostatic complications in pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) is high. The optimal anticoagulation strategy in children undergoing ECMO is unknown. Objectives To study the association between hemostatic complications, coagulation tests, and clinical parameters in pediatric patients undergoing ECMO and their effect on survival. Methods We performed a retrospective cohort study of pediatric patients undergoing centrifugal pump ECMO. Collected data included patient characteristics, risk factors, and coagulation test results. Statistical analysis was done using logistic regression analysis for repeated measurements. Dependent variables were thrombosis and bleeding, independent variables were rotational thromboelastometry (ROTEM), activated partial thromboplastin time (aPTT) and antifactor‐Xa assay (aXa) results, ECMO duration, age <29 days, sepsis and surgery. Results Seventy‐three patients with 623 ECMO days were included. Cumulative incidences of thrombosis and bleeding were 43.5% (95% confidence interval [CI], 26.0%‐59.8%) and 25.4% (95% CI, 13.4%‐39.3%), respectively. A lower maximum clot firmness of intrinsic ROTEM (INTEM; odds ratio [OR], 0.946; 95% CI, 0.920‐0.969), extrinsic ROTEM (OR, 0.945; 95% CI, 0.912‐0.973), and INTEM with heparinase (OR, 0.936; 95% CI, 0.896‐0.968); higher activated partial thromboplastin time aPTT; OR, 1.020; 95% CI, 1.006‐1.024) and age <29 days (OR, 2.900; 95% CI, 1.282‐6.694); surgery (OR, 4.426; 95% CI, 1.543‐12.694); and longer ECMO duration (OR, 1.149; 95% CI, 1.022‐1.292) significantly increased thrombotic risk. Surgery (OR, 2.698; 95% CI, 1.543‐12.694) and age <29 days (OR 2.242, 95% CI 1.282–6.694) were significantly associated with major bleeding. Patients with hemostatic complications had significantly decreased survival to hospital discharge ( P = .009). Conclusion The results of this study help elucidate the role of ROTEM, aPTT, anti–factor Xa, and clinical risk factors in predicting hemostatic complications in pediatric patients undergoing ECMO.

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Viscoelastic Assay-Guided Hemostatic Therapy in Perioperative and Critical Care

Iapichino

Costantini

Cecconi

2020

Annual Update in Intensive Care and Emergency Medicine

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Decreased maximum clot firmness in rotational thromboelastometry (ROTEM®) is associated with bleeding during extracorporeal mechanical circulatory support

Abstract: Hypocoagulation shown by ROTEM® was associated with bleeding complications in patients with mechanical circulatory support. In contrast, hypercoagulation did not correlate with clinical thrombosis.

Cited by 32 publications

References 27 publications

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

Platelets and extra-corporeal membrane oxygenation in adult patients: a systematic review and meta-analysis

Use of rotational thromboelastometry to predict hemostatic complications in pediatric patients undergoing extracorporeal membrane oxygenation: A retrospective cohort study

Viscoelastic Assay-Guided Hemostatic Therapy in Perioperative and Critical Care

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