Runtime and aPTT predict venous thrombosis and thromboembolism in patients on extracorporeal membrane oxygenation: a retrospective analysis

Abstract

Background Even though bleeding and thromboembolic events are major complications of extracorporeal membrane oxygenation (ECMO), data on the incidence of venous thrombosis (VT) and thromboembolism (VTE) under ECMO are scarce. This study analyzes the incidence and predictors of VTE in patients treated with ECMO due to respiratory failure.MethodsRetrospective analysis of patients treated on ECMO in our center from 04/2010 to 11/2015. Patients with thromboembolic events prior to admission were excluded. Diagnosis was made by imaging in survivors and postmortem examination in deceased patients.ResultsOut of 102 screened cases, 42 survivors and 21 autopsy cases [mean age 46.0 ± 14.4 years; 37 (58.7 %) males] fulfilling the above-mentioned criteria were included. Thirty-four patients (54.0 %) underwent ECMO therapy due to ARDS, and 29 patients (46.0 %) with chronic organ failure were bridged to lung transplantation. Despite systemic anticoagulation at a mean PTT of 50.6 ± 12.8 s, [VT/VTE 47.0 ± 12.3 s and no VT/VTE 53.63 ± 12.51 s (p = 0.037)], VT and/or VTE was observed in 29 cases (46.1 %). The rate of V. cava thrombosis was 15/29 (51.7 %). Diagnosis of pulmonary embolism prevailed in deceased patients [5/21 (23.8 %) vs. 2/42 (4.8 %) (p = 0.036)]. In a multivariable analysis, only aPTT and time on ECMO predicted VT/VTE. There was no difference in the incidence of clinically diagnosed VT in ECMO survivors and autopsy findings.ConclusionsVenous thrombosis and thromboembolism following ECMO therapy are frequent. Quality of anticoagulation and ECMO runtime predicted thromboembolic events.

Efficacy and safety of argatroban in patients with acute respiratory distress syndrome and extracorporeal lung support

“…Vice versa, patients with aPTT values below the targeted therapeutic range did not necessarily develop thromboembolic events. However, practically all the thromboembolic events occurred when minimal aPTT values were below 50 s. This is in line with Trudzinski et al, who found an aPTT level below 50 s to be predictive for thromboembolism in ARDS patients under ECMO [ 25 ]. On the other hand, almost all bleeding events occurred when the maximal aPTT of the patients was above 50–60 s. Strikingly, more than two-thirds of all bleeding events were associated with maximum aPTT values above 75 s. Although these results only reflect the population of this study, we propose that this aPTT value could be regarded as the utmost tolerable upper limit under extracorporeal lung support to avoid hemorrhage.…”

Low molecular weight heparin versus unfractioned heparin for anticoagulation during perioperative extracorporeal membrane oxygenation: A single center experience in 102 lung transplant patients

“…This was due to differences in timing of ECMO (Table ), as preoperative ECMO therapy (ie, bridge‐to‐transplant) was associated with longer ECMO durations while waiting for a compatible organ. The runtime of ECMO therapy is a well described factor in the probability of complications, including thromboembolic events . Therefore, we decided to perform post hoc corrections for these relevant baseline differences between the two groups.…”

Flow-induced platelet activation in components of the extracorporeal membrane oxygenation circuit

“…In a retrospective study, Trudzinski et al . 3 reported an incidence of 46.1% for venous thrombosis and/or thromboembolism in patients treated on ECMO with systemic anticoagulation.…”