The impact of temporary mechanical circulatory support strategies on thrombocytopenia

Dwaah, Henry; Jain, Nupur; Kapur, Navin K.; Ortoleva, Jamel; Chweich, Haval; Couper, Gregory S.; Kawabori, Masashi

doi:10.1016/j.jcrc.2022.154216

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…Most alterations of kinetic data only became significant after 3 to 5 days, so the timeframe used in the present study may have been too short to confirm the differences. The drop of platelets after implantation of a mechanical circulatory support (MCS) is a common phenomenon that is reversible after explantation 36 . In the present study, no recovery of the examined parameters was determined after explantation of the ECMO system.…”

Section: Discussionmentioning

confidence: 76%

“…The drop of platelets after implantation of a mechanical circulatory support (MCS) is a common phenomenon that is reversible after explantation. 36 In the present study, no recovery of the examined parameters was determined after explantation of the ECMO system. The reason for this could be the small number of patients and the high interindividual variability.…”

Section: Presence Of Cfdna In the Bloodstream At The Time Of A System...mentioning

confidence: 77%

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Clinical relevance of cell‐free DNA during venovenous extracorporeal membrane oxygenation

Lingel,

Haus,

Paschke

et al. 2023

Artificial Organs

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BackgroundThrombosis remains a critical complication during venovenous extracorporeal membrane oxygenation (VV ECMO). The involvement of neutrophil extracellular traps (NETs) in thrombogenesis has to be discussed. The aim was to verify NETs in the form of cell‐free DNA (cfDNA) in the plasma of patients during ECMO.MethodsA fluorescent DNA‐binding dye (QuantifFluor®, Promega) was used to detect cell‐free DNA in plasma samples. cfDNA concentrations from volunteers (n = 21) and patients (n = 9) were compared and correlated with clinical/technical data before/during support, ECMO end and time of a system exchange.ResultsBefore ECMO, patients with a median (IQR) age of 59 (51/63) years, SOFA score of 11 (10/15), and ECMO run time of 9.0 (7.0/19.5) days presented significantly higher levels of cfDNA compared to volunteers (6.4 (5.8/7.9) ng/μL vs. 5.9 (5.4/6.3) ng/μL; p = 0.044). Within 2 days after ECMO start, cfDNA, inflammatory, and hemolysis parameters remained unchanged, while platelets decreased (p = 0.005). After ECMO removal at the end of therapy, cfDNA, inflammation, and coagulation data (except antithrombin III) remained unchanged. The renewal of a system resulted in known alterations in fibrinogen, d‐dimers, and platelets, while cfDNA remained unchanged.ConclusionDetection of cfDNA in plasma of ECMO patients was not an indicator of acute and circuit‐induced thrombogenesis.

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Section: Discussionmentioning

confidence: 76%

Section: Presence Of Cfdna In the Bloodstream At The Time Of A System...mentioning

confidence: 77%

Clinical relevance of cell‐free DNA during venovenous extracorporeal membrane oxygenation

Lingel,

Haus,

Paschke

et al. 2023

Artificial Organs

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“…Thrombocytopenia defined as platelet count <150,000/μL or 50% less than baseline 5 is observed in up to 86% of MCS patients 7 . Device-related thrombocytopenia has rapid onset, with platelet count declining drastically within 24 hours following device implantation, and persisting until device removal 8 . The severity of platelet count drop depends on the type of device: veno-arterial ECMO −69.6%, veno-veno ECMO −40.9%, Impella 5.5 −20.9%, and Centrimag biventricular VAD −6.5% 8 .…”

Section: Introductionmentioning

confidence: 99%

“…Device-related thrombocytopenia has rapid onset, with platelet count declining drastically within 24 hours following device implantation, and persisting until device removal 8 . The severity of platelet count drop depends on the type of device: veno-arterial ECMO −69.6%, veno-veno ECMO −40.9%, Impella 5.5 −20.9%, and Centrimag biventricular VAD −6.5% 8 . Severely thrombocytopenic MCS patients have increased bleeding risk and longer ICU stays, require frequent platelet transfusions, and are at much higher risk of mortality with relative count drop in day 1 following device initiation being an independent prognostic factor of in-hospital mortality 5,9 .…”

Section: Introductionmentioning

confidence: 99%

Shear Stress Promotes Remodeling of Platelet Glycosylation via Upregulation of Platelet Glycosidase Activity: The Ulterior Cause of MCS-Related Thrombocytopenia?

Roka-Moiia,

Lewis,

Cleveland

et al. 2024

Preprint

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Objective: Mechanical circulatory support (MCS) is a mainstay of therapy for advanced and end-stage heart failure. Accompanied by systemic anticoagulation, contemporary MCS has become less thrombogenic, with bleeding complications emerging as a major cause of readmission and 1-year mortality of device-supported patients. Shear-mediated platelet dysfunction (SMPD) and thrombocytopenia of undefined etiology are primary drivers of MCS-related bleeding. Recently, it has been demonstrated that deprivation of platelet surface glycosylation is associated with the decline of hemostatic function, microvesiculation, and premature apoptosis. We tested the hypothesis that shear stress induces remodeling of platelet surface glycosylation via upregulation of glycosidase activity, thus facilitating platelet count decline and microvesiculation. Approach and Results: Human platelets were exposed to continuous shear stress in vitro. Platelets and platelet-derived microparticles were quantified via flow cytometry using size-standard fluorescent nanobeads. Platelet surface glycosylation was evaluated using lectin staining and multicolor flow cytometry; lectin blotting was utilized to verify glycosylation of individual glycoproteins. Platelet glycosidase activities were quantified using 4-methylumbelliferone-based fluorogenic substrates. We demonstrated that shear stress promotes selective remodeling of platelet glycosylation via downregulation of 2,6-sialylation, galactose, and mannose, while 2,3-sialylation remains unchanged. Shear-mediated deglycosylation is partially attenuated by neuraminidase inhibitors DANA and zanamivir, strongly suggesting the involvement of platelet neuraminidase in observed phenomena. Platelets exhibited high basal hexosaminidase and mannosidase activities; basal activities of platelet neuraminidase and galactosidase were rather low and were significantly upregulated by shear stress. Shear stress potentiated a progressive decline of platelet count and immense microvesiculation, both being further exacerbated by neuraminidase. Conclusion: Our data indicate that shear stress accumulation, consistent with supraphysiologic conditions of device-supported circulation, promotes remodeling of platelet glycosylation via selective upregulation of platelet glycosidase activity. Shear-mediated platelet deglycosylation is associated with platelet count drop and increased microvesiculation, thus offering a direct link between deglycosylation and thrombocytopenia observed in device-supported patients.

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Mechanische Kreislaufunterstützung im Schock

Rottmann,

Michels,

Wengenmayer

et al. 2023

Aktuelle Kardiologie

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ZusammenfassungMechanische Kreislaufunterstützungssysteme (engl. Mechanical Circulatory Support, MCS) haben in den letzten Jahren eine zunehmende Bedeutung in der akutmedizinischen Therapie des kritisch kranken Patienten im Schock erlangt. Aktuell stehen in Europa verschiede Systeme zur Verfügung, die sich in Wirkweise und Einsatzgebiet signifikant unterscheiden. Neben den MCS-Charakteristika und der Zentrumsexpertise sind aber auch Patientencharakteristika für die Auswahl des richtigen MCS zu beachten. Unterschiedliche Schockformen fordern eine differenzierte Therapie, je nach Ätiologie des Schocks und seiner hämodynamischen Akzentuierung (so braucht z. B. ein infarktbedingter kardiogener Schock mit führendem Linksherzversagen eine andere Therapie als ein infarktbedingter kardiogener Schock mit führendem Rechtsherzversagen). Die Auswahl des jeweiligen Herzunterstützungssystems richtet sich nach der Pathophysiologie der zugrunde liegenden Erkrankung. Bisweilen sind Kombinationen von mehreren Unterstützungssystemen erforderlich. Dieser Übersichtsartikel diskutiert die verschiedenen Systeme (extrakorporale Membranoxygenierung, intraaortale Ballonpumpe, Mikroaxillarpumpe/perkutanes linksventrikuläres Unterstützungssystem, perkutanes rechtsventrikuläres Unterstützungssystem) und deren Einsatzmöglichkeit im Kontext der verschiedenen Schockformen.

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The impact of temporary mechanical circulatory support strategies on thrombocytopenia

Cited by 6 publications

References 22 publications

Clinical relevance of cell‐free DNA during venovenous extracorporeal membrane oxygenation

Clinical relevance of cell‐free DNA during venovenous extracorporeal membrane oxygenation

Shear Stress Promotes Remodeling of Platelet Glycosylation via Upregulation of Platelet Glycosidase Activity: The Ulterior Cause of MCS-Related Thrombocytopenia?

Mechanische Kreislaufunterstützung im Schock

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