Antti Laine1, Tomi Niemi1, Raili Suojaranta-Ylinen2, Peter Raivio3, Leena Soininen2, Karl Lemström3, Pekka Hämmäinen3, Alexey Schramko1,2. 1. 1 Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland. 2. 2 Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland. 3. 3 Heart and Lung Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Abstract
BACKGROUND: : We aimed to characterize the coagulation disturbances which may increase the risk of bleeding, thrombosis or death shortly after implantation of an extracorporeal membrane oxygenation (ECMO) or ventricular assist (VAD) device. METHODS: : Antithrombotic treatment was started in 23 VAD and 24 ECMO patients according to the hospital protocol. Additionally, conventional laboratory testing, rotational thromboelastometry (ROTEM®) and platelet function analysis (Multiplate®) were performed at predetermined intervals. RESULTS: : Four out of twenty-four (16.7%) of ECMO patients and 6/23 (26.1%) of VAD patients had severe bleeding after the procedure. When all the patients were analyzed together, low maximum clot firmness (MCF) in ExTEM and FibTEM analyses was associated with severe bleeding (p<0.05) and low MCF in FibTEM with 30-day mortality. Low platelet count and hematocrit levels were also associated with severe bleeding. When VAD and ECMO patients were separated into different groups, the association between ROTEM® parameters, bleeding and survival was found only in limited time points. Four patients with VAD had cerebral ischemia indicative of thromboembolism. However, this had no significant correlation with ROTEM® or Multiplate® parameters. CONCLUSION: : Hypocoagulation shown by ROTEM® was associated with bleeding complications in patients with mechanical circulatory support. In contrast, hypercoagulation did not correlate with clinical thrombosis.
BACKGROUND: : We aimed to characterize the coagulation disturbances which may increase the risk of bleeding, thrombosis or death shortly after implantation of an extracorporeal membrane oxygenation (ECMO) or ventricular assist (VAD) device. METHODS: : Antithrombotic treatment was started in 23 VAD and 24 ECMO patients according to the hospital protocol. Additionally, conventional laboratory testing, rotational thromboelastometry (ROTEM®) and platelet function analysis (Multiplate®) were performed at predetermined intervals. RESULTS: : Four out of twenty-four (16.7%) of ECMO patients and 6/23 (26.1%) of VAD patients had severe bleeding after the procedure. When all the patients were analyzed together, low maximum clot firmness (MCF) in ExTEM and FibTEM analyses was associated with severe bleeding (p<0.05) and low MCF in FibTEM with 30-day mortality. Low platelet count and hematocrit levels were also associated with severe bleeding. When VAD and ECMO patients were separated into different groups, the association between ROTEM® parameters, bleeding and survival was found only in limited time points. Four patients with VAD had cerebral ischemia indicative of thromboembolism. However, this had no significant correlation with ROTEM® or Multiplate® parameters. CONCLUSION: : Hypocoagulation shown by ROTEM® was associated with bleeding complications in patients with mechanical circulatory support. In contrast, hypercoagulation did not correlate with clinical thrombosis.
Authors: Martin Beiderlinden; Patrick Werner; Astrid Bahlmann; Johann Kemper; Tobias Brezina; Maximilian Schäfer; Klaus Görlinger; Holger Seidel; Peter Kienbaum; Tanja A Treschan Journal: BMC Anesthesiol Date: 2018-02-09 Impact factor: 2.217
Authors: Bruce Cartwright; Hannah M Bruce; Geoffrey Kershaw; Nancy Cai; Jad Othman; David Gattas; Jacqueline L Robson; Sarah Hayes; Hayden Alicajic; Anna Hines; Alice Whyte; Nophanan Chaikittisilpa; Timothy James Southwood; Paul Forrest; Richard J Totaro; Paul G Bannon; Scott Dunkley; Vivien M Chen; Mark Dennis Journal: Sci Rep Date: 2021-04-12 Impact factor: 4.379
Authors: Joppe G Drop; Özge Erdem; Enno D Wildschut; Joost van Rosmalen; Moniek P M de Maat; Jan-Willem Kuiper; Robert Jan M Houmes; C Heleen van Ommen Journal: Res Pract Thromb Haemost Date: 2021-07-14