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Intensive Care Medicine

, Volume 44, Issue 9, pp 1460–1469 | Cite as

Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study

  • Antoine Kimmoun
  • Walid Oulehri
  • Romain Sonneville
  • Paul-Henri Grisot
  • Elie Zogheib
  • Julien Amour
  • Nadia Aissaoui
  • Bruno Megarbane
  • Nicolas Mongardon
  • Amelie Renou
  • Matthieu Schmidt
  • Emmanuel Besnier
  • Clément Delmas
  • Geraldine Dessertaine
  • Catherine Guidon
  • Nicolas Nesseler
  • Guylaine Labro
  • Bertrand Rozec
  • Marc Pierrot
  • Julie Helms
  • David Bougon
  • Laurent Chardonnal
  • Anne Medard
  • Alexandre Ouattara
  • Nicolas Girerd
  • Zohra Lamiral
  • Marc Borie
  • Nadine Ajzenberg
  • Bruno LevyEmail author
Original

Abstract

Purpose

Thrombocytopenia is a frequent and serious adverse event in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. Similarly to postcardiac surgery patients, heparin-induced thrombocytopenia (HIT) could represent the causative underlying mechanism. However, the epidemiology as well as related mortality regarding HIT and VA-ECMO remains largely unknown. We aimed to define the prevalence and associated 90-day mortality of HIT diagnosed under VA-ECMO.

Methods

This retrospective study included patients under VA-ECMO from 20 French centers between 2012 and 2016. Selected patients were hospitalized for more than 3 days with high clinical suspicion of HIT and positive anti-PF4/heparin antibodies. Patients were classified according to results of functional tests as having either Confirmed or Excluded HIT.

Results

A total of 5797 patients under VA-ECMO were screened; 39/5797 met the inclusion criteria, with HIT confirmed in 21/5797 patients (0.36% [95% CI] [0.21–0.52]). Fourteen of 39 patients (35.9% [20.8–50.9]) with suspected HIT were ultimately excluded because of negative functional assays. Drug-induced thrombocytopenia tended to be more frequent in Excluded HIT at the time of HIT suspicion (p = 0.073). The platelet course was similar between Confirmed and Excluded HIT (p = 0.65). Mortality rate was 33.3% [13.2–53.5] in Confirmed and 50% [23.8–76.2] in Excluded HIT (p = 0.48).

Conclusions

Prevalence of HIT among patients under VA-ECMO is extremely low at 0.36% with an associated mortality rate of 33.3%, which appears to be in the same range as that observed in patients treated with VA-ECMO without HIT. In addition, HIT was ultimately ruled out in one-third of patients with clinical suspicion of HIT and positive anti-PF4/heparin antibodies.

Keywords

ECLS Thrombocytopenia Immuno-allergic heparin-induced thrombocytopenia 

Notes

Acknowledgements

We thank Pierre Pothier (pmsys@videotron.ca) for editing the manuscript. Walid Oulehri and Romain Sonneville participated equally in this article.

Compliance of ethical standards

Conflicts of interest

Antoine Kimmoun received lecture fees from Aspen. Matthieu Schmidt received lecture fees from Gettinge and Drager. Alexandre Ouattara received honoraria as consultant to LFB, iSEP, Orion, Abiomed and Nordic Pharma. Bruno Levy received lecture fees from Gettinge. The other authors declare no conflict of interest related to the submitted paper.

Supplementary material

134_2018_5346_MOESM1_ESM.docx (33 kb)
Supplementary material 1 (DOCX 31 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Antoine Kimmoun
    • 1
  • Walid Oulehri
    • 2
  • Romain Sonneville
    • 3
  • Paul-Henri Grisot
    • 1
  • Elie Zogheib
    • 4
  • Julien Amour
    • 5
  • Nadia Aissaoui
    • 6
  • Bruno Megarbane
    • 7
  • Nicolas Mongardon
    • 8
  • Amelie Renou
    • 9
  • Matthieu Schmidt
    • 10
  • Emmanuel Besnier
    • 11
  • Clément Delmas
    • 12
  • Geraldine Dessertaine
    • 13
  • Catherine Guidon
    • 14
  • Nicolas Nesseler
    • 15
  • Guylaine Labro
    • 16
  • Bertrand Rozec
    • 17
  • Marc Pierrot
    • 18
  • Julie Helms
    • 19
  • David Bougon
    • 20
  • Laurent Chardonnal
    • 21
  • Anne Medard
    • 22
  • Alexandre Ouattara
    • 23
  • Nicolas Girerd
    • 24
  • Zohra Lamiral
    • 24
  • Marc Borie
    • 25
  • Nadine Ajzenberg
    • 26
  • Bruno Levy
    • 1
    Email author
  1. 1.Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des VaisseauxCHRU de Nancy, INSERM U1116, Université de LorraineNancyFrance
  2. 2.Department of Anesthesiology and Surgical Critical CareNouvel Hôpital Civil, CHU StrasbourgStrasbourgFrance
  3. 3.Department of Intensive Care Medicine and Infectious Diseases, Hôpital Bichat Claude Bernard, Assistance Publique, Hôpitaux de ParisINSERM, UMR 1148, Université Paris DiderotParisFrance
  4. 4.Cardiothoracic and Vascular Intensive Care Unit, Amiens University HospitalINSERM U1088, Jules Verne University of PicardyAmiensFrance
  5. 5.Department of Anesthesiology and Surgical Critical Care, Institut Hospitalo-Universitaire de Cardiométabolisme et Nutrition, Hôpital Pitié-Salpêtrière, Assistance Publique, Hôpitaux de ParisUMR INSERM 1166, Université SorbonneParisFrance
  6. 6.Critical Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de ParisINSERM U970, Université Paris-DescartesParisFrance
  7. 7.Department of Medical and Toxicological Critical Care, Hôpital Lariboisière, Assistance Publique-Hôpitaux de ParisINSERM UMRS-1144, Université Paris DiderotParisFrance
  8. 8.Department of Anesthesiology and Surgical Critical Care, CHU Henri Mondor, Assistance Publique-Hôpitaux de ParisINSERM U955 Team 3, Université Paris EstParisFrance
  9. 9.Department of Anesthesiology and Surgical Critical Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de ParisUniversité Paris-DescartesParisFrance
  10. 10.Medical Intensive Care Unit, Institut Hospitalo-Universitaire de Cardiométabolisme et Nutrition, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de ParisUMR INSERM 1166, Université SorbonneParisFrance
  11. 11.Department of Anesthesiology and Surgical Critical Care, Hôpital de RouenUniversité de RouenRouenFrance
  12. 12.Intensive Cardiac Care Unit, Hôpital de RangueilUniversité de Toulouse 3 Paul SabatierToulouseFrance
  13. 13.Intensive Cardiac Care Unit, Hôpital de GrenobleUniversité de Grenoble AlpesGrenobleFrance
  14. 14.Department of Cardiac SurgeryHôpital La TimoneMarseilleFrance
  15. 15.Department of Anesthesiology and Surgical Critical Care, Hôpital de PontchaillouINSERM, UMR 1214 and INSERM 1414, Université de Rennes 1RennesFrance
  16. 16.Medical Intensive Care Unit, Hôpital Jean MinjozUniversité de Franche-ComtéBesançonFrance
  17. 17.Department of Anesthesiology and Surgical Critical Care, Hôpital Guillaume et René Laennec, CHRU Nantes, Institut du ThoraxUniversité de NantesNantesFrance
  18. 18.Department of Medical Intensive Care and Hyperbaric Medicine, Hôpital d’AngersUniversité d’ AngersAngersFrance
  19. 19.Medical Intensive Care Unit, Nouvel Hôpital Civil, CHU de StrasbourgINSERM, UMR_S1109, Université de StrasbourgStrasbourgFrance
  20. 20.Intensive Care UnitHôpital Annecy GenevoisAnnecyFrance
  21. 21.Department of Anesthesiology and Surgical Critical Care, Hôpital Cardiologique Louis PradelHospices Civils de LyonLyonFrance
  22. 22.Department of Anesthesiology and Surgical Critical CareCHU de Clermont-FerrandClermont-FerrandFrance
  23. 23.Department of Anesthesiology and Surgical Critical Care, Centre Médico-Chirurgical Magellan, CHU de BordeauxINSERM, UMR 1034, Université de BordeauxBordeauxFrance
  24. 24.INSERM CIC1433, CHRU de Nancy, Université de LorraineNancyFrance
  25. 25.PARC, CHRU de NancyNancyFrance
  26. 26.Department of Hematology, Hôpital Bichat Claude Bernard, Assistance Publique, Hôpitaux de ParisINSERM, UMR 1148, Université Paris DiderotParisFrance

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