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Bleeding patients on extracorporeal membrane oxygenation have reduced platelet aggregation and plasma fibrinogen: a longitudinal observational study.

Authors :
Hvas CL
Christensen S
Balle CM
Munk-Andersen H
Jeppesen AN
Hvas AM
Source :
Scientific reports [Sci Rep] 2023 Sep 04; Vol. 13 (1), pp. 14557. Date of Electronic Publication: 2023 Sep 04.
Publication Year :
2023

Abstract

This study investigated changes in coagulation and associations with occurrence of bleeding and thrombosis during extracorporeal membrane oxygenation (ECMO) therapy. The study included 100 adult ECMO-patients. Standard coagulation parameters, platelet aggregation and thromboelastometry (ROTEM <superscript>®</superscript> ) were compared with healthy controls. Data on bleeding and thrombosis were collected until recovery or death. Mortality data were collected 30 days after weaning from ECMO. During ECMO therapy, 53 patients experienced at least one moderate or major bleed. Among these, 42 (79%) patients experienced the first bleeding on day 1 or 2. Platelet aggregation and ROTEM <superscript>®</superscript> revealed a hypocoagulable state in ECMO patients when compared with healthy controls. Patients bleeding on day 1 or 2, had lower platelet count (p = 0.04), poorer platelet aggregation and lower levels of fibrinogen (p < 0.01) than patients not bleeding on day 1 or 2. Further, ROTEM <superscript>®</superscript> clot propagation was reduced in bleeding patients (p < 0.001). Mortality was higher among bleeding patients than patients not bleeding on day 1 or 2 (67% versus 34%, p < 0.01). Congruity existed between ROTEM <superscript>®</superscript> measurements and standard coagulation assays, but plasma fibrinogen had a stronger association with bleeding than ROTEM <superscript>®</superscript> measurements. The present study does not support ROTEM <superscript>®</superscript> analysis as a routine part of coagulation monitoring during ECMO therapy.<br /> (© 2023. Springer Nature Limited.)

Details

Language :
English
ISSN :
2045-2322
Volume :
13
Issue :
1
Database :
MEDLINE
Journal :
Scientific reports
Publication Type :
Academic Journal
Accession number :
37666949
Full Text :
https://doi.org/10.1038/s41598-023-41773-3