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Javanbakht A, Schneider TM, Hendrickson JE. Red blood cell alloimmunization in patients on extracorporeal membrane oxygenation. Transfusion 2024; 64:761-762. [PMID: 38593282 DOI: 10.1111/trf.17761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/23/2024] [Accepted: 02/04/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Ayda Javanbakht
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Thomas M Schneider
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Jeanne E Hendrickson
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
- Department of Laboratory Medicine, Yale University, New Haven, Connecticut, USA
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Arachchillage DJ, Rajakaruna I, Scott I, Gaspar M, Odho Z, Banya W, Vlachou A, Isgro G, Cagova L, Wade J, Fleming L, Laffan M, Szydlo R, Ledot S, Jooste R, Vuylsteke A, Yusuff H. Impact of major bleeding and thrombosis on 180-day survival in patients with severe COVID-19 supported with veno-venous extracorporeal membrane oxygenation in the United Kingdom: a multicentre observational study. Br J Haematol 2021; 196:566-576. [PMID: 34622443 PMCID: PMC8653259 DOI: 10.1111/bjh.17870] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 01/19/2023]
Abstract
Bleeding and thrombosis are major complications in patients supported with extracorporeal membrane oxygenation (ECMO). In this multicentre observational study of 152 consecutive patients (≥18 years) with severe COVID‐19 supported by veno‐venous (VV) ECMO in four UK commissioned centres during the first wave of the COVID‐19 pandemic (1 March to 31 May 2020), we assessed the incidence of major bleeding and thrombosis and their association with 180‐day mortality. Median age (range) was 47 years (23–65) and 75% were male. Overall, the 180‐day survival was 70·4% (107/152). The rate of major bleeding was 30·9% (47/152), of which intracranial bleeding (ICH) was 34% (16/47). There were 96 thrombotic events (63·1%) consisting of venous 44·7% [68/152 of which 66·2% were pulmonary embolism (PE)], arterial 18·6% (13/152) and ECMO circuit thrombosis 9·9% (15/152). In multivariate analysis, only raised lactate dehydrogenase (LDH) at the initiation of VV ECMO was associated with an increased risk of thrombosis [hazard ratio (HR) 1·92, 95% CI 1·21‐3·03]. Major bleeding and ICH were associated with 3·87‐fold (95% CI 2·10–7·23) and 5·97‐fold [95% confidence interval (CI) 2·36–15·04] increased risk of mortality and PE with a 2·00‐fold (95% CI1·09–3·56) risk of mortality. This highlights the difficult balancing act often encountered when managing coagulopathy in COVID‐19 patients supported with ECMO.
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Affiliation(s)
- Deepa J Arachchillage
- Department of Haematology, Royal Brompton Hospital, London, UK.,Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Indika Rajakaruna
- Department of Computer Science, University of East London, London, UK
| | - Ian Scott
- Department of Anaesthesia and Critical Care, NHS Grampian, Aberdeen, UK
| | - Mihaela Gaspar
- Department of Haematology, Royal Brompton Hospital, London, UK
| | - Zain Odho
- Department of Biochemistry, Royal Brompton Hospital, London, UK
| | - Winston Banya
- Department of Medical Statistics, Royal Brompton Hospital, London, UK
| | - Aikaterini Vlachou
- Department of Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK
| | - Graziella Isgro
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lenka Cagova
- Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Joshua Wade
- Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Lucy Fleming
- Department of Anaesthesia and Critical Care, NHS Grampian, Aberdeen, UK
| | - Mike Laffan
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Richard Szydlo
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Stephane Ledot
- Department of Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK
| | - Rachel Jooste
- Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Alain Vuylsteke
- Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Hakeem Yusuff
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
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Descamps R, Moussa MD, Besnier E, Fischer MO, Preau S, Tamion F, Daubin C, Cousin N, Vincentelli A, Goutay J, Du Cheyron D. Anti-Xa activity and hemorrhagic events under extracorporeal membrane oxygenation (ECMO): a multicenter cohort study. Crit Care 2021; 25:127. [PMID: 33810800 PMCID: PMC8019180 DOI: 10.1186/s13054-021-03554-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Hemorrhagic events remain a major concern in patients under extracorporeal membrane oxygenation (ECMO) support. We tested the association between anticoagulation levels and hemorrhagic events under ECMO using anti-Xa activity monitoring. METHODS We performed a retrospective multicenter cohort study in three ECMO centers. All adult patients treated with veno-venous (VV)- or veno-arterial (VA)-ECMO in 6 intensive care units between September 2017 and August 2019 were included. Anti-Xa activities were collected until a hemorrhagic event in the bleeding group and for the duration of ECMO in the non-bleeding group. All dosages were averaged to obtain means of anti-Xa activity for each patient, and patients were compared according to the occurrence or not of bleeding. RESULTS Among 367 patients assessed for eligibility, 121 were included. Thirty-five (29%) presented a hemorrhagic complication. In univariate analysis, anti-Xa activities were significantly higher in the bleeding group than in the non-bleeding group, both for the mean anti-Xa activity (0.38 [0.29-0.67] vs 0.33 [0.22-0.42] IU/mL; p = 0.01) and the maximal anti-Xa activity (0.83 [0.47-1.46] vs 0.66 [0.36-0.91] IU/mL; p = 0.05). In the Cox proportional hazard model, mean anti-Xa activity was associated with bleeding (p = 0.0001). By Kaplan-Meier analysis with the cutoff value at 0.46 IU/mL obtained by ROC curve analysis, the probability of survival under ECMO without bleeding was significantly lower when mean anti-Xa was > 0.46 IU/mL (p = 0.0006). CONCLUSION In critically ill patients under ECMO, mean anti-Xa activity was an independent risk factor for hemorrhagic complications. Anticoagulation targets could be revised downward in both VV- and VA-ECMO.
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Affiliation(s)
- Richard Descamps
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France.
| | - Mouhamed D Moussa
- Inserm, CHU Lille, Surgical Critical Care, Department of Anesthesiology and Critical Care, Institut Pasteur de Lille, UMR1011-EGID, Univ. Lille, 59000, Lille, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, 76000, Rouen, France
| | - Marc-Olivier Fischer
- Department of Anesthesiology and Critical Care, Caen University Hospital, 14000, Caen, France
| | - Sébastien Preau
- Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France
| | - Fabienne Tamion
- UNIROUEN, Inserm U1096, FHU- REMOD-VHF, Normandie Univ, 76000, Rouen, France
- Department of Medical Intensive Care, Rouen University Hospital, 76000, Rouen, France
| | - Cédric Daubin
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
| | - Nicolas Cousin
- Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France
| | - André Vincentelli
- Inserm, CHU Lille, Department of Cardiac Surgery, Institut Pasteur de Lille, UMR1011-EGID, Univ. Lille, 59000, Lille, France
| | - Julien Goutay
- Department of Medical Intensive Care, Lille University Hospital, 59000, Lille, France
| | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
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