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Kimmoun A, Oulehri W, Sonneville R, Grisot PH, Zogheib E, Amour J, Aissaoui N, Megarbane B, Mongardon N, Renou A, Schmidt M, Besnier E, Delmas C, Dessertaine G, Guidon C, Nesseler N, Labro G, Rozec B, Pierrot M, Helms J, Bougon D, Chardonnal L, Medard A, Ouattara A, Girerd N, Lamiral Z, Borie M, Ajzenberg N, Levy B. Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation: a retrospective nationwide study. Intensive Care Med 2018; 44:1460-1469. [PMID: 30136139 DOI: 10.1007/s00134-018-5346-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/10/2018] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- Antoine Kimmoun
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre-les-Nancy, 54511, Nancy, France
| | - Walid Oulehri
- Department of Anesthesiology and Surgical Critical Care, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Hôpital Bichat Claude Bernard, Assistance Publique, Hôpitaux de Paris, INSERM, UMR 1148, Université Paris Diderot, Paris, France
| | - Paul-Henri Grisot
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre-les-Nancy, 54511, Nancy, France
| | - Elie Zogheib
- Cardiothoracic and Vascular Intensive Care Unit, Amiens University Hospital, INSERM U1088, Jules Verne University of Picardy, Amiens, France
| | - Julien Amour
- Department of Anesthesiology and Surgical Critical Care, Institut Hospitalo-Universitaire de Cardiométabolisme et Nutrition, Hôpital Pitié-Salpêtrière, Assistance Publique, Hôpitaux de Paris, UMR INSERM 1166, Université Sorbonne, Paris, France
| | - Nadia Aissaoui
- Critical Care Unit, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, INSERM U970, Université Paris-Descartes, Paris, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, INSERM UMRS-1144, Université Paris Diderot, Paris, France
| | - Nicolas Mongardon
- Department of Anesthesiology and Surgical Critical Care, CHU Henri Mondor, Assistance Publique-Hôpitaux de Paris, INSERM U955 Team 3, Université Paris Est, Paris, France
| | - Amelie Renou
- Department of Anesthesiology and Surgical Critical Care, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris-Descartes, Paris, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Institut Hospitalo-Universitaire de Cardiométabolisme et Nutrition, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, UMR INSERM 1166, Université Sorbonne, Paris, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Surgical Critical Care, Hôpital de Rouen, Université de Rouen, Rouen, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Hôpital de Rangueil, Université de Toulouse 3 Paul Sabatier, Toulouse, France
| | - Geraldine Dessertaine
- Intensive Cardiac Care Unit, Hôpital de Grenoble, Université de Grenoble Alpes, Grenoble, France
| | - Catherine Guidon
- Department of Cardiac Surgery, Hôpital La Timone, Marseille, France
| | - Nicolas Nesseler
- Department of Anesthesiology and Surgical Critical Care, Hôpital de Pontchaillou, INSERM, UMR 1214 and INSERM 1414, Université de Rennes 1, Rennes, France
| | - Guylaine Labro
- Medical Intensive Care Unit, Hôpital Jean Minjoz, Université de Franche-Comté, Besançon, France
| | - Bertrand Rozec
- Department of Anesthesiology and Surgical Critical Care, Hôpital Guillaume et René Laennec, CHRU Nantes, Institut du Thorax, Université de Nantes, Nantes, France
| | - Marc Pierrot
- Department of Medical Intensive Care and Hyperbaric Medicine, Hôpital d'Angers, Université d' Angers, Angers, France
| | - Julie Helms
- Medical Intensive Care Unit, Nouvel Hôpital Civil, CHU de Strasbourg, INSERM, UMR_S1109, Université de Strasbourg, Strasbourg, France
| | - David Bougon
- Intensive Care Unit, Hôpital Annecy Genevois, Annecy, France
| | - Laurent Chardonnal
- Department of Anesthesiology and Surgical Critical Care, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Anne Medard
- Department of Anesthesiology and Surgical Critical Care, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Ouattara
- Department of Anesthesiology and Surgical Critical Care, Centre Médico-Chirurgical Magellan, CHU de Bordeaux, INSERM, UMR 1034, Université de Bordeaux, Bordeaux, France
| | - Nicolas Girerd
- INSERM CIC1433, CHRU de Nancy, Université de Lorraine, Nancy, France
| | - Zohra Lamiral
- INSERM CIC1433, CHRU de Nancy, Université de Lorraine, Nancy, France
| | | | - Nadine Ajzenberg
- Department of Hematology, Hôpital Bichat Claude Bernard, Assistance Publique, Hôpitaux de Paris, INSERM, UMR 1148, Université Paris Diderot, Paris, France
| | - Bruno Levy
- Medical Intensive Care Unit Brabois, Institut Lorrain du Cœur et des Vaisseaux, CHRU de Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre-les-Nancy, 54511, Nancy, France.
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