ID:94 FC-D04-6 Novel Markers To Predict Haemorrhagic And Thrombotic Events in Patients Requiring ECMO Support: A Multi-centre Study

Background: Haemorrhagic and thrombotic events are frequently encountered complications with negative impact on ECMO outcomes. Besides anticoagulation intensity, the presence of a disseminated intravascular coagulation (DIC)-like state can be a contributing factor. No conventional biomarkers can readily predict occurrence of haemorrhage or thrombosis. Novel biomarkers, namely thrombin-antithrombin-III (TAT), plasmin-alpha2-plasmininhibitor complex (PIC), thrombomodulin (TM) and tissue plasminogen activator-inhibitor complex (t-PAIC), are early indicators of coagulation cascade activation. This study serves to explore their clinical application in ECMO management and correlation with conventional markers such as PT and APTT. Methods: In this multi-centre prospective study, adult patients receiving veno-arterial (V-A) or veno-venous (V-V) ECMO were recruited. Primary outcome was association of novel markers with haemorrhagic and thrombotic events. Results: 48 patients were prospectively recruited. The mean age was 56.3±12.9. Majority (68.8%) were male. 36 (75%) and 12 (25%) patients received V-A and V-V ECMO support respectively. The mean ECMO duration was 6.6±5.5 days and overall ICU mortality was 27.1%. Haemorrhagic and thrombotic events occurred in 21 (43.8%) and 21 (43.8%) patients respectively. Median values (IQR) for novel markers were TM 32.5 TU/mL (15.9 – 53), TAT 16.4 ng/mL (8.7 – 35.9), PIC 1.95 ug/mL (0.718 – 5), tPAI-C (ng/mL) 27.4 (18.2 – 39). TM, TAT and PIC were all positively correlated with PT where TM had the strongest correlation of all (r = 0.5526, p <0.001). Elevated PIC (OR 1.17, CI 1.034 – 1.335, p = 0.008) and elevated TAT (OR 1.03, CI 1.002 – 1.056, p = 0.0015) were associated with thrombotic events. Haemorrhagic events were not readily predicted by any novel markers. Conclusion: Elevated TAT and PIC were associated with thrombotic events in ECMO patients.