Key result
Moderate or severe bleeding on day 1 or 2 of ECMO therapy was associated with significantly lower platelet aggregation and a higher prevalence of hypofibrinogenemia (43% vs 9%, OR 7.7) compared to non-bleeding patients.
Why the study?
The study investigated changes in coagulation and their associations with the occurrence of bleeding and thrombosis during ECMO therapy.
Cohort (n=100)
No
Odds Ratio: 7.7 (95% CI 2.6–20.2)
Absolute Event Rate: 43% vs 9%
p-value: p=<0.001
In adult patients undergoing ECMO, reduced platelet aggregation and lower plasma fibrinogen levels are significantly associated with early moderate-to-severe bleeding and higher mortality.
Early hypocoagulability may flag bleeding risk in ECMO patients; leaves open whether targeted correction alters outcomes.
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 ® ) 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 ® 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 ® 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 ® measurements and standard coagulation assays, but plasma fibrinogen had a stronger association with bleeding than ROTEM ® measurements. The present study does not support ROTEM ® analysis as a routine part of coagulation monitoring during ECMO therapy.
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Hvas et al. (2023) conducted a cohort in Severe cardiac and/or pulmonary failure requiring ECMO therapy (n=100). Moderate or severe bleeding on day 1 or 2 of ECMO therapy vs. No or minor bleeding on day 1 or 2 was evaluated on Fibrinogen < 187 mg/dL (OR 7.7, 95% CI 2.6-20.2, p=<0.001). Moderate or severe bleeding on day 1 or 2 of ECMO therapy was associated with significantly lower platelet aggregation and a higher prevalence of hypofibrinogenemia (43% vs 9%, OR 7.7) compared to non-bleeding patients.
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