What is the clinical evidence from this study?

Study design: Cohort. Population: Venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) (n=93). Intervention: Dual antiplatelet therapy (DAPT) vs. No antiplatelet therapy. Primary outcome: Any bleeding event (p=0.353).

July 28, 2016Open Access

Dual Antiplatelet Therapy (DAPT) versus No Antiplatelet Therapy and Incidence of Major Bleeding in Patients on Venoarterial Extracorporeal Membrane Oxygenation

Key Result

Dual antiplatelet therapy did not significantly increase the incidence of any bleeding compared to no antiplatelet therapy in patients on venoarterial extracorporeal membrane oxygenation (66.7% vs. 57.1%, p=0.353).

Study Design

Type

Cohort (n=93)

Multicenter

Structured PICO

Does dual antiplatelet therapy increase the incidence of major bleeding in patients on venoarterial extracorporeal membrane oxygenation compared to no antiplatelet therapy?

Population

93 patients treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO), with a mean age of 57.8 years, evaluated retrospectively for bleeding events during an average therapy duration of 58.9 hours.

Exposure

Dual antiplatelet therapy (DAPT) consisting of aspirin plus a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel) added to background unfractionated heparin.

Comparator

No antiplatelet therapy (background therapy of unfractionated heparin only).

Outcome

Incidence of any bleeding, BARC3 bleeding, and pulmonary bleeding during VA-ECMO therapy.safety

In patients on VA-ECMO, the addition of dual antiplatelet therapy for indications such as coronary stenting does not appear to significantly increase the already high intrinsic risk of major bleeding.

Main Result

Absolute Event Rate: 66.7% vs 57.1%

p-value: p=0.353

Limitations

Retrospective, non-randomized design
Limited number of patients
Potential underreporting of minor bleedings
Baseline differences between groups (DAPT patients were significantly older and had different indications for ECMO)

Abstract

AIMS: Bleeding is a frequent complication in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). An indication for dual antiplatelet therapy due to coronary stent implantation is present in a considerable number of these patients. The objective of this retrospective study was to evaluate if dual antiplatelet therapy (DAPT) significantly increases the high intrinsic bleeding risk in patients on VA-ECMO. METHODS AND RESULTS: A total of 93 patients were treated with VA-ECMO between October 2010 and October 2013. Average time on VA-ECMO was 58.9 ± 1.7 hours. Dual antiplatelet therapy was given to 51.6% of all patients. Any bleeding was recorded in 60.2% of all patients. There was no difference in bleeding incidence in patients on DAPT when compared to those without any antiplatelet therapy including any bleeding (66.7% vs. 57.1%, p = 0.35), BARC3 bleeding (43.8% vs. 33.3%, p = 0.31) or pulmonary bleeding (16.7% vs. 19.0%, p = 0.77). This holds true after adjustment for confounders. Rate of transfusion of red blood cells were similar in patients with or without DAPT (35.4% vs. 28.6%, p = 0.488). CONCLUSIONS: Bleeding on VA-ECMO is frequent. This registry recorded no statistical difference in bleeding in patients on dual antiplatelet therapy when compared to no antiplatelet therapy. When indicated, DAPT should not be withheld from VA ECMO patients.

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