PMID- 36615162
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230308
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 12
IP  - 1
DP  - 2023 Jan 2
TI  - Heparin-Induced Thrombocytopenia in Patients Undergoing Venoarterial 
      Extracorporeal Membrane Oxygenation.
LID - 10.3390/jcm12010362 [doi]
LID - 362
AB  - Background: Heparin-induced thrombocytopenia (HIT) is a serious, immune-mediated 
      adverse drug reaction to unfractionated heparin (UFH) affecting also patients 
      undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO). Although 
      the association between VA-ECMO support and the development of thrombocytopenia 
      has long been known and discussed, HIT as one underlying cause is still 
      insufficiently understood. Therefore, the purpose of this study was to further 
      investigate the epidemiology, mortality, diagnosis, and clinical management of 
      HIT occurring in VA-ECMO patients treated with UFH. Methods: We conducted a 
      retrospective single-center study including adult patients (>/=18 years) with 
      VA-ECMO support in the cardiac intensive care unit (ICU) of the University 
      Hospital of Munich (LMU) between January 2013 and May 2022, excluding patients 
      with a known history of HIT upon admission. Differences in baseline 
      characteristics and clinical outcome between excluded HIT (positive anti-platelet 
      factor 4 (PF4)/heparin antibody test but negative functional assay) and confirmed 
      HIT (positive anti-PF4/heparin antibody test and positive functional assay) 
      VA-ECMO patients as well as diagnosis and clinical management of HIT were 
      analysed. Results: Among the 373 patients included, anti-PF4/heparin antibodies 
      were detected in 53/373 (14.2%) patients. Functional HIT testing confirmed HIT in 
      13 cases (3.5%) and excluded HIT in 40 cases (10.7%), corresponding to a 
      prevalence of confirmed HIT of 13/373 (3.5%) [1.6, 5.3] and a positive predictive 
      value (PPV) of 24.5% for the antibody screening test. The platelet course 
      including platelet recovery following argatroban initiation was similar between 
      all groups. One-month mortality in patients with excluded HIT was 14/40 (35%) and 
      3-month mortality 17/40 (43%), compared to 5/13 (38%) (p > 0.999), and 6/13 (46%) 
      (p > 0.999) in patients with confirmed HIT. Neurological outcome in both groups 
      measured by the cerebral performance category of survivors on hospital discharge 
      was similar, as well as adverse events during VA-ECMO therapy. Conclusions: With 
      a prevalence of 3.5%, HIT is a non-frequent complication in patients on VA-ECMO 
      and was not associated with a higher mortality rate. HIT was ultimately excluded 
      by functional essay in 75% of VA-ECMO patients with clinical suspicion of HIT and 
      positive anti-PF4/heparin antibody test. Argatroban seems to be an appropriate 
      and safe therapeutic option for confirmed HIT-positive patients on VA-ECMO 
      support.
FAU - Lusebrink, Enzo
AU  - Lusebrink E
AUID- ORCID: 0000-0002-3214-5672
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Scherer, Clemens
AU  - Scherer C
AUID- ORCID: 0000-0003-2816-6793
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Binzenhofer, Leonhard
AU  - Binzenhofer L
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Hoffmann, Sabine
AU  - Hoffmann S
AUID- ORCID: 0000-0001-6197-8801
AD  - Institut fur Medizinische Informationsverarbeitung Biometrie und Epidemiologie, 
      Klinikum der Universitat Munchen, 81377 Munich, Germany.
FAU - Hopler, Julia
AU  - Hopler J
AD  - Institut fur Medizinische Informationsverarbeitung Biometrie und Epidemiologie, 
      Klinikum der Universitat Munchen, 81377 Munich, Germany.
FAU - Kellnar, Antonia
AU  - Kellnar A
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Thienel, Manuela
AU  - Thienel M
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Joskowiak, Dominik
AU  - Joskowiak D
AUID- ORCID: 0000-0003-3995-8737
AD  - Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Peterss, Sven
AU  - Peterss S
AUID- ORCID: 0000-0003-1880-152X
AD  - Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Petzold, Tobias
AU  - Petzold T
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Deseive, Simon
AU  - Deseive S
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Hein, Ralph
AU  - Hein R
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Brunner, Stefan
AU  - Brunner S
AUID- ORCID: 0000-0001-6608-5279
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Kaab, Stefan
AU  - Kaab S
AUID- ORCID: 0000-0001-8824-3581
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Braun, Daniel
AU  - Braun D
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Theiss, Hans
AU  - Theiss H
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Hausleiter, Jorg
AU  - Hausleiter J
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Hagl, Christian
AU  - Hagl C
AD  - Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Massberg, Steffen
AU  - Massberg S
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
FAU - Orban, Martin
AU  - Orban M
AUID- ORCID: 0000-0001-9830-1941
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen and DZHK 
      (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, 
      81377 Munich, Germany.
LA  - eng
PT  - Journal Article
DEP - 20230102
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC9821297
OTO - NOTNLM
OT  - VA-ECMO
OT  - heparin-induced thrombocytopenia
OT  - thrombocytopenia
COIS- Martin Orban has received speaker honoraria from Abbott Medical, AstraZeneca, 
      Abiomed, Bayer vital, Biotronik, Bristol-Myers Squibb, CytoSorbents, Daiichi 
      Sankyo Deutschland, Edwards Lifesciences Services, and Sedana Medical, outside 
      the submitted work. Jorg Hausleiter has received speaker honoraria and research 
      support from Abbott Vascular and Edwards Lifesciences, outside the submitted 
      work. Sven Peterss and Stefan Brunner have received speaker honoraria from 
      AstraZeneca, outside the submitted work. The other authors declare no conflict of 
      interest.
EDAT- 2023/01/09 06:00
MHDA- 2023/01/09 06:01
PMCR- 2023/01/02
CRDT- 2023/01/08 01:32
PHST- 2022/11/27 00:00 [received]
PHST- 2022/12/17 00:00 [revised]
PHST- 2022/12/27 00:00 [accepted]
PHST- 2023/01/08 01:32 [entrez]
PHST- 2023/01/09 06:00 [pubmed]
PHST- 2023/01/09 06:01 [medline]
PHST- 2023/01/02 00:00 [pmc-release]
AID - jcm12010362 [pii]
AID - jcm-12-00362 [pii]
AID - 10.3390/jcm12010362 [doi]
PST - epublish
SO  - J Clin Med. 2023 Jan 2;12(1):362. doi: 10.3390/jcm12010362.