Platelet Count Trends and Prevalence of Heparin-Induced Thrombocytopenia in a Cohort of Extracorporeal Membrane Oxygenator Patients.
Citation: Critical Care Medicine. 44(11):e1031-e1037, 2016 NovPMID: 27441904Institution: MedStar Washington Hospital CenterDepartment: Surgery/Burn Services | Surgery/Surgical Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anticoagulants/ae [Adverse Effects] | *Extracorporeal Membrane Oxygenation | *Heparin/ae [Adverse Effects] | *Platelet Count | *Thrombocytopenia/ci [Chemically Induced] | Adult | Cohort Studies | Enzyme-Linked Immunosorbent Assay | Extracorporeal Membrane Oxygenation/sn [Statistics & Numerical Data] | Female | Hospitals, Teaching | Humans | Ischemia/co [Complications] | Male | Middle Aged | Platelet Count/td [Trends] | Prevalence | Retrospective Studies | Stroke/co [Complications] | Thrombocytopenia/co [Complications] | Thrombocytopenia/ep [Epidemiology] | Thromboembolism/co [Complications]Year: 2016Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:- 0090-3493
| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 27441904 | Available | 27441904 |
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: Prevalence of heparin-induced thrombocytopenia and heparin-induced thrombocytopenia-related thrombosis among extracorporeal membrane oxygenator patients at our institution is relatively high. Using platelet count trends to guide decision to test for heparin-induced thrombocytopenia is not an optimal strategy in extracorporeal membrane oxygenator patients. Without a validated pretest probability clinical score, serosurveillance in a defined high-risk group of extracorporeal membrane oxygenator patients may be needed.
DESIGN: Retrospective cohort study.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: Demographic and clinical data were collected prospectively on all extracorporeal membrane oxygenator patients. Heparin-induced thrombocytopenia testing results and platelet count variables were obtained from the electronic medical record. We used our institutional algorithm to interpret the results of heparin-induced thrombocytopenia testing. Ninety-six extracorporeal membrane oxygenator patients met the inclusion criteria. Eight patients met the algorithm criteria for heparin-induced thrombocytopenia diagnosis and seven of those had documented thromboembolic event while on extracorporeal membrane oxygenator (prevalence of heparin-induced thrombocytopenia and heparin-induced thrombocytopenia related thrombosis, 8.3 and 7.3, respectively). Heparin-induced thrombocytopenia positive patients were younger; all underwent venoarterial extracorporeal membrane oxygenator; spent more hours on extracorporeal membrane oxygenator; had significantly higher heparin-induced thrombocytopenia enzyme-linked immunosorbent assays optical density; had a higher prevalence of thromboembolic events and reached platelet count nadir later. There was no difference in mortality between heparin-induced thrombocytopenia positive and negative patients. Comparison of platelet count trends revealed that there was no statistically significant difference between the predefined study groups.
OBJECTIVES: To assess the prevalence of heparin-induced thrombocytopenia and to study platelet count trends potentially suggestive of heparin-induced thrombocytopenia in a population of extracorporeal membrane oxygenator patients.
PATIENTS: Extracorporeal membrane oxygenator patients who survived longer than 48 hours from extracorporeal membrane oxygenator initiation between January 1, 2009, and December 31, 2013.
SETTING: A total of 926-bed teaching hospital.
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