Tufts University School of Medicine, Boston, MA 02111, USA.
The CardioVascular Center, Tufts Medical Center, Boston, MA 02111, USA.
J Crit Care. 2023 Feb;73:154216. doi: 10.1016/j.jcrc.2022.154216. Epub 2022 Nov 23.
One common but not well-understood phenomenon of temporary mechanical circulatory support (MCS) use is thrombocytopenia. This clinical issue increases the risk of bleeding and the need for platelet transfusion. Additionally, heparin-induced thrombocytopenia must be considered as part of the differential diagnosis, which complicates patient management. In what follows, we analyze the degree and relative rate of platelet count drop with various temporary MCS strategies - Impella 5.5; Veno-venous Extracorporeal Membrane Oxygenation (VV ECMO); Veno-arterial ECMO (VA ECMO); Intra-aortic Balloon Pump (IABP) and Centrimag Biventricular Assist Device (BIVAD). A total of 337 cohort was investigated. 77 was included for analysis after strict exclusion criteria were utilized (platelet transfusions, bleeding complications, etc.). Repeated measure mixed effect and linear regression models were used to assess the percent platelet drop on implantation of MCS and recovery after explantation of MCS. A statistically significant mean percent drop occurred in MCS types - VA ECMO(-69.6%, p < 0.001), VV ECMO(-40.9%, p < 0.001), Impella 5.5(-20.9%, p = 0.01) and IABP(-28.3%, p = 0.01), except Centrimag BIVAD(-6.5%, p = 0.61). Platelet recovery to or above baseline occurred in VA ECMO(+107.0%, p = 0.42), Impella 5.5(+117.2%, p = 0.28), IABP(+108.3%, p = 0.37), VV-ECMO(163.3%, p = 0.01*) and Centrimag BIVAD(+100.1%, p = 0.99). These results show that the degree of thrombocytopenia depends on MCS device type and is reversible.
一种常见但尚未被充分理解的临时机械循环支持 (MCS) 使用现象是血小板减少症。这种临床问题会增加出血风险和血小板输注的需求。此外，肝素诱导的血小板减少症必须被视为鉴别诊断的一部分，这使患者的管理变得复杂。接下来，我们分析了各种临时 MCS 策略下血小板计数下降的程度和相对比率——Impella 5.5；静脉-静脉体外膜肺氧合 (VV ECMO)；静脉-动脉体外膜肺氧合 (VA ECMO)；主动脉内球囊泵 (IABP) 和 Centrimag 双心室辅助装置 (BIVAD)。共调查了 337 例队列。在使用严格的排除标准 (血小板输注、出血并发症等) 后，纳入了 77 例进行分析。重复测量混合效应和线性回归模型用于评估 MCS 植入时的血小板下降百分比和 MCS 取出后的恢复百分比。MCS 类型中存在统计学上显著的平均血小板下降百分比——VA ECMO（-69.6%，p < 0.001）、VV ECMO（-40.9%，p < 0.001）、Impella 5.5（-20.9%，p = 0.01）和 IABP（-28.3%，p = 0.01），但 Centrimag BIVAD 除外（-6.5%，p = 0.61）。VA ECMO（+107.0%，p = 0.42）、Impella 5.5（+117.2%，p = 0.28）、IABP（+108.3%，p = 0.37）、VV-ECMO（163.3%，p = 0.01*）和 Centrimag BIVAD（+100.1%，p = 0.99）的血小板恢复到或高于基线。这些结果表明，血小板减少症的程度取决于 MCS 装置类型，且是可逆的。
