PB0670 - Heparin-induced thrombocytopenia in extracorporeal membrane oxygenation supported patients: a systematic review and meta-analysis

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Danyu Song, MM

Doctor
Department of Laboratory Medicine, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)

Co-Author(s)

YJ

Yu Jin

Doctor
Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)
YZ

Yang Zhang

Professor
Department of Laboratory Medicine, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)
ZZ

Zhou Zhou

Professor
Department of Laboratory Medicine, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)

Background: In recent years, extracorporeal membrane oxygenation(ECMO) is increasingly used in critically ill patients with respiratory or cardiac failure. Heparin is usually used as anticoagulation therapy during ECMO support. But heparin-induced thrombocytopenia(HIT) which results in considerable morbidity and mortality is still not well described.

Aims: The purpose of this meta-analysis and systematic review is to thoroughly report the incidence of HIT on ECMO, as well as the characteristics and outcomes of HIT patients.

Methods: We searched from PUBMED EMbase, Cochrane and Scopus for studies examining HIT in adult patients supported by ECMO. All studies conforming to the inclusion criteria were screened from 1975 to September 2022. Nineteen studies from total 1,625 abstracts were selected.

Results: The pooled prevalence of HIT in ECMO supported patients was 4.2%(95% CI 2.7-5.6 18 studies). 15.9% (95% CI 9.0-22.8 12studies) patients on ECMO have been suspected HIT. ELISA is the most commonly used immunoassay.The median of optimal OD values of ELISA test in HIT confirmed patients range from 1.08 to 2.40.In most studies, SRA was performed as HIT confirming test. In the subgroup analysis, the pooled prevalence of HIT in ECMO patients was 2.7% in studies which diagnostic mode is functional assays.In studies diagnose by immunoassay, the pooled prevalence was 14.5%. In HIT patients, the percentage platelet decline range from 32% to 78.9%. Argatroban was most commonly used as alternative anticoagulation after withdrawal heparin. In confirmed HIT patients,44.4%(95%CI 27.0-62.4) developed thrombosis event, while 50.1%(95%CI 24.9-75.4) patients had bleeding event.Eventually,49.5%(95%CI 32.7-66.3) patients on ECMO with HIT died.

Conclusion(s): According to our study, the pooled prevalence of HIT in ECMO supported patients is 4.2%.it contributes to adverse outcomes. Therefore, it is crucial for clinicians to be conscious and make quick decision on subsequent treatment. Further research and development of clinical suspicion tools, laboratory assays are warranted.