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Article Dans Une Revue Intensive Care Medicine Année : 2018

Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation a retrospective nationwide study

1 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
2 Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]
3 Service de Réanimation Médicale [CHRU Nancy]
4 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
5 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
6 Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux
7 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
8 PARCC - UMR-S U970 - Paris-Centre de Recherche Cardiovasculaire
9 VariaPsy - U1144 - Variabilité de réponse aux Psychotropes
10 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
11 IMRB - Institut Mondor de Recherche Biomédicale
12 Hôpital Henri Mondor
13 HEGP - Hôpital Européen Georges Pompidou [APHP]
14 UNIROUEN - Université de Rouen Normandie
15 IUT de Tarbes
16 UGA [2016-2019] - Université Grenoble Alpes [2016-2019]
17 TIMONE - Hôpital de la Timone [CHU - APHM]
18 CIC - Centre d'Investigation Clinique [Rennes]
19 UFC - Université de Franche-Comté
20 UN - Université de Nantes
21 UA - Université d'Angers
22 IRM - Immuno-Rhumatologie Moléculaire
23 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
24 Hôpital Louis Pradel [CHU - HCL]
25 CHU Clermont-Ferrand
26 Biologie des maladies cardiovasculaires = Biology of Cardiovascular Diseases
27 CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy]
28 INRS ( Vandoeuvre lès Nancy) - Institut national de recherche et de sécurité (Vandoeuvre lès Nancy)
Clément Delmas
Anne Medard
  • Fonction : Auteur

Résumé

Purpose - Thrombocytopenia is a frequent and serious adverse event in patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for refractory cardiogenic shock. Similarly to postcardiac surgery patients, heparin-induced thrombocytopenia (HIT) could represent the causative underlying mechanism. However, the epidemiology as well as related mortality regarding HIT and VA-ECMO remains largely unknown. We aimed to define the prevalence and associated 90-day mortality of HIT diagnosed under VA-ECMO. Methods - This retrospective study included patients under VA-ECMO from 20 French centers between 2012 and 2016. Selected patients were hospitalized for more than 3 days with high clinical suspicion of HIT and positive anti-PF4/heparin antibodies. Patients were classified according to results of functional tests as having either Confirmed or Excluded HIT. Results - A total of 5797 patients under VA-ECMO were screened; 39/5797 met the inclusion criteria, with HIT confirmed in 21/5797 patients (0.36% [95% CI] [0.21-0.52]). Fourteen of 39 patients (35.9% [20.8-50.9]) with suspected HIT were ultimately excluded because of negative functional assays. Drug-induced thrombocytopenia tended to be more frequent in Excluded HIT at the time of HIT suspicion (p = 0.073). The platelet course was similar between Confirmed and Excluded HIT (p = 0.65). Mortality rate was 33.3% [13.2-53.5] in Confirmed and 50% [23.8-76.2] in Excluded HIT (p = 0.48). Conclusions - Prevalence of HIT among patients under VA-ECMO is extremely low at 0.36% with an associated mortality rate of 33.3%, which appears to be in the same range as that observed in patients treated with VA-ECMO without HIT. In addition, HIT was ultimately ruled out in one-third of patients with clinical suspicion of HIT and positive anti-PF4/heparin antibodies.
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Dates et versions

hal-01862276 , version 1 (27-08-2018)

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Antoine Kimmoun, Walid Oulehri, Romain Sonneville, Paul-Henri Grisot, Elie Zogheib, et al.. Prevalence and outcome of heparin-induced thrombocytopenia diagnosed under veno-arterial extracorporeal membrane oxygenation a retrospective nationwide study. Intensive Care Medicine, 2018, 44 (9), pp.1460-1469. ⟨10.1007/s00134-018-5346-y⟩. ⟨hal-01862276⟩
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