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D-dimer predicts bleeding complication in out-of-hospital cardiac arrest resuscitated with ECMO
Takayuki Otani1, Hirotaka Sawano1, Tomoaki Natsukawa1
1Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6, Tsukumodai, Suita-city, Osaka 565-0862, Japan.
Insights
High D-dimer levels may predict major bleeding in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR). This finding suggests hyperfibrinolysis could be a key factor in bleeding complications for these critical patients.
Area of Science:
- Cardiology
- Critical Care Medicine
- Hematology
Background:
- Bleeding is a frequent complication in patients with out-of-hospital cardiac arrest (OHCA) who receive extracorporeal cardiopulmonary resuscitation (ECPR).
- Identifying risk factors for bleeding is crucial for managing these high-risk patients.
- Understanding bleeding predictors can improve patient outcomes and treatment strategies.
Purpose of the Study:
- To investigate the risk factors associated with major bleeding complications in patients undergoing ECPR.
- To evaluate the predictive value of specific biomarkers for bleeding in the ECPR population.
Main Methods:
- A retrospective analysis of OHCA patients treated with ECPR between October 2009 and December 2016 was conducted.
- Patients were categorized based on the occurrence of major bleeding (Bleeding Academic Research Consortium class ≥3) within 24 hours of admission.
- Statistical comparisons were made between patients with and without major bleeding.
Main Results:
- Of 133 ECPR patients, 102 were included, with 70% experiencing major bleeding.
- Significant differences were observed in age, prior antiplatelet therapy, hemoglobin, platelet count, and D-dimer levels between groups.
- Multivariate analysis identified elevated D-dimer levels as a significant predictor of major bleeding (OR 1.066, 95% CI 1.018-1.116).
Conclusions:
- D-dimer levels show potential as a predictive marker for major bleeding in ECPR patients.
- The findings suggest a potential link between hyperfibrinolysis and bleeding complications in this patient cohort.
- Further research into hyperfibrinolysis management in ECPR may be warranted.
Purpose:
In out-of-hospital cardiac arrest (OHCA) patients resuscitated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), known as extracorporeal cardiopulmonary resuscitation (ECPR), bleeding is a common complication. The purpose of this study was to assess the risk factors for bleeding complications in ECPR patients.
Methods:
We retrospectively analyzed the data for OHCA patients admitted to our hospital and resuscitated with ECPR between October 2009 and December 2016. We compared patients with and without major bleeding (i.e. the Bleeding Academic Research Consortium class≥3 bleeding) within 24h of hospital admission. Patients, whose bleeding complication was not evaluated, were excluded.
Results:
During the study period, 133 OHCA patients were resuscitated with ECPR, of whom 102 (77%) were included. In total, 71 (70%) patients experienced major bleeding. There were significant differences in age (median 65 vs. 50years, P<0.001), prior antiplatelet therapy (25% vs. 3%, P=0.008), hemoglobin (median 11.6 vs. 12.6g/dL, P=0.003), platelet count (median 125 vs. 155×103/μL, P=0.001), and D-dimer levels on admission (median 18.8 vs. 6.7μg/mL, P<0.001) among patients with and those without major bleeding. Multivariate analysis showed significant associations between major bleeding and D-dimer levels (odds ratio, 1.066; 95% confidence interval, 1.018-1.116). Area under receiver-operating characteristic curve, which describes the accuracy of D-dimer levels in predicting major bleeding, was 0.76 (95% confidence interval, 0.66-0.87).
Conclusion:
D-dimer levels may predict major bleeding in ECPR patients, suggesting that hyperfibrinolysis may be related to bleeding.
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