Re-evaluating the association between thrombocytopenia and bleeding in extracorporeal membrane oxygenation (ECMO)

Area of Science:

• Critical Care Medicine
• Hematology
• Cardiovascular Research

Background:

• The optimal platelet count threshold for transfusions in patients undergoing extracorporeal membrane oxygenation (ECMO) to prevent bleeding is not well-defined.
• Bleeding complications are a significant concern in patients requiring ECMO support.

Purpose of the Study:

• To investigate the association between platelet count and the incidence of bleeding complications in adult patients receiving ECMO.
• To determine the efficacy of prophylactic platelet transfusions in mitigating bleeding risks within specific platelet count ranges during ECMO.

Main Methods:

• A single-center retrospective study included 291 adult patients supported with venovenous (VV) or venoarterial (VA) ECMO between 2017 and 2022.
• Patients were stratified based on platelet count: 'thrombocytopenic' (≤30 × 10³ cells/μL) versus 'non-thrombocytopenic' (>30 × 10³ cells/μL).
• Multivariable logistic regression and post-hoc analyses examined the relationship between platelet count, transfusion status, and major bleeding events.

Main Results:

• Of 291 patients, 24% were categorized as thrombocytopenic, and 50% experienced at least one major bleeding event.
• Thrombocytopenia was not significantly associated with an increased risk of major bleeding, potentially confounded by a high prophylactic transfusion rate (72%).
• A significant reduction in major bleeding complications was observed in patients with a nadir platelet count between 31 and 50 × 10³ cells/μL who received prophylactic platelet transfusions (p = 0.003).

Conclusions:

• The findings suggest that a prophylactic platelet transfusion threshold of ≤50 × 10³ cells/μL may be beneficial for preventing bleeding in ECMO patients.
• Further prospective studies are warranted to confirm the optimal platelet transfusion strategy during ECMO support.