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- Title
Platelet factor-4 concentration in adult veno-arterial ECMO patients.
- Authors
Mazzeffi, Michael; Clark, Madeline; Grazioli, Alison; Dugan, Colleen; Rector, Raymond; Dalton, Heidi; Madathil, Ronson; Menaker, Jay; Herr, Daniel; Tanaka, Kenichi
- Abstract
Background: Heparin induced thrombocytopenia (HIT) is reported at a variable rate in extracorporeal membrane oxygenation (ECMO) patients. A critical factor impacting platelet factor-4 (PF4)-heparin antibody formation is plasma PF4 concentration. We hypothesized that PF4 concentration would be increased during veno-arterial (VA) ECMO. Methods: Plasma PF4 concentration was measured during the first 5 ECMO days in 20 VA ECMO patients and 10 control plasma samples. PF4-heparin ratios were estimated using an assumed heparin concentration of 0.4 IU/mL. This correlates with an activated partial thromboplastin time of 60 to 80 seconds, which is the anticoagulation target in our center. Results: Twenty VA ECMO patients were enrolled, 10 of which had pulmonary embolism. Median PF4 concentration was 0.03 µg/mL [0.01, 0.13] in control plasma. Median PF4 concentration was 0.21 µg/mL [0.12, 0.34] on ECMO day 1 or 2, 0.16 µg/mL [0.09, 0.25] on ECMO day 3, and 0.12 µg/mL [0.09, 0.22] on ECMO day 5. Estimated median PF4-heparin ratios were 0.04, 0.03, and 0.02 respectively. Two patients (10%) developed HIT that was confirmed by serotonin release assay. PF4 concentration did not differ significantly in these patients compared to non-HIT patients (p = 0.37). No patient had an estimated PF4-heparin ratio between 0.7 and 1.4, which is the reported optimal range for PF4-heparin antibody formation. Conclusion: Our data suggest that PF4 concentration is mildly elevated during VA ECMO compared to control plasma. Estimated PF4-heparin ratios were not optimal for HIT antibody formation. These data support epidemiologic studies where HIT incidence is low during VA ECMO.
- Subjects
MARYLAND; HEART failure treatment; PARTIAL thromboplastin time; REFERENCE values; PULMONARY embolism; EXTRACORPOREAL membrane oxygenation; MANN Whitney U Test; COMPARATIVE studies; RISK assessment; CARDIOGENIC shock; GLYCOPROTEINS; DESCRIPTIVE statistics; RESEARCH funding; HEPARIN; THROMBOCYTOPENIA; DATA analysis software; DISEASE risk factors; ADULTS
- Publication
Perfusion, 2021, Vol 36, Issue 7, p688
- ISSN
0267-6591
- Publication type
Article
- DOI
10.1177/0267659120965104