Platelet factor-4 concentration in adult veno-arterial ECMO patients

Author:

Mazzeffi Michael1ORCID,Clark Madeline2,Grazioli Alison34,Dugan Colleen5,Rector Raymond5,Dalton Heidi6,Madathil Ronson7ORCID,Menaker Jay8,Herr Daniel9,Tanaka Kenichi1

Affiliation:

1. Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD, USA

2. University of Maryland School of Medicine, Baltimore, MD, USA

3. National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health, Bethesda, MD, USA

4. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

5. University of Maryland Medical Center, Baltimore, MD, USA

6. Fairfax INOVA Hospital, Fairfax, VA, USA

7. Division of Cardiothoracic Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA

8. Department of Surgery, University of Maryland School of Medicine, Program in Trauma, Baltimore, MD, USA

9. Department of Medicine, University of Maryland School of Medicine, Program in Trauma, Baltimore, MD, USA

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.

Funder

Society of Cardiovascular Anesthesiologists

Publisher

SAGE Publications

Subject

Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Safety Research,Radiology Nuclear Medicine and imaging,General Medicine

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