SESSION TITLE: Critical Care - It's Not Just the Lungs
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 26, 2015 at 07:30 AM - 08:30 AM
PURPOSE: Anticoagulation is an integral part of Extra Corporeal Membrane Oxygenation (ECMO) therapy. Historically heparin has been used as the agent of choice for anticoagulation in such patients. However in the instance when heparin induced thrombocytopenia (HIT) is suspected, anticoagulation has to be switched to other agents like argatroban, biliverdin, lepirudin. Currently there is paucity of data available on this subject and argatroban use has been considered to be associated with increased bleeding in ECMO patients.
METHODS: Retrospective chart review was performed on all patients requiring ECMO therapy at our institution. Data was collected on type of anticoagulation administered to patients and amount of blood products required by patients while on ECMO therapy. Massive Transfusion was defined as administration of 3 or more Packed Red Blood Cells in a 24 hr period. This data was also collected along with final outcomes of patients.
RESULTS: 19 patients required ECMO therapy in the year 2014 at our institution. 13 patients had heparin as the mode for anticoagulation whereas 6 had argatroban used secondary to suspicion of HIT. Patients on argatroban required 0.78 PRBC/ECMO day compared to 0.80 PRBC/ECMO day in patients on heparin (p=0.95), whereas platelet requirement in argatroban group was 0.30 Units / ECMO day compared to 0.47 Units / ECMO day (p=0.53). There were 10 instances of massive transfusions in the argatroban group compared to 16 in the heparin group. 5 out of 6 patients survived in the argatroban group. All patients receiving argatroban were on veno-venous ECMO whereas in the heparin group 10 received veno-venous and 3 received veno-arterial ECMO. 5 patients in the argatroban group received ECMO secondary to ARDS and 1 received secondary to pulmonary embolism. 10 patients in the heparin group received ECMO secondary to ARDS and 3 secondary to cardiogenic shock. Average number of ECMO days was 16.33 in the argatroban group and 9.46 in the heparin group (p=0.13).
CONCLUSIONS: Argatroban can be safely administered in patients who have a suspicion of HIT. From our experience we can state that it has not shown to demonstrate increased requirements of blood products when compared to heparin.
CLINICAL IMPLICATIONS: Clinicians should be able to use argatroban has a safe agent in ECMO patients when there is clinical suspicion of HIT. Previous beliefs that argatroban therapy is associated with more blood transfusions were not demonstrated in our analysis.
DISCLOSURE: The following authors have nothing to disclose: Killol Patel, Pankhoori Saraf, David Shiu, Chaitali Patel, Nadeem Ali, Joshua Lee, Nida Junaid, Pratik Patel, Thiri Anandarangam, Harish Seethamraju
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