Management of Bivalirudin Anticoagulation Therapy for Extracorporeal Membrane Oxygenation in Heparin-Induced Thrombocytopenia: A Case Report and a Systematic Review

Abstract Background: Extracorporeal membrane oxygenation (ECMO) support can be life-saving in critically ill COVID-19 patients. However, there are many complications associated with this procedure, including Heparin-induced thrombocytopenia (HIT.) Despite its rarity in ECMO cases, HIT can lead to devastating consequences and is difficult to manage. Case presentation: In this report, we present a case of a COVID-19 patient on ECMO support who was diagnosed with HIT and required intensive treatment. Initially, HIT was only suspected due to newly-developed thrombocytopenia and oxygenator dysfunction, with thrombi observed later. Regarding his treatment, since there was no recommended replacement to heparin available to us at the time of diagnosis, we decided to use rivaroxaban temporarily. No adverse events were recorded during that period. The patient was able to make a full recovery.Conclusion: HIT may jeopardize patient’s care during ECMO. As COVID-19 may bring about a surge in the number of patients requiring ECMO support, we need consented guidance to optimize treatment in this specific situation.

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Suspected Heparin-Induced Thrombocytopenia in a COVID-19 Patient on Extracorporeal Membrane Oxygenation Support: A Case Report.

10.21203/rs.3.rs-50546/v2 ◽

2020 ◽

Author(s):

Xuan T. Phan ◽

Tuan Huu Nguyen ◽

Tung T. Tran ◽

Thu-Hien T. Huynh ◽

Thuy-Ha T. Hoang ◽

...

Keyword(s):

Case Report ◽

Adverse Events ◽

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Specific Situation ◽

Heparin Induced Thrombocytopenia ◽

Case Presentation ◽

Membrane Oxygenation ◽

Life Saving ◽

Number Of Patients

Abstract Background: Extracorporeal membrane oxygenation (ECMO) support can be life-saving in critically ill COVID-19 patients. However, there are many complications associated with this procedure, including Heparin-induced thrombocytopenia (HIT.) Despite its rarity in ECMO cases, HIT can lead to devastating consequences and is difficult to manage. Case presentation: In this report, we present a case of a COVID-19 patient on ECMO support who was diagnosed with HIT and required intensive treatment. Initially, HIT was only suspected due to newly-developed thrombocytopenia and oxygenator dysfunction, with thrombi observed later. Regarding his treatment, since there was no recommended replacement to heparin available to us at the time of diagnosis, we decided to use rivaroxaban temporarily. No adverse events were recorded during that period. The patient was able to make a full recovery. Conclusion: HIT may jeopardize patient’s care during ECMO. As COVID-19 may bring about a surge in the number of patients requiring ECMO support, we need consented guidance to optimize treatment in this specific situation.

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Suspected heparin-induced thrombocytopenia in a COVID-19 patient on extracorporeal membrane oxygenation support: a case report

Thrombosis Journal ◽

10.1186/s12959-020-00252-9 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

Xuan T. Phan ◽

Tuan H. Nguyen ◽

Tung T. Tran ◽

Thu-Hien T. Huynh ◽

Thuy-Ha T. Hoang ◽

...

Keyword(s):

Case Report ◽

Adverse Events ◽

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Specific Situation ◽

Heparin Induced Thrombocytopenia ◽

Case Presentation ◽

Membrane Oxygenation ◽

Life Saving ◽

Number Of Patients

Abstract Background Extracorporeal membrane oxygenation (ECMO) support can be life-saving in critically ill COVID-19 patients. However, there are many complications associated with this procedure, including Heparin-induced thrombocytopenia (HIT.) Despite its rarity in ECMO cases, HIT can lead to devastating consequences and is difficult to manage. Case presentation In this report, we present a case of a COVID-19 patient on ECMO support who was diagnosed with HIT and required intensive treatment. Initially, HIT was only suspected due to newly-developed thrombocytopenia and oxygenator dysfunction, with thrombi observed later. Regarding his treatment, since there was no recommended replacement to heparin available to us at the time of diagnosis, we decided to use rivaroxaban temporarily. No adverse events were recorded during that period. The patient was able to make a full recovery. Conclusion HIT may jeopardize patient’s care during ECMO. As COVID-19 may bring about a surge in the number of patients requiring ECMO support, we need consented guidance to optimize treatment in this specific situation.

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Suspected Heparin-Induced Thrombocytopenia in a COVID-19 Patient on Extracorporeal Membrane Oxygenation Support: A Case Report.

10.21203/rs.3.rs-50546/v3 ◽

2020 ◽

Author(s):

Xuan T. Phan ◽

Tuan Huu Nguyen ◽

Tung T. Tran ◽

Thu-Hien T. Huynh ◽

Thuy-Ha T. Hoang ◽

...

Keyword(s):

Case Report ◽

Adverse Events ◽

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Specific Situation ◽

Heparin Induced Thrombocytopenia ◽

Case Presentation ◽

Membrane Oxygenation ◽

Life Saving ◽

Number Of Patients

Abstract Background: Extracorporeal membrane oxygenation (ECMO) support can be life-saving in critically ill COVID-19 patients. However, there are many complications associated with this procedure, including Heparin-induced thrombocytopenia (HIT.) Despite its rarity in ECMO cases, HIT can lead to devastating consequences and is difficult to manage. Case presentation: In this report, we present a case of a COVID-19 patient on ECMO support who was diagnosed with HIT and required intensive treatment. Initially, HIT was only suspected due to newly-developed thrombocytopenia and oxygenator dysfunction, with thrombi observed later. Regarding his treatment, since there was no recommended replacement to heparin available to us at the time of diagnosis, we decided to use rivaroxaban temporarily. No adverse events were recorded during that period. The patient was able to make a full recovery.Conclusion: HIT may jeopardize patient’s care during ECMO. As COVID-19 may bring about a surge in the number of patients requiring ECMO support, we need consented guidance to optimize treatment in this specific situation.

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Suspected Heparin-Induced Thrombocytopenia in a COVID-19 Patient on Extracorporeal Membrane Oxygenation Support: A Case Report.

10.21203/rs.3.rs-50546/v1 ◽

2020 ◽

Author(s):

Xuan T. Phan ◽

Tuan Huu Nguyen ◽

Tung T. Tran ◽

Thu-Hien T. Huynh ◽

Thuy-Ha T. Hoang ◽

...

Keyword(s):

Case Report ◽

Adverse Events ◽

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Specific Situation ◽

Heparin Induced Thrombocytopenia ◽

Case Presentation ◽

Membrane Oxygenation ◽

Life Saving ◽

Number Of Patients

Abstract Background: Extracorporeal membrane oxygenation (ECMO) support can be life-saving in critically ill COVID-19 patients. However, there are many complications associated with this procedure, including Heparin-induced thrombocytopenia (HIT.) Despite its rarity in ECMO cases, HIT can lead to devastating consequences and is difficult to manage.Case presentation: In this report, we present a case of a COVID-19 patient on ECMO support who was diagnosed with HIT and required intensive treatment. Initially, the patient showed no remarkable sign of thrombosis and HIT was only suspected due to newly-developed thrombocytopenia and oxygenator dysfunction. Regarding his treatment, since there was no recommended replacement to heparin available to us at the time of diagnosis, we decided to use Rivaroxaban temporarily. No adverse events were recorded during that period. The patient was able to make a full recovery.Conclusion: HIT may jeopardize patient’s care during ECMO. As COVID-19 may bring about a surge in the number of patients requiring ECMO support, we need consented guidance to optimize treatment in this specific situation.

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The use of extracorporeal membrane oxygenation in the anticipated difficult airway: a case report and systematic review

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-018-1099-x ◽

2018 ◽

Vol 65 (6) ◽

pp. 685-697 ◽

Cited By ~ 22

Author(s):

Gemma Malpas ◽

Orlando Hung ◽

Ainslie Gilchrist ◽

Chrison Wong ◽

Blaine Kent ◽

...

Keyword(s):

Systematic Review ◽

Case Report ◽

Extracorporeal Membrane Oxygenation ◽

Difficult Airway ◽

Membrane Oxygenation

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Acute limb ischemia in a patient with pre-fibrotic myelofibrosis complicated by heparin-induced thrombocytopenia and thrombosis – case report and systematic review of dabigatran use

VASA ◽

10.1024/0301-1526/a000876 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Marina Di Pilla ◽

Stefano Barco ◽

Clara Sacco ◽

Giovanni Barosi ◽

Corrado Lodigiani

Keyword(s):

Systematic Review ◽

Case Report ◽

Lower Limb ◽

Limb Ischemia ◽

Acute Limb Ischemia ◽

Review Of The Literature ◽

Heparin Induced Thrombocytopenia ◽

Lower Limb Ischemia ◽

Vein Thrombosis ◽

Left Lower Limb

Summary: A 49-year-old man was diagnosed with pre-fibrotic myelofibrosis after acute left lower-limb ischemia requiring amputation and portal vein thrombosis. After surgery he developed heparin-induced thrombocytopenia (HIT) with venous thromboembolism, successfully treated with argatroban followed by dabigatran. Our systematic review of the literature supports the use of dabigatran for suspected HIT.

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Anticoagulation after VA-ECMO decannulation, providing new insights

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.168 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

A Maestro-Benedicto ◽

A Duran-Cambra ◽

M Vila-Perales ◽

J Sans-Rosello ◽

J Carreras-Mora ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Anticoagulation Therapy ◽

Thromboembolic Events ◽

Bleeding Events ◽

Membrane Oxygenation ◽

Funding Sources ◽

Va Ecmo ◽

A Prospective Study

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an essential tool for the management of refractory cardiogenic shock. Little is known about the incidence of thromboembolic events after V-A ECMO decannulation, although some studies report a high incidence of cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation (VV-ECMO). Due to this fact, in our institution anticoagulation therapy is systematically prescribed for at least 3 months after VA-ECMO per protocol. AIM The main objective of this study was to explore the feasibility of 3-month anticoagulation therapy after VA-ECMO decannulation. METHODS We performed a prospective study that included 27 consecutive patients who were successfully treated with VA-ECMO in a medical ICU between 2016 and 2019 and were prescribed 3-month anticoagulation therapy per protocol after decannulation. Exclusion criteria was dying on ECMO or while on the ICU. Data analysis included demographics, mean days on ECMO, 3-month survival, and thromboembolic and bleeding events (excluding immediate post-decannulation bleeding, since anticoagulation was prescribed 24h after). RESULTS Our cohort consisted mainly of men (N = 21, 78%), with a mean age of 60 ± 11 years and a mean time on VA-ECMO of 8 ± 3 days, who primarily suffered from post-cardiotomy cardiogenic shock (N = 9, 34%) or acute myocardial infarction (N = 6, 23%). 5 patients (18%) received a heart transplant. Regarding anticoagulation, 15 patients (60%) had other indications apart from the protocol, like incidental thrombus diagnosis (N = 7, 26%) or valve surgery (N = 5, 18%). Anticoagulation therapy was not feasible in 1 patient (4%) with severe thrombopenia. No patients had severe or life-threatening bleeding events in the follow-up, although 8 patients (30%) had bleeding events, mainly gastrointestinal bleeding (N = 4, 15%), requiring withdrawal of anticoagulation in 1 patient. The incidence of thromboembolic events was 7%; two patients with low-risk pulmonary embolisms. During the 3-month follow-up survival rate was 95%. CONCLUSIONS This is the only study to date addressing the strategy of 3-month anticoagulation therapy after VAECMO, showing it is feasible and safe and may be helpful in reducing or ameliorate thromboembolic complications in the follow-up, although it is not exempt of complications. Abstract Figure. Kaplan-Meier survival analysis

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