ECMO 논문리뷰 - 출혈 합병증에서 혈소판과 항응고제와의 관련성

Hemorrhagic complications during extracorporeal membrane oxygenation – The role of anticoagulation and platelets
Annemieke Oude Lansink-Hartgring a,⁎, Adrianus J. de Vries b, Joep M. Droogh a, Walter M. van den Bergha

Journal of Critical Care 54 (2019) 239–243

 

Background

Both hemorrhagic and thromboembolic complications have a significant impact on morbidity and mortality

일부 연구에서는 수혈 그 자체가 mortality에 영향을 준다고 설명

Rigorous evaluations of anticoagulation use in ECMO patients are therefore urgently needed

 

Results

Minor/major hemorrhagic complication을 모두 묶어서 통계 자료를 돌림

A higher aPTT was associated with the occurrence of hemorrhagic complications (adjusted HR per 10 s increase 1.14; (95% CI 1.05–1.24). The adjusted hazard ratio per 10 × 109 platelets cells/L increase for the occurrence of hemorrhagic complications was 0.97 (95% CI 0.94–1.01) (Table 4).With the stepwise backward regression analyses we found that VA ECMO, duration of ECMO support, and higher aPTT were independent risk factors for the occurrence of hemorrhagic complications (Table 5). Platelets were not a statistical significant risk factor for the occurrence of hemorrhagic complications (hazard ratio 0.96, 95% CI 0.93–1.01).

Risk factors for the occurrence of hemorrhagic complications are a higher aPTT, duration of ECMO, and VA ECMO of which the latter is the most important.

 

Limitations

overrepresentation of postcardiotomy patients