The Effect of Mechanical Circulatory Support on Thrombocytopenia

PurposeThe use of mechanical circulatory support(MCS) devices in patients with cardiopulmonary compromise has seen a significant rise in recent times. One well-known complication of MCS use is thrombocytopenia which places patients at increased risk of bleeding and platelet transfusions. The degree of platelet drop occurring in various MCS devices, however, remains not well-studied. Here, we analyze the degree of thrombocytopenia in commonly used MCS devices.MethodsSingle-center retrospective study of patients placed on MCS between January 2018 and August 2021. Three MCS (Impella 5.5 n= 8; Veno-venous extracorporeal membrane oxygenation n=11; Veno-arterial extracorporeal membrane oxygenation n=15) were compared by analyzing platelet counts in patients at baseline day 0 pre-implantation of device, and at day 1, 2, 3, and 7 post-implantation. Post-explantation platelet counts were analyzed at day 1 pre-explantation and at day 1 and 7 post explantation of device. Patients positive for heparin-induced thrombocytopenia or serotonin release assay, had significant bleeding complications and received platelets transfusion or expired within 7 days on MCS were excluded from analysis.ResultsPatients on veno-arterial extracorporeal membrane oxygenation had a statistically significant decrease (50%, p = 0.048) in their platelet numbers on day-1 after implantation compared to patients on Impella 5.5 or veno-venous extracorporeal membrane oxygenation (25%). Platelet numbers continued to decrease but stabilized throughout day 2 to day 7 in all devices, until after explantation when there is a statistically significant increase in platelet recovery in veno-venous extracorporeal membrane oxygenation(100%, p = 0.024) compared to Impella 5.5 and veno-arterial extracorporeal membrane oxygenation.ConclusionPatients placed on veno-arterial extracorporeal membrane oxygenation are at significant risk of thrombocytopenia compared to patients on Impella 5.5 or veno-venous extracorporeal membrane oxygenation. The use of mechanical circulatory support(MCS) devices in patients with cardiopulmonary compromise has seen a significant rise in recent times. One well-known complication of MCS use is thrombocytopenia which places patients at increased risk of bleeding and platelet transfusions. The degree of platelet drop occurring in various MCS devices, however, remains not well-studied. Here, we analyze the degree of thrombocytopenia in commonly used MCS devices. Single-center retrospective study of patients placed on MCS between January 2018 and August 2021. Three MCS (Impella 5.5 n= 8; Veno-venous extracorporeal membrane oxygenation n=11; Veno-arterial extracorporeal membrane oxygenation n=15) were compared by analyzing platelet counts in patients at baseline day 0 pre-implantation of device, and at day 1, 2, 3, and 7 post-implantation. Post-explantation platelet counts were analyzed at day 1 pre-explantation and at day 1 and 7 post explantation of device. Patients positive for heparin-induced thrombocytopenia or serotonin release assay, had significant bleeding complications and received platelets transfusion or expired within 7 days on MCS were excluded from analysis. Patients on veno-arterial extracorporeal membrane oxygenation had a statistically significant decrease (50%, p = 0.048) in their platelet numbers on day-1 after implantation compared to patients on Impella 5.5 or veno-venous extracorporeal membrane oxygenation (25%). Platelet numbers continued to decrease but stabilized throughout day 2 to day 7 in all devices, until after explantation when there is a statistically significant increase in platelet recovery in veno-venous extracorporeal membrane oxygenation(100%, p = 0.024) compared to Impella 5.5 and veno-arterial extracorporeal membrane oxygenation. Patients placed on veno-arterial extracorporeal membrane oxygenation are at significant risk of thrombocytopenia compared to patients on Impella 5.5 or veno-venous extracorporeal membrane oxygenation.