Association between platelet indices and next-day bleeding and clotting in children and adults on extracorporeal membrane oxygenation: A retrospective study

Madhuradhar Chegondi; Aravinth Jawahar; Aditya Badheka; Oliver Karam

doi:10.1177/02676591261445354

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Association between platelet indices and next-day bleeding and clotting in children and adults on extracorporeal membrane oxygenation: A retrospective study

Journal article

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Association between platelet indices and next-day bleeding and clotting in children and adults on extracorporeal membrane oxygenation: A retrospective study

Madhuradhar Chegondi, Aravinth Jawahar, Aditya Badheka and Oliver Karam

Perfusion

04/18/2026

DOI: 10.1177/02676591261445354

PMID: 41999570

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Abstract

IntroductionBleeding and clotting phenotypes are common in patients supported with Extracorporeal Membrane Oxygenation (ECMO) and are associated with increased mortality. However, tools to distinguish bleeding from clotting phenotypes remain limited. Readily available platelet indices may help characterize these phenotypes.MethodsWe retrospectively studied patients admitted to neonatal, pediatric, and adult intensive care units (ICUs) at two centers from 2018 to 2022, who were on ECMO and required platelet transfusions. The association between pre-transfusion platelet indices (platelet count, mean platelet volume, platelet mass index) and bleeding or clotting on subsequent day was assessed with day-level univariable and multivariable logistic regression models.ResultsWe enrolled 268 patients receiving ECMO support (75% veno-arterial), with a median age was 51 years (IQR 18.9-65.6). A total of 1395 platelet transfusion events were analyzed, of which 18% were followed by bleeding and 5% by thrombosis within 24 h. After multivariable adjustment, higher pre-transfusion platelet counts independently associated with subsequent bleeding (adjusted odds ratio [aOR] 1.001, = 0.03) but not with subsequent thrombosis (aOR 0.99, = 0.18). Lower pre-transfusion mean platelet volume (MPV) were independently associated with increased bleeding risk (aOR 0.87, = 0.049), while MPV was not associated with thrombosis (aOR 1.03, = 0.47). Platelet mass index (PMI) was not independently associated with bleeding (aOR 1.00, = 0.80) or thrombosis (aOR 1.00, = 0.32). All platelet indices demonstrated poor discriminatory performance for predicting bleeding or thrombosis, with area under the curve values ranging from 0.42 to 0.55.ConclusionsAlthough platelet count and MPV were independently associated with subsequent bleeding, neither index reliably distinguished bleeding phenotypes. Improved tools are needed to predict hemostatic outcomes in patients supported with ECMO.

Adults

platelet count

platelet mass index

bleeding

clotting

children

extracorporeal membrane oxygenation

mean platelet volume

Details

Title: Subtitle: Association between platelet indices and next-day bleeding and clotting in children and adults on extracorporeal membrane oxygenation: A retrospective study
Creators: Madhuradhar Chegondi - University of Iowa, Stead Family Department of Pediatrics
Aravinth Jawahar - University of Iowa
Aditya Badheka - University of Iowa, Critical Care
Oliver Karam - Yale University
Resource Type: Journal article
Publication Details: Perfusion
DOI: 10.1177/02676591261445354
PMID: 41999570
ISSN: 1477-111X
eISSN: 1477-111X
Publisher: Sage
Grant note: Children's Miracle Network, Stead Family Children's Hospital, University of Iowa
Dr. Chegondi disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Children's Miracle Network, Stead Family Children's Hospital, University of Iowa, Iowa City, IA, USA.
Language: English
Electronic publication date: 04/18/2026
Academic Unit: Critical Care; Stead Family Department of Pediatrics
Record Identifier: 9985154943902771

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