Journal article
Incidence and severity of thrombocytopenia associated with use of intravascular microaxial ventricular assist devices for treatment of cardiogenic shock
Catheterization and cardiovascular interventions, Vol.101(2), pp.318-323
02/01/2023
DOI: 10.1002/ccd.30520
PMID: 36490219
Abstract
Introduction The use of temporary mechanical circulatory support (MCS) for patients with refractory cardiogenic shock has increased over the past decade. Impella devices (intravascular microaxial ventricular assist devices [VADs]) have become common MCS options but reportedly cause thrombocytopenia. Limited published data regarding the incidence or severity of microaxial VAD-associated thrombocytopenia exists. ObjectivesThe goal of this study was to determine the incidence, timing, and severity of thrombocytopenia in a microaxial VAD population. MethodsA retrospective multicenter review of electronic medical records identified all patients implanted with microaxial VAD at three US academic teaching hospitals between June 2015 and August 2017. Patients were excluded for short-term procedural microaxial VAD use during percutaneous coronary intervention. ResultsSixty-four patients underwent microaxial VAD insertion (95% for left-sided support) during the observed time period. Support was in place for a median duration of 5.2 (interquartile range [IQR]: 2.4-10.0) days. Within 7 days postinsertion, 98.5% of patients developed thrombocytopenia (platelet count <150,000/mu l) and 81.3% of patients experienced a >50% platelet decrease. Average platelet count nadir was 68,200/mu l or 63.9% from baseline occurring on median day 3.8 (IQR: 2.4-5.4). Twenty-four patients (38.1%) were tested for heparin-induced thrombocytopenia by the heparin-dependent antibody (HDA) test. All HDAs were either negative or had serotonin release assay negative confirmation. Postdevice removal, platelet counts returned to baseline or >150,000/mu l in 63% of patients by Day 5. ConclusionMicroaxial VAD-associated thrombocytopenia is common. Practitioners should consider this when evaluating supported patients for other causes of thrombocytopenia. Platelet counts return to preimplantation levels within days of device removal.
Details
- Title: Subtitle
- Incidence and severity of thrombocytopenia associated with use of intravascular microaxial ventricular assist devices for treatment of cardiogenic shock
- Creators
- Jenna Goetz - Barnes-Jewish HospitalMichael O'Brien - Massachusetts General HospitalHeather Bream-Rouwenhorst - University of IowaAlexander Toyoda - Massachusetts General HospitalRyan Hobbs - University of IowaPhillip A. Horwitz - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Catheterization and cardiovascular interventions, Vol.101(2), pp.318-323
- Publisher
- Wiley
- DOI
- 10.1002/ccd.30520
- PMID
- 36490219
- ISSN
- 1522-1946
- eISSN
- 1522-726X
- Number of pages
- 6
- Language
- English
- Electronic publication date
- 12/09/2022
- Date published
- 02/01/2023
- Academic Unit
- Cardiovascular Medicine; Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9984359879302771
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