Comparison of the effects of phosphorylcholin versus heparin-based surface coating on clinical and histologic outcomes during veno-arterial extracorporeal membrane oxygenation support: a propensity score weighted analysis
Mouhamed Djahoum Moussa , Osama Abou-Arab , Senna Staessens , Marie Jungling , Julien Labreuche , Antoine Lamer , Christophe Beyls , Natacha Rousse , Antoine Rauch , Valentin Loobuyck , Camille Beaudeux , Adeline Pierache , Delphine Deblauwe , Delphine Corseaux , Martin Dubernet , Mathieu Guilbart , Lise Thellier , Yazine Mahjoub , Francis Juthier , Hervé Dupont , Emmanuel Robin
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引用次数: 0
Abstract
Background
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is associated with a high rate of thrombotic complications, which are prevented using systemic anticoagulation and surface coating technologies. Heparin and phosphorylcholin (PPC) coatings are widely used in clinical practice, but little is known about their effectiveness in VA-ECMO setting.
Objectives
To compare the effects of heparin and PPC coatings on thrombotic complications, bleeding, blood trauma, inflammation, thrombi composition, and mortality.
Methods
A retrospective multicenter clinical cohort was studied for clinical endpoints, and a prospective histologic cohort was investigated for thrombi composition. The clinical cohort included adult patients supported by VA-ECMO for cardiogenic shock, without any constitutive or acquired hemostasis disease disorder, from January 2013 to December 2020. Thrombi retrieved from circuit junctions underwent histochemical and immunochemical analysis for erythrocytes, von Willebrand factor (VWF), platelets, fibrinogen, and neutrophil extracellular traps content. The clinical cohort was compared using a propensity score overlap weighting. A P value <.05 was significant.
Results
Compared with PPC coating, heparin coating was associated with a lower incidence of thrombotic complications before and after propensity score overlap weighting (hazard ratio [HR]: 0.67; 95% CI: 0.48-0.93; P = .015), a lower decrease in hemoglobin, but a greater decrease in platelet count. In the histologic analysis, PPC coating resulted in a greater content of VWF. The other endpoints were similar among groups.
Conclusion
Compared with PPC coating, heparin coating is associated with fewer thrombotic complications during VA-ECMO support. Kinetics of platelet count and hemoglobin, thrombi contents differed according to coating types.
Trial registration
The prospective substudy is ancillary to the WITECMO-H multicenter study registered at ClinicalTrial.gouv (NCT 03070912).
期刊介绍：
The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community.
Types of Publications:
The journal publishes a variety of content, including:
Original research reports
State-of-the-art reviews
Brief reports
Case reports
Invited commentaries on publications in the Journal
Forum articles
Correspondence
Announcements
Scope of Contributions:
Editors invite contributions from both fundamental and clinical domains. These include:
Basic manuscripts on blood coagulation and fibrinolysis
Studies on proteins and reactions related to thrombosis and haemostasis
Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms
Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases
Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.
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