Comparison of the effects of Phosphorylcholin versus Heparin-Based Surface Coating on Clinical and Histological Outcomes During Veno-Arterial ECMO Support: A Propensity Score Weighted Analysis.

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2025-02-26 DOI:10.1016/j.jtha.2025.02.020

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, Simon F De Meyer, André Vincentelli, Sophie Susen, 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 (Heparin-coating) and phosphorylcholin (PPC-coating) 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-coating and PPC-coating 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 were underwent histochemical and immunochemical analysis for erythrocytes, Von Willebrand factor (VWF), platelets, fibrinogen, and neutrophil extra-cellular traps contents. The clinical cohort was compared using a propensity score overlap weighting (PSOW). A P-value <0.05 was significant.

Results: Compared with PPC-coating, Heparin-coating was associated with a lower incidence of thrombotic complications before and after PSOW [HR=0.67 (95%CI, 0.48; 0.93), P-value =0.015], 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.

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

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.