Tranexamic Acid for Bleeding Management in Adult Patients on Extracorporeal Membrane Oxygenation.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 Dec 2023
01 Dec 2023
Historique:
medline:
4
12
2023
pubmed:
1
11
2023
entrez:
1
11
2023
Statut:
ppublish
Résumé
This study described the outcomes of patients receiving topical, nebulized, endobronchial, or systemic tranexamic acid (TXA) for bleeding events while on extracorporeal membrane oxygenation (ECMO). We performed a single-center case series including adult patients >18 years old supported on either venovenous (VV) or venoarterial (VA) ECMO from January 1, 2014, to April 21, 2021. The primary outcome was hemostatic control defined as a composite of initial cessation of therapeutic interventions to mitigate bleeding or resumption of anticoagulation if previously held. Secondary outcomes included changes in transfusion requirements and lysis at 30-minute (LY30) values, venous thromboembolism (VTE) events, and seizures. In total, 47 patients were included for full analysis. There were 19 patients with surgical bleeds, 18 patients with medical bleeds, and 10 patients with multiple bleeds. Overall, initial hemostatic control was achieved in 79%, 67%, and 90% of patients, respectively. Pre- and post-TXA transfusion requirements were not significantly different ( p = 0.2), although the intraindividual change in median LY30 was -5.1% compared with baseline (95% confidence interval [CI], -12.4% to -1.5%, p = 0.005). The occurrence of VTE and seizures was relatively low and similar among patient bleeding groups. Tranexamic acid provided initial hemostatic control in roughly three quarters of patients with bleeding events on ECMO and side effects were infrequent.
Identifiants
pubmed: 37913503
doi: 10.1097/MAT.0000000000002056
pii: 00002480-990000000-00343
doi:
Substances chimiques
Tranexamic Acid
6T84R30KC1
Hemostatics
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e474-e481Informations de copyright
Copyright © ASAIO 2023.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Nunez JI, Gosling AF, O’Gara B, et al.: Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: An ELSO registry analysis. Intensive Care Med. 48: 213–224, 2022.
Murphy DA, Hockings LE, Andrews RK, et al.: Extracorporeal membrane oxygenation-hemostatic complications. Transfus Med Rev. 29: 90–101, 2015.
Mazzeffi M, Strauss E, Meyer M, et al.: Coagulation factor levels and underlying thrombin generation patterns in adult extracorporeal membrane oxygenation patients. Anesth Analg. 129: 659–666, 2019.
Durila M, Smetak T, Hedvicak P, Berousek J: Extracorporeal membrane oxygenation–induced fibrinolysis detected by rotational thromboelastometry and treated by oxygenator exchange. Perfusion. 34: 330–333, 2019.
Lotz C, Streiber N, Roewer N, Lepper PM, Muellenbach RM, Kredel M: Therapeutic interventions and risk factors of bleeding during extracorporeal membrane oxygenation. ASAIO J. 63: 624–630, 2017.
Relke N, Chornenki NLJ, Sholzberg M: Tranexamic acid evidence and controversies: An illustrated review. Res Pract Thromb Haemost. 5: e12546, 2021.
Seelhammer TG, Mangla J, Demirci O: The use of thromboelastography to titrate tranexamic acid therapy for abatement of lysis-induced hemorrhagic complications during venoarterial extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth. 33: 1059–1062, 2019.
Scaravilli V, Fumagalli J, Rosso L, et al.: Heparin-free lung transplantation on venovenous extracorporeal membrane oxygenation bridge. ASAIO J. 67: e191–e197, 2021.
Cabanilla MG, Villalobos NE, Ahmed S: A role for nebulized tranexamic acid in veno-venous ECMO patients. J Clin Pharm Ther. 47: 125–128, 2022.
Stevens PE, Levin A; Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members: Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 158: 825–830, 2013.
Lee WM, Stravitz RT, Larson AM: Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011. Hepatology (Baltimore, Md.). 55: 965–967, 2012.
Schmidt M, Bailey M, Sheldrake J, et al.: Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med. 189: 1374–1382, 2014.
Schmidt M, Burrell A, Roberts L, et al.: Predicting survival after ECMO for refractory cardiogenic shock: The survival after veno-arterial-ECMO (SAVE)-score. Eur Heart J. 36: 2246–2256, 2015.
Chapman MP, Moore EE, Ramos CR, et al.: Fibrinolysis greater than 3% is the critical value for initiation of antifibrinolytic therapy. J Trauma Acute Care Surg. 75: 961–7; discussion 967, 2013.
Fisser C, Reichenbächer C, Müller T, et al.: Incidence and risk factors for cannula-related venous thrombosis after venovenous extracorporeal membrane oxygenation in adult patients with acute respiratory failure. Crit Care Med. 47: e332–e339, 2019.
Menaker J, Tabatabai A, Rector R, et al.: Incidence of cannula-associated deep vein thrombosis after veno-venous extracorporeal membrane oxygenation. ASAIO J. 63: 588–591, 2017.
Lecker I, Wang DS, Whissell PD, Avramescu S, Mazer CD, Orser BA: Tranexamic acid-associated seizures: Causes and treatment. Ann Neurol. 79: 18–26, 2016.
Buckley LF, Reardon DP, Camp PC, et al.: Aminocaproic acid for the management of bleeding in patients on extracorporeal membrane oxygenation: Four adult case reports and a review of the literature. Heart Lung. 45: 232–236, 2016.
Coleman M, Davis J, Maher KO, Deshpande SR: Clinical and hematological outcomes of aminocaproic acid use during pediatric cardiac ECMO. J Extra Corpor Technol. 53: 40–45, 2021.
Wilson JM, Bower LK, Fackler JC, Beals DA, Bergus BO, Kevy SV: Aminocaproic acid decreases the incidence of intracranial hemorrhage and other hemorrhagic complications of ECMO. J Pediatr Surg. 28: 536–540; discussion 540, 1993.
van der Staak FH, de Haan AF, Geven WB, Festen C: Surgical repair of congenital diaphragmatic hernia during extracorporeal membrane oxygenation: Hemorrhagic complications and the effect of tranexamic acid. J Pediatr Surg. 32: 594–599, 1997.
Nellis ME, Vasovic LV, Goel R, Karam O: Epidemiology of the use of hemostatic agents in children supported by extracorporeal membrane oxygenation: A Pediatric Health Information System Database Study. Front Pediatr. 9: 673613, 2021.
Aubron C, DePuydt J, Belon F, et al.: Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation. Ann Intensive Care. 6: 97, 2016.
Bontempo LJ, Manning SL: Tracheostomy emergencies. Emerg Med Clin North Am. 37: 109–119, 2019.
Salas De Armas IA, Dinh K, Akkanti B, et al.: Tracheostomy while on extracorporeal membrane oxygenation: A comparison of percutaneous and open procedures. J Extra Corpor Technol. 52: 266–271, 2020.
Repessé X, Au SM, Bréchot N, et al.: Recombinant factor VIIa for uncontrollable bleeding in patients with extracorporeal membrane oxygenation: Report on 15 cases and literature review. Crit Care. 17: R55, 2013.
Picetti R, Shakur-Still H, Medcalf RL, Standing JF, Roberts I: What concentration of tranexamic acid is needed to inhibit fibrinolysis? A systematic review of pharmacodynamics studies. Blood Coagul Fibrinolysis. 30: 1–10, 2019.
Parzy G, Daviet F, Puech B, et al.: Venous thromboembolism events following venovenous extracorporeal membrane oxygenation for severe acute respiratory syndrome coronavirus 2 based on CT scans. Crit Care Med. 48: e971–e975, 2020.