Bleeding complications, coagulation disorders, and their management in acute myocardial infarction-related cardiogenic shock rescued by veno-arterial ECMO: A retrospective cohort study.

Purpose: Management of dual antiplatelet therapy (DAPT) in patients on venoarterial-extracorporeal membrane (VA-ECMO) after acute myocardial infarction (AMI) is challenging. Our objective was to describe the frequency, management and outcomes of severe bleeding complications and determine their occurrence risk factors.
Material and Methods: We conducted a retrospective observational cohort study including post-AMI cardiogenic shock patients requiring VA-ECMO. Severe bleeding was defined based on the Bleeding Academic Research Consortium classification. We calculated multivariable Fine-Gray models to assess factors associated with risk of severe bleeding.
Results: From January 2015 to July 2019, 176 patients received VA-ECMO after AMI and 132 patients were included. Sixty-five (49%) patients died. Severe bleeding occurred in 39% of cases. Severe thrombocytopenia (< 50 G/L) and hypofibrinogenemia (<1,5 g/L) occurred in respectively 31% and 19% of patients. DAPT was stopped in 32% of patients with a 6% rate of stent thrombosis. Anticoagulation was stopped in 39% of patients. Using a multivariate competing risk model, female sex, time on ECMO, troponin at admission and Impella® implantation were independently associated with severe bleeding.
Conclusions: Bleeding complications and coagulation disorders were frequent and severe in patients on VA-ECMO after AMI, leading of antiplatelet therapy withdrawal in one third of patients.
Competing Interests: Declaration of competing interest Matthieu Schmidt reports lecture fees from Getinge, Drager and Xenios outside the submitted work. Alain Combes reports grants from Getinge, personal fees from Getinge, Baxter and Xenios outside the submitted work. Charles Edouard Luyt reported personal fees from Bayer Healthcare, Carmat, Faron, Merck Sharp & Dohme, ThermoFischer Brahms, and Biomérieux; and grants from Bayer Healthcare outside the submitted work. Guillaume Lebreton reports lecture fees from Livanova and Abiomed, outside of the submitted work. The other authors declare that they have no conflicts of interest related to the purpose of this manuscript.
(Copyright © 2023. Published by Elsevier Inc.)