Abstract
We aimed to investigate whether prior exposure to antiplatelet therapy (anti-PLT) was associated with stroke incidence after the initiation of extracorporeal membrane oxygenation (ECMO) therapy. We conducted a population-based cohort study based on health records obtained from the National Health Insurance Service database in South Korea. Adult patients (aged ≥ 18 years) who underwent ECMO therapy in the intensive care unit during 2009–2018 were enrolled. In total, 17,237 patients who underwent ECMO therapy were included; stroke occurred in 779 (4.5%) of 17,237 patients within 7 days of initiating the ECMO therapy. The number of patients in the anti-PLT and control groups was 3909 (22.7%) and 13,328 (77.3%), respectively. In the multivariable logistic regression analysis, the anti-PLT group showed 33% lower incidence of stroke than the control group (odds ratio (OR): 0.67, 95% confidence interval (CI): 0.55–0.82; p < 0.001). The cardiovascular group showed 35% lower incidence of stroke than the control group (OR: 0.65, 95% CI: 0.52–0.78; p < 0.001), whereas the respiratory group (p = 0.821) and the other group (p = 0.705) did not show any significant association. Prior anti-PLT therapy was associated with a lower incidence of stroke within 7 days of initiating ECMO therapy, which was more evident in the cardiovascular group.
Highlights
To treat patients with refractory cardiac and/or respiratory failure, extracorporeal membrane oxygenation (ECMO) has been used as an option of rescue therapy [1,2]
The need for informed consent was waived because analyses were performed retrospectively with anonymized data, which were derived from the South Korean National Health Insurance Service (NHIS) database
Our results suggest that prior anti-PLT therapy might modify the risk of stroke during the 7-day period after initiating ECMO therapy by inhibiting blood clots and emboli formation [19]
Summary
To treat patients with refractory cardiac and/or respiratory failure, extracorporeal membrane oxygenation (ECMO) has been used as an option of rescue therapy [1,2]. The clinical indications of ECMO support include post-cardiac surgery management, heart failure, intractable arrhythmia, heart inflammation, pulmonary hypertension, severe trauma, respiratory failure, and acute respiratory distress syndrome (ARDS) [3,4,5,6,7]. Initiation of extracorporeal circulation stimulates inflammation and activates the coagulation cascade, leading to thrombosis of the ECMO circuit and the occurrence of thromboembolic complications after ECMO therapy [9]. Occurrence of venous thromboembolism among 13 patients with coronavirus disease (COVID-19)-related ARDS who underwent venovenous (VV) ECMO therapy [10]. The clinical use of ECMO therapy as a life-saving therapy has been expanding [11], the systemic inflammatory response to extracorporeal circulation triggers various complications [12]. One of the most severe complications in critically ill patients undergoing
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