Predictors And Outcomes Of Ecmo In Patients With Thrombophilia: Insights From A Nationwide Database
Abstract
Introduction
Thrombophilic disorders increase the risk of blood clot formation and are associated with morbidity in various settings. However, the impact of thrombophilia on ECMO (Extracorporeal membrane oxygenation) patients is not well studied. We aimed to investigate the association between thrombophilia and ECMO outcomes.
Methods
We utilized the National Inpatient Sample to identify ECMO hospitalizations between 2016 and 2020. ICD-10 codes for thrombophilic conditions including protein C resistance, prothrombin gene mutation, antiphospholipid syndrome, lupus anticoagulant syndrome, other primary thrombophilia, other thrombophilia were used. We used propensity-score matching (PSM) to match patients with thrombophilia to those without thrombophilia based on age, sex, race and comorbidities.
Results
The total sample included 4845 weighted matched ECMO hospitalizations, of those 1615 (33.3%) had thrombophilia, and 3230 (66.7%) did not have thrombophilia. There was no statistically significant difference in the inpatient mortality between the two groups (confidence interval (CI), 0.82-1.05). Patients with thrombophilia had significantly higher odds of deep vein thrombosis (Odds Ratio (OR), 2.16 [CI, 1.87-2.51]), pulmonary embolism (OR, 2.33 [CI, 1.97-2.76]), heparin-induced thrombocytopenia (OR, 1.51 [CI, 1.02-2.24]). Rates of intracranial bleeding were higher among thrombophilia patients, but they had a lower risk of gastrointestinal bleeding. There was no statistically significant difference in the rates of DIC or seizures. There was a trend toward increased risk of stroke but it did not reach statistical significance (OR, 1.25 [CI, 1.00-1.56]).
Conclusion
Thrombophilia is associated with increased morbidity in ECMO patients.