Scientific Poster Session III - Original Research

Original Research
  Monday, November 13, 2023
  01:00 PM–02:30 PM

Abstract

Introduction:

The incidence of bleeding complications during veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains high. Therapeutic anticoagulation is required to maintain circuit integrity; however, many patients also have indications for aspirin. The purpose of this study is to evaluate bleeding outcomes of patients receiving concomitant anticoagulation and aspirin while supported with V-A ECMO.

Research Question or Hypothesis:

We hypothesized that initiation of aspirin during V-A ECMO would not result in excess major bleeding complications.

Study Design:

This single-center, retrospective, cohort study evaluated adult patients receiving aspirin while on V-A ECMO between 1/1/2016 and 08/02/2021.

Methods:

The primary outcome of this study was major bleeding (bleeding that required surgical intervention, decrease in hemoglobin =2 g/dL, or requiring transfusion of =2 units of packed red blood cells concurrently). Aspirin and no aspirin groups were propensity score matched using 1:1 nearest neighbor matching without replacement. Groups were matched on age, etiology of shock, coronary artery disease, prior cerebrovascular accident, prior gastrointestinal bleed, prior intracranial hemorrhage, baseline hemoglobin and platelet count, peripheral cannulation, post-cardiotomy status, SAVE score, and aspirin or P2Y12 inhibitor use prior to ECMO.

Results:

A total of 293 patients met criteria for study inclusion. Of those, 102 (34.8%) received aspirin while on V-A ECMO. After propensity score matching, 69 patients in each group were used for the final analysis; covariates were well-balanced. The majority of patients on aspirin received 81 mg of aspirin (72.5%) and median duration of therapy was 3.9 (1-6.1) days. There was no significant difference in major bleeding between the groups (29% aspirin vs. 39.1% no aspirin; p=0.28). Median ECMO duration was 6 days.

Conclusion: The initiation of aspirin while on V-A ECMO did not result in excess major bleeding compared to patients on anticoagulation alone. These findings suggest aspirin can be safely initiated and continued for short durations in patients requiring V-A ECMO support.

Presenting Author

Bobbie Nguyen PharmD
Inova Fairfax Medical Center

Authors

Allison Bathula PharmD, BCCCP
University of Maryland Medical Center

Alison Grazioli MD
University of Maryland Medical Center

Mehrnaz Pajoumand Pharm.D.
University of Maryland Medical Center

Michael Plazak PharmD
University of Maryland Medical Center

Joseph Rabin MD
University of Maryland Medical Center

Bradley Taylor MD
University of Maryland Medical Center

Doug Tran MD
University of Maryland Medical Center

David Zapata MD
University of Maryland Medical Center

Richard Rovelli PharmD
University of Maryland Medical Center

Aakash Shah MD
University of Maryland Medical Center