The following is a summary of “Impact of temporary mechanical circulatory support strategies on thrombocytopenia” published in the November 2022 issue of Critical Care by Dwaah, et al.

Thrombocytopenia is a common but poorly understood side effect of temporary mechanical circulatory support (MCS). Bleeding and the requirement for platelet transfusions are both made more likely by this medical condition. Patient care is further complicated by the inclusion of heparin-induced thrombocytopenia in the differential diagnosis.

Following, researchers compare the relative and absolute decrease in platelet count induced by the Impella 5.5, veno-venous extracorporeal membrane oxygenation (VV ECMO), veno-arterial ECMO (VA ECMO), intra-aortic balloon pump (IABP), and centrimag biventricular assist device (BIVAD), as well as other temporary MCS strategies. Overall, 337 people in the cohort were studied. After using stringent inclusion and exclusion criteria, 77 were included in the study (platelet transfusions, bleeding complications, etc.). Platelet recovery following MCS removal was compared to platelet recovery after implantation using a linear regression model and a repeated-measures mixed-effects model. 

Except for Centrimag BIVAD (-6.5%, P=0.61), all other MCS types showed a statistically significant mean percent drop: -VA ECMO (-69.6%, P<0.001), VV ECMO (-40.9%, P<0.001), Impella 5.5 (-20.9%, P=0.01), and IABP (-28.3%, P=0.01). The VA ECMO group (+107.0%, P=0.42), Impella 5.5 group (+117.2%, P=0.28), IABP group (+108.3%, P=0.37), VV-ECMO group (163.3%, P=0.01*), and the Centrimag BIVAD group (+100.1%, P=0.99) all had platelet recoveries at or above baseline. These findings demonstrate that the severity of thrombocytopenia is device-specific and reversible while using an MCS.