title: Dual Antiplatelet Therapy (DAPT) versus No Antiplatelet Therapy and Incidence of Major Bleeding in Patients on Venoarterial Extracorporeal Membrane Oxygenation.
abstract: OBJECTIVE
  Bleeding is a frequent complication in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO). An indication for dual antiplatelet therapy due to coronary stent implantation is present in a considerable number of these patients. The objective of this retrospective study was to evaluate if dual antiplatelet therapy (DAPT) significantly increases the high intrinsic bleeding risk in patients on VA-ECMO.
  
  
  RESULTS
  A total of 93 patients were treated with VA-ECMO between October 2010 and October 2013. Average time on VA-ECMO was 58.9 ± 1.7 hours. Dual antiplatelet therapy was given to 51.6% of all patients. Any bleeding was recorded in 60.2% of all patients. There was no difference in bleeding incidence in patients on DAPT when compared to those without any antiplatelet therapy including any bleeding (66.7% vs. 57.1%, p = 0.35), BARC3 bleeding (43.8% vs. 33.3%, p = 0.31) or pulmonary bleeding (16.7% vs. 19.0%, p = 0.77). This holds true after adjustment for confounders. Rate of transfusion of red blood cells were similar in patients with or without DAPT (35.4% vs. 28.6%, p = 0.488).
  
  
  CONCLUSIONS
  Bleeding on VA-ECMO is frequent. This registry recorded no statistical difference in bleeding in patients on dual antiplatelet therapy when compared to no antiplatelet therapy. When indicated, DAPT should not be withheld from VA ECMO patients.
authors.affiliation: Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
authors.forename: Dawid L
authors.identifier: http://orcid.org/0000-0002-9423-9682
authors.initials: DL
authors.lastname: Staudacher
authors.affiliation: Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Biever
authors.affiliation: Heart Center Freiburg University, Department of Cardiovascular Surgery, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Benk
authors.affiliation: Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Ahrens
authors.affiliation: Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.affiliation: Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Wengenmayer
mesh_terms: D000368:Aged; D016913:Blood Component Transfusion; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*
chemical_list: D010975:Platelet Aggregation Inhibitors