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Background:  Severe thrombocytopenia is a common complication of extracorporeal membrane oxygenation (ECMO). Oseltamivir can be used to treat infection-associated thrombocytopenia.   Objective:  To evaluate the effect of oseltamivir on attenuating severe thrombocytopenia during ECMO.   Methods:  This was a single-center real-world study in critically ill patients supported with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients suspected or confirmed with influenza received oseltamivir according to the Chinese guidelines. Thrombocytopenia and survival were compared between the oseltamivir-treated and untreated group. The factors associated with survival were analyzed by multivariable Cox analysis.   Results:  A total of 82 patients were included. All patients developed thrombocytopenia after initiating VA-ECMO. Twenty-three patients received oseltamivir (O +  group), and 59 did not use oseltamivir (O −  group). During the first 8 days after VA-ECMO initiation, the platelet count in the O +  group was higher than that in the O −  group (all  P  < 0.05). The patients in the O +  group had a higher median nadir platelet count (77,000/μl, 6,000–169,000/μl) compared with the O −  group (49,000/μl, 2,000–168,000/μl;  P  = 0.04). A nadir platelet count of <50,000/μl was seen in 26% of the patients in the O +  group, compared with 53% in the O −  group ( P  = 0.031). No significant difference in survival from cardiac failure was seen between the O +  and O −  group (48 vs. 56%,  P  = 0.508). The Sequential Organ Failure Assessment (SOFA) score on initiation of VA-ECMO were independently associated with survival (OR = 1.12, 95% confidence interval (95% CI): 1.02–1.22,  P  = 0.015).   Conclusions:  Oseltamivir could ameliorate VA-ECMO-related thrombocytopenia. These findings suggested the prophylactic potential of oseltamivir on severe thrombocytopenia associated with the initiation of VA-ECMO.

frontiers in cardiovascular medicine

Oseltamivir Improved Thrombocytopenia During Veno-Arterial Extracorporeal Membrane Oxygenation in Adults With Refractory Cardiac Failure: A Single-Center Retrospective Real-World Study