Abstract Number: OC 61.3
Meeting: ISTH 2022 Congress
Theme: Acquired Bleeding Disorders » Coagulopathy of Major Bleeding (Trauma, PPH, Vascular/surgical, ECMO, GI bleeding, etc.)
Background: Rates of major haemorrhage during the use of Extracorporeal Membrane Oxygenation (ECMO) are high. The fibrinolytic system plays a role in bleeding and survival following trauma and cardiopulmonary bypass but its role during ECMO is poorly described.
Aims: To assess the changes in markers of fibrinolysis and fibrinolytic enzymes during veno-venous ECMO and their roles in haemostatic complications during ECMO.
Methods: Blood samples were taken from 17 patients >18 years old at a single, high-volume ECMO centre. Samples were taken at pre-ECMO, 1-hour, 1-day, 2-days, 7-days, pre-decannulation, 1-hour and 1-day after, and during major bleeding. Samples were analysed by ELISA for fibrinogen, Plasmin-Antiplasmin (PAP), D-Dimer, tPA antigen (Ag), uPA Ag, PAI-1 and TAFI according to manufacturer’s protocols. Ethical approval was gained for the study with nominated consultee consent.
Results: Fibrinogen, PAI-1, D-Dimer and PAP levels were increased before ECMO whereas other factors were normal. Fibrinogen fell 1-hour after cannulation. D-Dimers increased over the first 2-days of ECMO and stabilised at 7-days. PAP increased at 2- and 7-days. D-Dimers and PAP fell 1-day after decannulation in comparison to pre-decannulation. There was a positive correlation between D-Dimer and PAP during ECMO (R=+0.61).
Patient with intracranial haemorrhage (n=4) at ECMO initiation had a higher increase in D-Dimer than those without (median change +2421 vs -705 ng/mL FEU, p=0.069). D-Dimer levels were increased in those with PE (n=4) to those without (n=13) at ECMO initiation (median 9948 vs PE 6192 ng/mL FEU, p=0.047). During non-intracranial major haemorrhage (n=3), TAFI was lower compared to those without (median 114.5 vs 154.5%, p=0.004) whereas PAI-1 levels were higher (median=111 ng/mL vs 54.3 ng/mL, p=0.003).
Conclusion(s): Fibrinolysis is activated during ECMO in critically unwell patients, with D-Dimers reflective of fibrinolytic activity. This study suggests that fibrinolysis may have a role in major bleeding during ECMO.
To cite this abstract in AMA style:
Doyle A, Parmar K, Breen K, Barrett N, Retter A, Hunt B. Changes in fibrinolysis during Extracorporeal Membrane Oxygenation in critically ill adult patients [abstract]. https://abstracts.isth.org/abstract/changes-in-fibrinolysis-during-extracorporeal-membrane-oxygenation-in-critically-ill-adult-patients/. Accessed March 21, 2024.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/changes-in-fibrinolysis-during-extracorporeal-membrane-oxygenation-in-critically-ill-adult-patients/