Abstract Number: PB0079
Meeting: ISTH 2021 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: Intra-device thrombosis remains one of the most common complications during extracorporeal membrane oxygenation (ECMO) support. Despite monitored-heparin anticoagulation, ±35% of patients develop acute thrombosis in the membrane oxygenator or blood pumps. This often results in equipment malfunctioning which necessitates hazardous elective/full system exchanges. Yet, surprisingly little is known about the composition of thrombi formed in the ECMO circuit.
Aims: To investigate thrombus formation at different site in the ECMO circuit via histological analysis of ECMO thrombi.
Methods: Thrombi (n=51) were collected immediately after veno-arterial ECMO circuit removal from 15 patients at the CHU Lille (Lille, France). Of those thrombi, 13 originated from the pump, 15 from the oxygenator and 23 from the tubing. Quantitative histological analysis was performed for the amount red blood cells (RBCs), platelets, fibrin, von Willebrand factor (VWF), leukocytes and citrullinated histone H3 (H3Cit).
Results: ECMO thrombi consist of a heterogenous composition with fibrin (40.9+/-17.2%) and VWF (34.7+/-15.6%) being the major thrombus components, followed by RBCs (25.4+/-22.8%), platelets (24.0+/-17.1%) and smaller amounts of H3Cit (5.4+/-6.3%). Hierarchal clustering analysis of the four major histological parameters identified two typical thrombus types: RBC-rich and fibrin-rich thrombi with no significant differences in VWF/platelet content. Thrombus location (pump, oxygenator or tubing) was not significantly associated with individual histological parameters or thrombus types. Our data, yet preliminary, indicate that the pump/oxygenator type might influence thrombus composition as Quadrox oxygenators induce the formation of fibrin-rich thrombi (50.1%+/-20.0%) compared to A.LONE oxygenators (27.9%+/-6.4%). In contrast to Revolution pumps (26.7%+/-28.6% RBCs, 15.0%+/-12.5% platelets), Rotaflow pumps (38.4%+/-26.9% RBCs, 39.2%+/-25.0% platelets) seem to induce the formation of RBC-rich and platelet-rich thrombi.
Conclusions: Despite monitored-heparin anticoagulation, overall ECMO thrombus composition is heterogenous, consisting mainly of fibrin/VWF but regardless of thrombus location. Such data are important to further improve current anticoagulation strategies in ECMO patients and to reduce ECMO circuit thrombogenicity.
To cite this abstract in AMA style:
Staessens S, Moussa M, Pierarche A, Boulleaux E, Ung A, Desender L, Pradines B, Rousse N, Duhamel A, Rauch A, Vanhoorelbeke K, Corseaux D, De Meyer SF, Susen S. Elucidating Thrombus Formation in ECMO Circuits: A Detailed Histological Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/elucidating-thrombus-formation-in-ecmo-circuits-a-detailed-histological-study/. Accessed April 18, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/elucidating-thrombus-formation-in-ecmo-circuits-a-detailed-histological-study/