Abstract Number: PB0293
Meeting: ISTH 2020 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: Bleeding and thrombosis are common during Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) but their etiology remains unclear.
Aims: To determine the changes in haemostasis during VV-ECMO and correlation with major bleeding (MB) and thrombosis.
Methods: The study was approved by an external ethics committee. Samples were collected into citrate +/- corn trypsin inhibitor at commencement of VV-ECMO (prior to bolus dose unfractionated heparin [UFH]) (day 0) and after 24hrs (D1) and 5-day intervals (D5, D10 etc) until completion of VV-ECMO from 22 consecutive patients between September 2018 to Jan 2019. Samples were also collected 1hr and 24hrs after decannulation. All assays were performed after neutralising UFH with hepzyme.
Results: Mean age was 45.2 ±11.4yrs and 60% were male. Median (range) on VV-ECMO was 9.5days (5-29). Factor(F) II, V, VIII, IX, X, XI, XII and von Willebrand antigen (VWF:Ag)/VWF Ristocetin Cofactor (VWF:RCo) ratio fell with nadirs at D25 which was the longest VV-ECMO duration sampled. Post-decannulation and 24hrs post VV-ECMO, these factors returned to day0 levels or above. Endogenous thrombin potential [ETP] and peak thrombin fell and lag time and time to peak thrombin increased at D25. 27%(6/22), 54%(12/22) and 32%(7/22) patients respectively had circuit change, thrombosis and MB. Circuit changes and MB associated with longer ECMO (21.5 vs 9.6,p=0.0001 and 18.4 vs 10.3,p=0.012; days respectively) but with thrombosis (14.5 vs 10.9 days,p=0.27). Time to event analysis linked increased FV and FVIII to reduced circuit changes and increased FV, FVIII, FIX and ETP to increased thrombosis. Increased D-dimer predicted circuit change. Bleeding linked only to ETP where educed risk of MB associated with increased ETP.
Conclusions: MB and thrombosis occurred in 32% and 54% patients respectively. Intrinsic coagulation factors reduced gradually during VV-ECMO but increased factor V, VIII and ETP associated with development of thrombosis whilst ETP was a predictor of both bleeding and thrombosis.
To cite this abstract in AMA style:
Jayakody Arachchillage D, Gaspar M, Ahnström J, Gierula M, Fox S, Banya W, Passariello M, Laffan M, Patel BV, Ledot S. Prospective Study of Haemostatic Activation Markers and Correlation with Bleeding and Thrombotic Complications in Patients Receiving Veno-Venous Extra-Corporeal Membrane Oxygenation (VV-ECMO) – HAE Study [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/prospective-study-of-haemostatic-activation-markers-and-correlation-with-bleeding-and-thrombotic-complications-in-patients-receiving-veno-venous-extra-corporeal-membrane-oxygenation-vv-ecmo-hae-st/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/prospective-study-of-haemostatic-activation-markers-and-correlation-with-bleeding-and-thrombotic-complications-in-patients-receiving-veno-venous-extra-corporeal-membrane-oxygenation-vv-ecmo-hae-st/