Acquired von Willebrand syndrome and impaired platelet function during venovenous extracorporeal membrane oxygenation: Rapid onset and fast recovery
Acquired von Willebrand syndrome and impaired platelet function during venovenous extracorporeal membrane oxygenation: Rapid onset and fast recovery
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DOI：
10.1016/j.healun.2018.03.013
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发表时间：
2018-08-01
影响因子：
8.9
通讯作者：
Zieger, Barbara
中科院分区：
文献类型：
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作者：
Kalbhenn, Johannes;Schlagenhauf, Axel;Zieger, Barbara
背景：出血是静脉-静脉体外膜氧合（vvECMO）的高死亡率的原因之一。获得性血管性血友病综合征（AVWS）的发展已被确定为ECMO期间的相关病理。本研究旨在确定植入术后AVWS的发病情况以及植入术后VWF参数的恢复情况。方法：在某高校ECMO中心接受vvECMO治疗的59例患者，分别在ECMO植入前、治疗中和移植后获得VWF参数。在一个亚组患者中，进行了血小板光透射聚集测定和血小板颗粒分泌的流式细胞术定量。结果：所有患者在vvECMO植入后数小时均出现严重AVWS。移植后AVWS在3小时内恢复的占60%，在6小时内恢复的占86%，所有患者均在1天内恢复。聚类分析显示，在ADP、利斯托司汀、胶原蛋白和肾上腺素刺激后，血小板聚集性降低。流式细胞术血小板分析显示CD62和CD63的表达严重降低。结论：所有患者在vvECMO支持期间均迅速发生AVWS和血小板功能障碍，导致严重的凝血功能损害。移植后，AVWS绝大多数在数小时内恢复，导致高凝状态。这些发现增加了对具有降低剪切应力的新型体外技术的需求，并将ECMO期间强化抗凝的重点转移到移植后的时间点。(C) 2018国际心肺移植学会。版权所有。
BACKGROUND: Bleeding contributes to the high mortality of venovenous extracorporeal membrane oxygenation (vvECMO). The development of acquired von Willebrand syndrome (AVWS) has been identified as relevant pathology during ECMO. This study was performed to determine the onset of AVWS after implantation and the recovery of von Willebrand factor (VWF) parameters after explantation of ECMO in a large cohort of patients.METHODS: VWF parameters of 59 patients treated with vvECMO at a university ECMO center were obtained before ECMO implantation, during therapy, and after explantation. In a subgroup of patients, light transmission aggregometry of platelets and flow-cytometric quantification of platelet granule secretion were performed.RESULTS: All patients developed severe AVWS hours after implantation of vvECMO. After explantation, AVWS recovered within 3 hours in 60%, within 6 hours in 86%, and in all patients within 1 day. Aggregometry showed hypoaggregability of platelets after stimulation with ADP, ristocetin, collagen, and epinephrine. Flow-cytometric platelet analyses revealed severely reduced expression of CD62 and CD63.CONCLUSIONS: All patients during vvECMO support rapidly develop AVWS and platelet dysfunction, resulting in severe impairment of coagulation. After explantation, AVWS overwhelmingly recovers within hours, resulting in a hypercoagulative state. These findings augment the need for novel extracorporeal technologies with reduced shear stress, and shift the emphasis for intense anticoagulation during ECMO instead to a time-point after explantation. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.