Association of coagulation dysfunction with thrombosis, bleeding, and mortality in patients supported by veno-venous extracorporeal membrane oxygenation for viral pneumonia.

IF 5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2025-08-26 DOI:10.1016/j.jtha.2025.08.010

Deepa J Arachchillage, Mihaela Gaspar, Magdalena Gierula, Farah Kamani, Alex Rosenberg, Golzar Mobayen, Nilanthi Karawitage, Saravanan Vinayagam, Mike Laffan, Stephane Ledot, Josefin Ahnström

{"title":"Association of coagulation dysfunction with thrombosis, bleeding, and mortality in patients supported by veno-venous extracorporeal membrane oxygenation for viral pneumonia.","authors":"Deepa J Arachchillage, Mihaela Gaspar, Magdalena Gierula, Farah Kamani, Alex Rosenberg, Golzar Mobayen, Nilanthi Karawitage, Saravanan Vinayagam, Mike Laffan, Stephane Ledot, Josefin Ahnström","doi":"10.1016/j.jtha.2025.08.010","DOIUrl":null,"url":null,"abstract":"Background: Bleeding and thrombosis remain leading causes of morbidity and mortality in patients supported by extracorporeal membrane oxygenation (ECMO).Objectives: To assess hemostatic changes during veno-venous (VV)-ECMO support after respiratory failure due to viral pneumonia and their association with major bleeding, thrombosis, and mortality.Methods: Coagulation factors (factors [F]II, FV, FVII, FVIII, FIX, FX, FXI, FXII), von Willebrand profile, and thrombin generation (TG) were measured at cannulation, during VV-ECMO (every fifth day), 1 hour, and 24 hours after decannulation in 50 patients (August 2018-January 2020).Results: Median age was 47 (18-68) years, 56% were men, and median VV-ECMO duration was 9 (3-41) days. Intracranial hemorrhage and ischemic stroke were detected in 10% and 4%, respectively, within 24 hours of initiating VV-ECMO. The 180-day mortality was 10%; 58% developed thrombosis and 28% major bleeding (43% were intracranial hemorrhage). Coagulation factor levels fell significantly within 24 hours of initiating VV-ECMO but returned to normal by day 5. TG decreased significantly throughout VV-ECMO, with nadir at decannulation. Tissue factor pathway inhibitor alpha level increased throughout VV-ECMO and correlated with reduced (r = -0.54, P < .001) and delayed (r = 0.6, P < .001) TG. The von Willebrand factor (VWF) Ristocetin cofactor activity (VWF:RCo)/VWF antigen (VWF:Ag) ratio was significantly reduced by 24 hours of initiation and during VV-ECMO compared to precannulation. In multivariate analyses, older age, thrombocytopenia, increased creatinine level, and reduced TG at cannulation were associated with mortality. VWF:RCo/VWF:Ag ratio <0.7 and low TG (< 500 nM·min) at precannulation predicted major bleeding while raised fibrinogen level and TG increased thrombotic risk. Major bleeding was associated with increased mortality (3.6-fold) while thrombosis had no impact.Conclusion: Precannulation reduced TG (<500 nM·min), reduced VWF:RCo/VWF:Ag ratio and increased tissue factor pathway inhibitor alpha levels had significant impacts on major bleeding, which was associated with increased mortality.","PeriodicalId":17326,"journal":{"name":"Journal of Thrombosis and Haemostasis","volume":" ","pages":""},"PeriodicalIF":5.0000,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thrombosis and Haemostasis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jtha.2025.08.010","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Bleeding and thrombosis remain leading causes of morbidity and mortality in patients supported by extracorporeal membrane oxygenation (ECMO).

Objectives: To assess hemostatic changes during veno-venous (VV)-ECMO support after respiratory failure due to viral pneumonia and their association with major bleeding, thrombosis, and mortality.

Methods: Coagulation factors (factors [F]II, FV, FVII, FVIII, FIX, FX, FXI, FXII), von Willebrand profile, and thrombin generation (TG) were measured at cannulation, during VV-ECMO (every fifth day), 1 hour, and 24 hours after decannulation in 50 patients (August 2018-January 2020).

Results: Median age was 47 (18-68) years, 56% were men, and median VV-ECMO duration was 9 (3-41) days. Intracranial hemorrhage and ischemic stroke were detected in 10% and 4%, respectively, within 24 hours of initiating VV-ECMO. The 180-day mortality was 10%; 58% developed thrombosis and 28% major bleeding (43% were intracranial hemorrhage). Coagulation factor levels fell significantly within 24 hours of initiating VV-ECMO but returned to normal by day 5. TG decreased significantly throughout VV-ECMO, with nadir at decannulation. Tissue factor pathway inhibitor alpha level increased throughout VV-ECMO and correlated with reduced (r = -0.54, P < .001) and delayed (r = 0.6, P < .001) TG. The von Willebrand factor (VWF) Ristocetin cofactor activity (VWF:RCo)/VWF antigen (VWF:Ag) ratio was significantly reduced by 24 hours of initiation and during VV-ECMO compared to precannulation. In multivariate analyses, older age, thrombocytopenia, increased creatinine level, and reduced TG at cannulation were associated with mortality. VWF:RCo/VWF:Ag ratio <0.7 and low TG (< 500 nM·min) at precannulation predicted major bleeding while raised fibrinogen level and TG increased thrombotic risk. Major bleeding was associated with increased mortality (3.6-fold) while thrombosis had no impact.

Conclusion: Precannulation reduced TG (<500 nM·min), reduced VWF:RCo/VWF:Ag ratio and increased tissue factor pathway inhibitor alpha levels had significant impacts on major bleeding, which was associated with increased mortality.

查看原文本刊更多论文

病毒性肺炎经静脉-静脉体外膜氧合治疗患者凝血功能障碍与血栓形成、出血和死亡率的关系

背景：出血和血栓形成仍然是体外膜氧合（ECMO）患者发病和死亡的主要原因。目的：评估病毒性肺炎导致呼吸衰竭后静脉-静脉(VV)-ECMO支持期间的止血变化及其与大出血、血栓形成和死亡率的关系。方法：对50例患者（2018年8月- 2020年1月）在插管时、VV-ECMO期间（每5天）、脱管后1小时和24小时的凝血因子（II、V、VII、VIII、IX、X、XI、XII）、冯氏血氏谱和凝血酶生成（TG）进行测定。结果：中位年龄为47（18-68）岁，56%为男性，中位VV-ECMO持续时间为9（3-41）天。颅内出血（ICH）和缺血性脑卒中发生率分别为10%和4%，在开始VV-ECMO的24小时内。180天死亡率为10%；58%发生血栓，28%发生大出血（43%为脑出血）。凝血因子在启动VV-ECMO后24小时内明显下降，但在第5天恢复正常。在整个VV-ECMO过程中，TG显著降低，在脱管时降至最低点。组织因子通路抑制因子α (TFPIα)在VV-ECMO期间升高，并与降低（r=-0.54） p相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.