Acquired von Willebrand syndrome in ECMO patients: A 3-year cohort study

Bernd Panholzer; Tido Bajorat; Assad Haneya; Dorothee Kowalski; David Juhl; Angela Rocke; Maria Shneyder; Piotr Kuta; Hartmut Clausnizer; Ralf Junker; Arne Kowalski; Aysun Tulun; Akram Al-Suraimi; Jochen Cremer; Johannes Kalbhenn; Barbara Zieger; Ulrike Nowak-Göttl

doi:10.1016/j.bcmd.2020.102526

Acquired von Willebrand syndrome in ECMO patients: A 3-year cohort study

Bernd Panholzer, Tido Bajorat, Assad Haneya, Dorothee Kowalski, David Juhl, Angela Rocke, Maria Shneyder, Piotr Kuta, Hartmut Clausnizer, Ralf Junker, Arne Kowalski, Aysun Tulun, Akram Al-Suraimi, Jochen Cremer, Johannes Kalbhenn, Barbara Zieger, Ulrike Nowak-Göttl^*

^*Corresponding author for this work

25 Citations (Scopus)

Abstract

Background: Bleeding is a common but possibly underreported side effect of Extracorporeal Membrane Oxygenation (ECMO). Impairment of primary hemostasis by acquired von Willebrand syndrome (aVWS) and platelet dysfunction as well as activation and consumption of plasmatic coagulation factors contribute to hemorrhage. The aim of the present cohort study of consecutively enrolled patients admitted to our ECMO center was to collect demographic, medical and laboratory data possibly associated with i) development of clinically relevant bleeding and/or ii) death during a 12-months follow-up. Results: Within a 3-year period 338 white patients aged 18–89 years (median: 60; male 64.5%) were enrolled. 78 of 338 patients (23%) presented with clinical relevant bleeding symptoms. The overall death rate was 74.6% within a median time of 9 days (1–229) post intervention. Logistic-regression analysis adjusted for age and gender revealed that i) the presence of blood group O versus non-O (Odds ratio (OR)/95%CI: 1.9/1.007–3.41), ECMO duration per day (1.1/1.06–1.14), veno-venous versus veno-arterial ECMO cannulation (2.33/1.2–4.5) and the overall need for blood product administered per unit (1.02/1.016–1.028) was independenly associated with bleeding in patients suffering from aVWS. ii) Older age (increase per year) at ECMO start (1.015/1.012–1.029) and an increasing amount of blood product units were significantly related with death (1.007/1.001–1.013). Patients with veno-venous versus veno-arterial cannulation survived longer (0.48/0.24–0.94). Conclusion: In the present cohort study we found a clinical relevant bleeding rate of 23% in subjects with aVWS associated with blood group O, a longer ECMO duration and veno-venous cannulation.

Original language	English
Article number	102526
Journal	Blood Cells, Molecules, and Diseases
Volume	87
Pages (from-to)	102526
ISSN	1079-9796
DOIs	https://doi.org/10.1016/j.bcmd.2020.102526
Publication status	Published - 01.03.2021

Funding

The study was supported by grants from the Förderverein “Schlaganfall und Thrombosen im Kindesalter e.V.”, and restricted research grants from LFB (pilot study) and Octapharma (main study). None of the aforementioned funding agencies had a role in study design, conduct, interpretation, or reporting, i.e. that the authors had no interests which might be perceived as posing a conflict or bias. We thank Hartmut Clausnizer and Christa Zeidler for data management.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1016/j.bcmd.2020.102526

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Panholzer, B., Bajorat, T., Haneya, A., Kowalski, D., Juhl, D., Rocke, A., Shneyder, M., Kuta, P., Clausnizer, H., Junker, R., Kowalski, A., Tulun, A., Al-Suraimi, A., Cremer, J., Kalbhenn, J., Zieger, B., & Nowak-Göttl, U. (2021). Acquired von Willebrand syndrome in ECMO patients: A 3-year cohort study. Blood Cells, Molecules, and Diseases, 87, 102526. Article 102526. https://doi.org/10.1016/j.bcmd.2020.102526

@article{ccd8b4bf851e4d94915e1eda752b9707,

title = "Acquired von Willebrand syndrome in ECMO patients: A 3-year cohort study",

abstract = "Background: Bleeding is a common but possibly underreported side effect of Extracorporeal Membrane Oxygenation (ECMO). Impairment of primary hemostasis by acquired von Willebrand syndrome (aVWS) and platelet dysfunction as well as activation and consumption of plasmatic coagulation factors contribute to hemorrhage. The aim of the present cohort study of consecutively enrolled patients admitted to our ECMO center was to collect demographic, medical and laboratory data possibly associated with i) development of clinically relevant bleeding and/or ii) death during a 12-months follow-up. Results: Within a 3-year period 338 white patients aged 18–89 years (median: 60; male 64.5\%) were enrolled. 78 of 338 patients (23\%) presented with clinical relevant bleeding symptoms. The overall death rate was 74.6\% within a median time of 9 days (1–229) post intervention. Logistic-regression analysis adjusted for age and gender revealed that i) the presence of blood group O versus non-O (Odds ratio (OR)/95\%CI: 1.9/1.007–3.41), ECMO duration per day (1.1/1.06–1.14), veno-venous versus veno-arterial ECMO cannulation (2.33/1.2–4.5) and the overall need for blood product administered per unit (1.02/1.016–1.028) was independenly associated with bleeding in patients suffering from aVWS. ii) Older age (increase per year) at ECMO start (1.015/1.012–1.029) and an increasing amount of blood product units were significantly related with death (1.007/1.001–1.013). Patients with veno-venous versus veno-arterial cannulation survived longer (0.48/0.24–0.94). Conclusion: In the present cohort study we found a clinical relevant bleeding rate of 23\% in subjects with aVWS associated with blood group O, a longer ECMO duration and veno-venous cannulation.",

author = "Bernd Panholzer and Tido Bajorat and Assad Haneya and Dorothee Kowalski and David Juhl and Angela Rocke and Maria Shneyder and Piotr Kuta and Hartmut Clausnizer and Ralf Junker and Arne Kowalski and Aysun Tulun and Akram Al-Suraimi and Jochen Cremer and Johannes Kalbhenn and Barbara Zieger and Ulrike Nowak-G{\"o}ttl",

note = "Funding Information: The study was supported by grants from the F{\"o}rderverein “Schlaganfall und Thrombosen im Kindesalter e.V.”, and restricted research grants from LFB (pilot study) and Octapharma (main study). None of the aforementioned funding agencies had a role in study design, conduct, interpretation, or reporting, i.e. that the authors had no interests which might be perceived as posing a conflict or bias. We thank Hartmut Clausnizer and Christa Zeidler for data management. Publisher Copyright: {\textcopyright} 2020 Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2021",

month = mar,

day = "1",

doi = "10.1016/j.bcmd.2020.102526",

language = "English",

volume = "87",

pages = "102526",

journal = "Blood Cells, Molecules, and Diseases",

issn = "1079-9796",

publisher = "Academic Press Inc.",

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Panholzer, B, Bajorat, T, Haneya, A, Kowalski, D, Juhl, D, Rocke, A, Shneyder, M, Kuta, P, Clausnizer, H, Junker, R, Kowalski, A, Tulun, A, Al-Suraimi, A, Cremer, J, Kalbhenn, J, Zieger, B & Nowak-Göttl, U 2021, 'Acquired von Willebrand syndrome in ECMO patients: A 3-year cohort study', Blood Cells, Molecules, and Diseases, vol. 87, 102526, pp. 102526. https://doi.org/10.1016/j.bcmd.2020.102526

TY - JOUR

T1 - Acquired von Willebrand syndrome in ECMO patients: A 3-year cohort study

AU - Panholzer, Bernd

AU - Bajorat, Tido

AU - Haneya, Assad

AU - Kowalski, Dorothee

AU - Juhl, David

AU - Rocke, Angela

AU - Shneyder, Maria

AU - Kuta, Piotr

AU - Clausnizer, Hartmut

AU - Junker, Ralf

AU - Kowalski, Arne

AU - Tulun, Aysun

AU - Al-Suraimi, Akram

AU - Cremer, Jochen

AU - Kalbhenn, Johannes

AU - Zieger, Barbara

AU - Nowak-Göttl, Ulrike

N1 - Funding Information: The study was supported by grants from the Förderverein “Schlaganfall und Thrombosen im Kindesalter e.V.”, and restricted research grants from LFB (pilot study) and Octapharma (main study). None of the aforementioned funding agencies had a role in study design, conduct, interpretation, or reporting, i.e. that the authors had no interests which might be perceived as posing a conflict or bias. We thank Hartmut Clausnizer and Christa Zeidler for data management. Publisher Copyright: © 2020 Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2021/3/1

Y1 - 2021/3/1

N2 - Background: Bleeding is a common but possibly underreported side effect of Extracorporeal Membrane Oxygenation (ECMO). Impairment of primary hemostasis by acquired von Willebrand syndrome (aVWS) and platelet dysfunction as well as activation and consumption of plasmatic coagulation factors contribute to hemorrhage. The aim of the present cohort study of consecutively enrolled patients admitted to our ECMO center was to collect demographic, medical and laboratory data possibly associated with i) development of clinically relevant bleeding and/or ii) death during a 12-months follow-up. Results: Within a 3-year period 338 white patients aged 18–89 years (median: 60; male 64.5%) were enrolled. 78 of 338 patients (23%) presented with clinical relevant bleeding symptoms. The overall death rate was 74.6% within a median time of 9 days (1–229) post intervention. Logistic-regression analysis adjusted for age and gender revealed that i) the presence of blood group O versus non-O (Odds ratio (OR)/95%CI: 1.9/1.007–3.41), ECMO duration per day (1.1/1.06–1.14), veno-venous versus veno-arterial ECMO cannulation (2.33/1.2–4.5) and the overall need for blood product administered per unit (1.02/1.016–1.028) was independenly associated with bleeding in patients suffering from aVWS. ii) Older age (increase per year) at ECMO start (1.015/1.012–1.029) and an increasing amount of blood product units were significantly related with death (1.007/1.001–1.013). Patients with veno-venous versus veno-arterial cannulation survived longer (0.48/0.24–0.94). Conclusion: In the present cohort study we found a clinical relevant bleeding rate of 23% in subjects with aVWS associated with blood group O, a longer ECMO duration and veno-venous cannulation.

AB - Background: Bleeding is a common but possibly underreported side effect of Extracorporeal Membrane Oxygenation (ECMO). Impairment of primary hemostasis by acquired von Willebrand syndrome (aVWS) and platelet dysfunction as well as activation and consumption of plasmatic coagulation factors contribute to hemorrhage. The aim of the present cohort study of consecutively enrolled patients admitted to our ECMO center was to collect demographic, medical and laboratory data possibly associated with i) development of clinically relevant bleeding and/or ii) death during a 12-months follow-up. Results: Within a 3-year period 338 white patients aged 18–89 years (median: 60; male 64.5%) were enrolled. 78 of 338 patients (23%) presented with clinical relevant bleeding symptoms. The overall death rate was 74.6% within a median time of 9 days (1–229) post intervention. Logistic-regression analysis adjusted for age and gender revealed that i) the presence of blood group O versus non-O (Odds ratio (OR)/95%CI: 1.9/1.007–3.41), ECMO duration per day (1.1/1.06–1.14), veno-venous versus veno-arterial ECMO cannulation (2.33/1.2–4.5) and the overall need for blood product administered per unit (1.02/1.016–1.028) was independenly associated with bleeding in patients suffering from aVWS. ii) Older age (increase per year) at ECMO start (1.015/1.012–1.029) and an increasing amount of blood product units were significantly related with death (1.007/1.001–1.013). Patients with veno-venous versus veno-arterial cannulation survived longer (0.48/0.24–0.94). Conclusion: In the present cohort study we found a clinical relevant bleeding rate of 23% in subjects with aVWS associated with blood group O, a longer ECMO duration and veno-venous cannulation.

UR - https://www.scopus.com/pages/publications/85097748316

UR - https://www.mendeley.com/catalogue/b6a68b27-0aa6-3c35-90e2-9cf01b2b2dec/

U2 - 10.1016/j.bcmd.2020.102526

DO - 10.1016/j.bcmd.2020.102526

M3 - Journal articles

C2 - 33338698

AN - SCOPUS:85097748316

SN - 1079-9796

VL - 87

SP - 102526

JO - Blood Cells, Molecules, and Diseases

JF - Blood Cells, Molecules, and Diseases

M1 - 102526

ER -

Acquired von Willebrand syndrome in ECMO patients: A 3-year cohort study

Abstract

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