PB0085 - Pitfalls of Complications due to Coagulopathy in Patients with Severe COVID-19 during ECMO: Beware of Bleeding Caused by Acquired von Willebrand Syndrome

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Hiroyasu Ishikura, PhD, MD (he/him/his)

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan

Co-Author(s)

YI

Yuhei Irie

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan
KM

Kentaro Muranishi

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan
JM

Junichi Maruyama

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan
MN

Maiko Nakashio

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan
YO

Yuko Okura

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan
SM

Shinichi Morimoto

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan
YI

Yoshito Izutani

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan
YN

Yoshihiko Nakamura

Department of emergency and critical care medicine
Faculty of medicine, Fukuoka university
Fukuoka, Fukuoka, Japan

Background: COVID-19-associated coagulopathy (CAC) is widely recognized as one of the major complications of COVID-19. COVID-19 is characterized by a higher complication of thrombosis than other viral respiratory infections. However, we have observed that critically ill patients requiring extracorporeal membrane oxygenation (ECMO) frequently develop not only thrombosis, but also hemorrhage.

Aims: This study aimed to investigate the causes of hemorrhage rather than thrombosis in patients with severe COVID-19 requiring ECMO.

Methods: Forty-three patients who were supported by mechanical ventilation because of severe COVID-19 with acute respiratory distress syndrome were admitted to our hospital’s ECMO center in the intensive care unit from June 2020 to August 2021. The patients were classified as the ECMO group (n=22) and the non-ECMO group (n=21). The antigen amount (Ag), activity (Ac), and Ac/Ag ratio of von Willebrand factor (VWF) were measured.

Results: The hemorrhagic complication rate was significantly higher in the ECMO group than in the non-ECMO group (68.2% [15/22] vs 19.1% [4/21]; p< 0.01). Regarding VWF, Ag and Ac significantly increased over time in the non-ECMO group, and Ac significantly decreased in the ECMO group. Consequently, the Ac/Ag ratio was significantly lower in the ECMO group than in the non-ECMO group (days 3–4 of hospitalization: 79.2±9.32 vs 54.4±11.31; p< 0.01).

Conclusion(s): Our findings suggested that the ECMO group developed acquired VWS caused by high shear stress from blood pumps (centrifugal pumps), developed coagulopathy, and were eventually complicated by hemorrhage. However, the higher VWF Ag/Ac ratio in the non-ECMO group suggested that this increase was closely associated with thrombus formation.
Patients with severe COVID-19 are at risk of hemorrhage or thrombosis depending on whether ECMO is performed. Patients with COVID-19, especially critically ill patients, should have timely and repeated measurements of VWF Ag and Ac to avoid these adverse complications.