PB0825 - Effect of von Willbrand factor concentrate on von Willebrand factor parameters during ECMO

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Johannes Bösch, MD

Resident physician, PhD student
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria

Co-Author(s)

DF

Dietmar Fries

Senior physician, Chief of Division
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine, Division of Critical Care Medicine
Innsbruck, Tirol, Austria
Anna Tobiasch, MSc

Research Assistent
Medical University Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria
CI

Christian Irsara

Resident physician
Central Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Innsbruck
Innsbruck, Tirol, Austria
TH

Theresa Hermann

Medical student
Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck
Innsbruck, Tirol, Austria
AH

Andrea Hofer

Medical student
Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck
Innsbruck, Tirol, Austria
CV

Corinna Velik-Salchner

Senior physician
Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck
Innsbruck, Tirol, Austria
Mirjam Bachler, PhD

Senior Postdoc
University Hospital Innsbruck, Department of Anaesthesiology and Intensive Care Medicine
Innsbruck, Tirol, Austria

Background: Patients on extracorporeal membrane oxygenation (ECMO) commonly develop bleeding events. Acquired von Willebrand syndrome (avWS), due to loss of high-molecular-weight von Willebrand factor (vWF) multimers, may play a significant role in the pathomechanism as it occurs in almost all ECMO patients. Treatment options are rare and no prophylactic strategy has been investigated so far.

Aims: The aim of the clinical trial was to describe the influence of continuously administered, prophylactic von Willebrand factor concentrate (vWFC) on vWF parameters during ECMO compared to placebo.

Methods: Data from an ethics-approved, prospective, randomized, double-blind, placebo-controlled, single-center trial were analyzed. Patient informed consent was obtained according to local law. Critically ill patients on ECMO either received off-label 25 IU/kg human plasma-derived vWFC as a bolus followed by 50 IU/24h via continuous infusion starting 24 (± 12) hours after ECMO start or placebo in equivalent volumes. Main objectives were differences in vWF parameters (vWF:antigen, vWF:GP1b activity, vWF:CBA (collagen binding activity), vWF:RCo (ristocetin co-factor activity), vWF multimeric bands) directly before vWFC and 24h after start of administration.

Results: 18 patients (9 in the vWFC group, 9 in the placebo group) were included in the analysis. 15 (83%) of them were treated with veno-arterial and 3 (17%) patients with veno-venous ECMO. There were no significant inter-group differences regarding age, gender, or ECMO-type.
The administration of vWFC had no effect on vWF multimeric bands (p=0.673), but increased the binding capacity as shown in functional tests, such as vWF:CBA (p < 0.001) and vWF:RCo (p=0.002). Interestingly, there was no statistically significant difference in vWF:antigen (p=0.136) and vWF:GP1b activity (p=0.050).

Conclusion(s): Administration of human plasma-derived von Willebrand factor concentrate in avWS during ECMO has no effect on vWF multimeric bands but increases functionality of vWF (CBA and RCo) compared to placebo.