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Poster Networking

Acquired and Critical Care Bleeding

PB1021 - Bleeding Events during Extracorporeal Membrane Oxygenation can be predicted by the assessment of Loss in High-Molecular-Weight Multimers of von Willebrand Factor.

Tuesday, June 25, 2024
13:45 – 14:45 ICT
Room: Exhibition Hall
Background: Extracorporeal membrane oxygenation (ECMO) is becoming more prevalent in critically ill patients providing support for cardiac and/or pulmonary functions. ECMO is particularly challenging because high risk of bleeding.

Aims: Aim of this study is to evaluate VWF functional activities and multimeric profile after ECMO implantation and correlate severity of these abnormalities to bleeding events during the time course of ECMO support.

Methods: In 64 patients implanted with an ECMO, we investigated VWF antigen and activity levels associated to multimeric profile quantified by a semi-automated assay. 294 samples from patients implanted with ECMO were collected and analyzed. Thirty-seven patients (57.8%) had bleeding during ECMO implantation.

Results: Along follow-up, we observed significant decrease in of high molecular weight multimers (HMWM) and Intermediate molecular weight multimers (IMWM) with an increase in low molecular weight multimers (LMWM) in bleeding’s patients (respectively with a p=0.014, 0.005 and 0.001). Moreover, we observed significant decrease in levels of HMWM and IMWM associated to an increase in LMWM in bleeding’s patients before the bleeding event in contrast to patients with no bleeding during the support (respectively with a p=0.026, 0.009 and 0.001). We then wanted to explore relevance of early detection of AVWS at day 1 and 2 with bleeding before or after 5 days of support. We demonstrated that decreased HMWM level was able to predict early bleeding (p=0.035). Thus, we explored relevance of HMWM and flow rate in a logistic regression analysis on early/late bleeding event. After adjustment on flow rate, HMW multimers decrease is associated to early bleeding event with OR 0.73 (0.55-0.92, p=0.012) while flow rate was not associated to bleeding in univariate and multivariate analysis.

Conclusion(s): All in all, this study highlights that evaluating HMWM level after ECMO implantation could be a potential early predictive indicator of bleeding risk during ECMO support independently of flow rate.