Abstract
Purpose
Extracorporeal life support (ECLS) is used for patients with refractory heart failure with or without respiratory failure. This temporary support is provided by blood pumps which are connected to large vessels. Bleeding episodes are a typical complication in patients with ECLS. Recently, several studies illustrated that acquired von Willebrand syndrome (AVWS) can contribute to bleeding tendencies in patients with long-term ventricular assist devices (VAD). AVWS is characterized by loss of the high molecular weight (HMW) multimers of von Willebrand factor (VWF) as a result of high shear stress and leads to impaired binding of VWF to platelets and to subendothelial matrix. Since ECLS and VAD share several features, we investigated patients with ECLS for AVWS.
Methods
We analyzed 32 patients with ECLS and 19 of them without support. To diagnose AVWS, ratios of ristocetin cofactor activity (VWF:RCo) and collagen binding capacity (VWF:CB) to VWF antigen (VWF:Ag) were employed in conjunction with multimeric analysis.
Results
Reduced VWF:RCo/VWF:Ag ratios were identified in 28 ECLS patients. Furthermore, VWF:CB/VWF:Ag ratios were decreased in 31 patients. HMW multimers of VWF were missing in the same 31 patients. Thus, 31 of 32 ECLS patients presented with AVWS. Twenty-two of the 32 patients suffered from bleeding complications. Without support, AVWS was not detectable in any analyzed patient.
Conclusion
Our data indicate that AVWS is a typical disorder in patients with ECLS. We hypothesize that AVWS could contribute to aggravation of bleeding tendencies in ECLS patients.
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Acknowledgments
We thank Ms. Ulrike Heizmann and Mr. Bernd Koch for technical support. The indispensable expertise and dedication of our perfusionist team are highly appreciated. The study presented here is supported in part by CLS Behring, Hattersheim am Main, Germany, according to agreement with the University Freiburg Medical Center, and it is associated with the comprehensive project “Cardiac assist devices for long-term support in cardiac insufficiency” supported by the German Research Foundation, Bonn, Germany (reference no. PAK 350).
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C. Heilmann and U. Geisen contributed equally to this study.
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Heilmann, C., Geisen, U., Beyersdorf, F. et al. Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS). Intensive Care Med 38, 62–68 (2012). https://doi.org/10.1007/s00134-011-2370-6
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DOI: https://doi.org/10.1007/s00134-011-2370-6