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<p>This study investigated the interplay between thrombosis and hemorrhage in critically ill COVID-19 patients, particularly those on extracorporeal membrane oxygenation (ECMO). Forty-three mechanically ventilated patients were divided into ECMO (<i>n</i> = 22) and non-ECMO (<i>n</i> = 21) groups. Thrombotic events occurred similarly in both groups (22.7% in ECMO, 28.6% in non-ECMO), both higher than the approximately 5% observed in patients hospitalized with viral respiratory illnesses other than COVID-19. However, bleeding events were significantly more frequent in the ECMO group (72.7%) compared to the non-ECMO group (14.3%) (<i>P</i> &lt; 0.01). ECMO patients showed decreased platelet counts, fibrinogen, von Willebrand factor (VWF) activity using a ristocetin cofactor (VWF: RCo) assay, and developed acquired von Willebrand syndrome (AvWS) (VWF: RCo/VWF antigen (Ag) ratio &lt; 0.7), along with increased D-dimer and lower high-molecular-weight VWF multimers. In contrast, the non-ECMO group showed no significant changes in platelet counts, fibrinogen, VWF: RCo, or D-dimer. Over time, both VWF: Ag and VWF: RCo increased significantly in both groups, but the VWF: RCo/VWF: Ag ratio remained above 0.7, and high-molecular-weight VWF multimers did not change significantly. These findings emphasize the need for vigilance regarding thrombotic and hemorrhagic complications, particularly in ECMO patients, where ECMO-induced shear stress may lead to AvWS, necessitating monitoring of VWF: Ag and VWF: RCo.</p>

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Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月2日

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  • Hiroyasu Ishikura,
  • Yuhei Irie,
  • Maiko Nakashio,
  • Junichi Maruyama,
  • Yoshihiko Nakamura,
  • Takahiro Yamagaito,
  • Maho Yoshida,
  • Hiroki Hatomoto,
  • Shintaro Yamasaki,
  • Kota Hoshino

摘要

This study investigated the interplay between thrombosis and hemorrhage in critically ill COVID-19 patients, particularly those on extracorporeal membrane oxygenation (ECMO). Forty-three mechanically ventilated patients were divided into ECMO (n = 22) and non-ECMO (n = 21) groups. Thrombotic events occurred similarly in both groups (22.7% in ECMO, 28.6% in non-ECMO), both higher than the approximately 5% observed in patients hospitalized with viral respiratory illnesses other than COVID-19. However, bleeding events were significantly more frequent in the ECMO group (72.7%) compared to the non-ECMO group (14.3%) (P < 0.01). ECMO patients showed decreased platelet counts, fibrinogen, von Willebrand factor (VWF) activity using a ristocetin cofactor (VWF: RCo) assay, and developed acquired von Willebrand syndrome (AvWS) (VWF: RCo/VWF antigen (Ag) ratio < 0.7), along with increased D-dimer and lower high-molecular-weight VWF multimers. In contrast, the non-ECMO group showed no significant changes in platelet counts, fibrinogen, VWF: RCo, or D-dimer. Over time, both VWF: Ag and VWF: RCo increased significantly in both groups, but the VWF: RCo/VWF: Ag ratio remained above 0.7, and high-molecular-weight VWF multimers did not change significantly. These findings emphasize the need for vigilance regarding thrombotic and hemorrhagic complications, particularly in ECMO patients, where ECMO-induced shear stress may lead to AvWS, necessitating monitoring of VWF: Ag and VWF: RCo.