Acquired von Willebrand syndrome in patients treated with veno-arterial extracorporeal membrane oxygenation

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a powerful device for treatment of patients with life-threatening heart failure. Although bleeding is often associated with VA ECMO and sometimes results in a fatal outcome, its precise causes remain unknown. On the other hand, excessive...

Full description

Saved in:
Bibliographic Details
Published in:Cardiovascular intervention and therapeutics 2019-10, Vol.34 (4), p.358-363
Main Authors: Tamura, Toshihiro, Horiuchi, Hisanori, Obayashi, Yuki, Fuki, Masayuki, Imanaka, Miyako, Kuroda, Maiko, Nishimura, Shunsuke, Amano, Masashi, Sakamoto, Jiro, Tamaki, Yodo, Enomoto, Soichiro, Miyake, Makoto, Kondo, Hirokazu, Izumi, Chisato, Nakagawa, Yoshihisa
Format: Article
Language:English
Subjects:
Adult
Aged
Cardiology
Extracorporeal Membrane Oxygenation - adverse effects
Female
Gastrointestinal Hemorrhage - etiology
Hemothorax - etiology
Humans
Interventional Radiology
Male
Medicine
Medicine & Public Health
Middle Aged
Myocardial Infarction - therapy
Myocarditis - therapy
Original Article
Pulmonary Embolism - therapy
von Willebrand Diseases - etiology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is a powerful device for treatment of patients with life-threatening heart failure. Although bleeding is often associated with VA ECMO and sometimes results in a fatal outcome, its precise causes remain unknown. On the other hand, excessive high shear stress in the cardiovascular system causes acquired von Willebrand syndrome (aVWS), characterized by loss of von Willebrand factor (vWF) large multimers. vWF large multimers of five consecutive patients treated with VA ECMO were quantitatively evaluated using the vWF large multimer indices, defined as the ratio of the large multimer ratio of a patient to that of a healthy subject analyzed simultaneously. All 5 patients exhibited oozing type of bleeding at the skin insertion sites under treatment with PCPS at flow rates of 2.5–3.0 l/min/m 2 , including two severe cases of bleeding; one patient had massive gastrointestinal bleeding and another had hemothorax. Their vWF large multimer indices were 20.8, 28.8, 27.6, 51.0, and 31.0% (means 31.8 ± 11.4%). Surprisingly, these values are much lower than those observed in severe aortic stenosis reported previously by us (Tamura et al. in J Atheroscler Thromb 22:1115–1123, 2015 ), where vWF multimer indices in 31 severe aortic stenosis patients with peak pressure gradient through the aortic valves of 85.1 ± 29.4 mmHg were 75.0 ± 21.7% ( p 
ISSN:1868-4300
1868-4297
DOI:10.1007/s12928-019-00568-y