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Published in: Intensive Care Medicine 1/2012

01-01-2012 | Original

Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS)

Authors: Claudia Heilmann, Ulrich Geisen, Friedhelm Beyersdorf, Lea Nakamura, Christoph Benk, Georg Trummer, Michael Berchtold-Herz, Christian Schlensak, Barbara Zieger

Published in: Intensive Care Medicine | Issue 1/2012

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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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Metadata
Title
Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS)
Authors
Claudia Heilmann
Ulrich Geisen
Friedhelm Beyersdorf
Lea Nakamura
Christoph Benk
Georg Trummer
Michael Berchtold-Herz
Christian Schlensak
Barbara Zieger
Publication date
01-01-2012
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2370-6

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