• Michael Mazzeffi, Allison Bathula, Ali Tabatabai, Jay Menaker, David Kaczorowski, Ronson Madathil, Samuel Galvagno, Chetan Pasrija, Raymond Rector, Kenichi Tanaka, and Daniel Herr.
• University of Maryland School of Medicine, Department of Anesthesiology, Baltimore, MD. Electronic address: mmazzeffi@som.umaryland.edu.
• J. Cardiothorac. Vasc. Anesth. 2021 Mar 1; 35 (3): 882-887.

ObjectiveTo review the use of Von Willebrand Factor (VWF) concentrate for treatment of acquired Von Willebrand syndrome (VWS)-related bleeding in adult extracorporeal membrane oxygenation (ECMO) patients and determine if it was associated with improved VWF laboratory parameters.DesignRetrospective observational cohort study.SettingTertiary care academic medical center.ParticipantsAdult ECMO patients who received VWF concentrate for treatment of acquired VWS- related bleeding.InterventionsNone, observational study.Measurements And Main ResultsTen adult ECMO patients received VWF concentrate for treatment of bleeding with evidence of acquired VWS over a 15-month period. Six patients were on veno-arterial ECMO and 4 were on veno-venous ECMO. The most common site of bleeding was airway or tracheal bleeding. The mean dose of VWF concentrate was 41 IU/kg. Mean VWF antigen was 263 ± 93 IU/dL before treatment and 394 ± 54 after treatment. Mean ristocetin cofactor activity was 127 ± 47 IU/dL before treatment and 240 ± 33 after treatment. The mean VWF ristocetin cofactor activity antigen ratio increased from 0.52 ± 0.14 before treatment to 0.62 ± 0.04 after treatment. Four of 10 patients had complete resolution of their bleeding within 24 hours, and 6 of 10 had complete resolution of their bleeding within 2- to- 4 days. There were 3 patients who had thrombotic events potentially related to VWF concentrate administration. No patient had an arterial thrombosis, stroke, or myocardial infarction.ConclusionsVWF concentrate administration increases VWF function in adult ECMO patients, but also may be associated with increased thrombotic risk. Larger studies are needed to determine VWF concentrate's safety, efficacy, and optimal dosing in adult ECMO patients.Copyright © 2020 Elsevier Inc. All rights reserved.

15 keywords...

hide…