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Hypercoagulopathy, acquired coagulation disorders and anticoagulation before, during and after extracorporeal

Johannes Kalbhenn1, Hannah Glonnegger2, Maya Wilke1

  • 1Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Perfusion
|March 15, 2021
PubMed

Insights

COVID-19 patients on vvECMO experience distinct coagulation changes. Advanced testing is crucial for managing bleeding and clotting risks during and after extracorporeal membrane oxygenation support.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is associated with high rates of thromboembolism and bleeding.
  • Venovenous extracorporeal membrane oxygenation (vvECMO) is a life-support measure for severe COVID-19 but carries its own risks of coagulation complications.
  • The interplay between COVID-19-related coagulopathy and vvECMO support requires further investigation.

Purpose of the Study:

  • To characterize coagulation disorders in COVID-19 patients before, during, and after vvECMO support.
  • To differentiate the evolving coagulation abnormalities associated with vvECMO in the context of COVID-19.
  • To identify potential targets for tailored therapeutic interventions.

Main Methods:

  • Observational case series of six consecutive COVID-19 patients requiring vvECMO.
  • Routine coagulation parameters, coagulation factors, von Willebrand factor (VWF) multimer analysis, platelet aggregometry, and immunological screening were performed.
  • Coagulation status was assessed at different phases: pre-vvECMO, during vvECMO, and post-vvECMO explantation.

Main Results:

  • COVID-19 patients exhibited distinct phases of coagulation disorders: initial hypercoagulability with increased VWF and factor VIII, followed by acquired von Willebrand syndrome and platelet dysfunction during vvECMO leading to bleeding, and subsequent hypercoagulopathy post-explantation.
  • Five out of six patients developed immunological abnormalities that exacerbated coagulation.
  • Routine coagulation tests were insufficient to discriminate these complex coagulation disorders.

Conclusions:

  • COVID-19-induced coagulopathy and vvECMO-related bleeding disorders present a complex, multi-phasic picture.
  • Standard coagulation tests are inadequate for precise diagnosis and management.
  • Specific diagnostic analyses and tailored treatments are necessary to effectively manage coagulation derangements in COVID-19 patients on vvECMO.
Abstract

Keywords:
COVID19ECMOacquired von Willebrand syndromeanticoagulationbleedingcoagulopathyfactor VIIIhaemostasisthrombosis

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