Factor XIII Activity Might Already Be Impaired Before Veno-Venous ECMO in ARDS Patients: A Prospective, Observational Single-Center Cohort Study

Overview

Journal J Clin Med

Specialty General Medicine

Date 2021 Apr 3

PMID 33799338

Citations 6

Authors

Onnen Moerer

Jan Felix Huber-Petersen

Joern Schaeper

Claudia Binder

Saskia Wand

Affiliations

Soon will be listed here.

Abstract

Direct complications in patients receiving extracorporeal (veno-venous) membrane oxygenation (vvECMO) are mainly either due to bleeding or thromboembolism. We aimed to evaluate the course of routine coagulation parameters and the activity of different coagulation factors-with special focus on factor XIII (F XIII)-before, during and after vvECMO in acute respiratory distress syndrome (ARDS) patients. The activity of coagulation factors and rotational thrombelastometry were analyzed in 20 ECMO patients before (T-1) and 6 h (T0), one (T1), three (T3) and seven days (T7) after the implantation, as well as one and three days after the termination of ECMO. F XIII activity was already severely decreased to 37% (30/49) before ECMO. F XIII activity was the only coagulation factor continuously declining during vvECMO, being significantly decreased at T3 (31% (26/45) vs. 24% (18/42), = 0.0079) and T7 (31% (26/45) vs. 23% (17/37), = 0.0037) compared to T0. Three days after termination of vvECMO, platelet count and fibrinogen nearly doubled and factors II, V, XI and XIII showed spontaneous significant increases. Severe ARDS patients showed a considerably diminished factor XIII activity before vvECMO initiation and its activity continuously declined later on. Thus, incorporation of F XIII monitoring into the regular hemostaseologic routine during vvECMO therapy seems advisable. Due to the potential development of a hypercoagulatory state after the termination of vvECMO, tight hemostasiologic monitoring should persist in the initial phase after ECMO termination.

Citing Articles

Bleeding patients on extracorporeal membrane oxygenation have reduced platelet aggregation and plasma fibrinogen: a longitudinal observational study.

Hvas C, Christensen S, Mains Balle C, Munk-Andersen H, Jeppesen A, Hvas A Sci Rep. 2023; 13(1):14557.

PMID: 37666949 PMC: 10477285. DOI: 10.1038/s41598-023-41773-3.

Acquired Factor XIII Deficiency Is Common during ECMO Therapy and Associated with Major Bleeding Events and Transfusion Requirements.

Noitz M, Brooks R, Szasz J, Jenner D, Bock C, Krenner N J Clin Med. 2023; 12(12).

PMID: 37373805 PMC: 10299514. DOI: 10.3390/jcm12124115.

Bleeding and Thrombotic Issues during Extracorporeal Membrane Oxygenation.

Ranucci M, Cotza M, Di Dedda U J Clin Med. 2022; 11(18).

PMID: 36143022 PMC: 9503624. DOI: 10.3390/jcm11185375.

The impact of acquired coagulation factor XIII deficiency in traumatic bleeding and wound healing.

Kleber C, Sablotzki A, Casu S, Olivieri M, Thoms K, Horter J Crit Care. 2022; 26(1):69.

PMID: 35331308 PMC: 8943792. DOI: 10.1186/s13054-022-03940-2.

Monitoring of Unfractionated Heparin Therapy in the Intensive Care Unit Using a Point-of-Care aPTT: A Comparative, Longitudinal Observational Study with Laboratory-Based aPTT and Anti-Xa Activity Measurement.

Lardinois B, Hardy M, Michaux I, Horlait G, Rotens T, Jacqmin H J Clin Med. 2022; 11(5).

PMID: 35268436 PMC: 8911237. DOI: 10.3390/jcm11051338.

References

Wallisch M, Lorentz C, Lakshmanan H, Johnson J, Carris M, Puy C . Antibody inhibition of contact factor XII reduces platelet deposition in a model of extracorporeal membrane oxygenator perfusion in nonhuman primates. Res Pract Thromb Haemost. 2020; 4(2):205-216. PMC: 7040549. DOI: 10.1002/rth2.12309. View

Granja T, Hohenstein K, Schussel P, Fischer C, Prufer T, Schibilsky D . Multi-Modal Characterization of the Coagulopathy Associated With Extracorporeal Membrane Oxygenation. Crit Care Med. 2020; 48(5):e400-e408. DOI: 10.1097/CCM.0000000000004286. View

Karagiannidis C, Brodie D, Strassmann S, Stoelben E, Philipp A, Bein T . Extracorporeal membrane oxygenation: evolving epidemiology and mortality. Intensive Care Med. 2016; 42(5):889-896. DOI: 10.1007/s00134-016-4273-z. View

Hellmann C, Schmutz A, Kalbhenn J . Bleeding during veno-venous ECMO cannot reliably be predicted by rotational thrombelastometry (ROTEM™). Perfusion. 2017; 33(4):289-296. DOI: 10.1177/0267659117746231. View

Lee S, Chang S, Lee I, Kim Y, Chung S . Depletion of plasma factor XIII prevents disseminated intravascular coagulation-induced organ damage. Thromb Haemost. 2001; 85(3):464-9. View

Wang Z, Wilhelmsson C, Hyrsl P, Loof T, Dobes P, Klupp M . Pathogen entrapment by transglutaminase--a conserved early innate immune mechanism. PLoS Pathog. 2010; 6(2):e1000763. PMC: 2820530. DOI: 10.1371/journal.ppat.1000763. View

Menges T, von Lessen A, Welters I, Wagner R, Ruwoldt R, Boldt J . [Intracranial hemorrhage and hemostasis. Monitoring patients after intracranial hemorrhage by determination and follow-up of activation products of blood coagulation]. Infusionsther Transfusionsmed. 1994; 21(4):244-50. View

Weber C, Gorlinger K, Meininger D, Herrmann E, Bingold T, Moritz A . Point-of-care testing: a prospective, randomized clinical trial of efficacy in coagulopathic cardiac surgery patients. Anesthesiology. 2012; 117(3):531-47. DOI: 10.1097/ALN.0b013e318264c644. View

Thiagarajan R, Barbaro R, Rycus P, McMullan D, Conrad S, Fortenberry J . Extracorporeal Life Support Organization Registry International Report 2016. ASAIO J. 2016; 63(1):60-67. DOI: 10.1097/MAT.0000000000000475. View

10.

Kalbhenn J, Schmidt R, Nakamura L, Schelling J, Rosenfelder S, Zieger B . Early diagnosis of acquired von Willebrand Syndrome (AVWS) is elementary for clinical practice in patients treated with ECMO therapy. J Atheroscler Thromb. 2014; 22(3):265-71. DOI: 10.5551/jat.27268. View

11.

Kalbhenn J, Wittau N, Schmutz A, Zieger B, Schmidt R . Identification of acquired coagulation disorders and effects of target-controlled coagulation factor substitution on the incidence and severity of spontaneous intracranial bleeding during veno-venous ECMO therapy. Perfusion. 2015; 30(8):675-82. DOI: 10.1177/0267659115579714. View

12.

Vaquer S, de Haro C, Peruga P, Oliva J, Artigas A . Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome. Ann Intensive Care. 2017; 7(1):51. PMC: 5429319. DOI: 10.1186/s13613-017-0275-4. View

13.

Adam E, Meier J, Klee B, Zacharowski K, Meybohm P, Weber C . Factor XIII activity in patients requiring surgical re-exploration for bleeding after elective cardiac surgery - A prospective case control study. J Crit Care. 2019; 56:18-25. DOI: 10.1016/j.jcrc.2019.11.012. View

14.

Fichtner F, Moerer O, Laudi S, Weber-Carstens S, Nothacker M, Kaisers U . Mechanical Ventilation and Extracorporeal Membrane Oxygena tion in Acute Respiratory Insufficiency. Dtsch Arztebl Int. 2019; 115(50):840-847. PMC: 6375070. DOI: 10.3238/arztebl.2018.0840. View

15.

Ito A, Iwashita Y, Esumi R, Sasaki K, Yukimitsu M, Kato T . Acquired factor XIII deficiency in two patients with bleeding events during veno-venous extracorporeal membrane oxygenation treatment. J Artif Organs. 2019; 23(3):283-287. PMC: 7458886. DOI: 10.1007/s10047-019-01148-w. View

16.

Wand S, Huber-Petersen J, Schaeper J, Binder C, Moerer O . Platelet Function Disturbance During Veno-Venous ECMO in ARDS Patients Assessed by Multiple Electrode Aggregometry-A Prospective, Observational Cohort Study. J Clin Med. 2019; 8(7). PMC: 6678447. DOI: 10.3390/jcm8071056. View

17.

Loof T, Morgelin M, Johansson L, Oehmcke S, Olin A, Dickneite G . Coagulation, an ancestral serine protease cascade, exerts a novel function in early immune defense. Blood. 2011; 118(9):2589-98. DOI: 10.1182/blood-2011-02-337568. View

18.

Mazzeffi M, Strauss E, Meyer M, Hasan S, Judd M, Abuelkasem E . Coagulation Factor Levels and Underlying Thrombin Generation Patterns in Adult Extracorporeal Membrane Oxygenation Patients. Anesth Analg. 2019; 129(3):659-666. DOI: 10.1213/ANE.0000000000004275. View

19.

Fisser C, Reichenbacher C, Muller T, Schneckenpointner R, Malfertheiner M, Philipp A . Incidence and Risk Factors for Cannula-Related Venous Thrombosis After Venovenous Extracorporeal Membrane Oxygenation in Adult Patients With Acute Respiratory Failure. Crit Care Med. 2019; 47(4):e332-e339. DOI: 10.1097/CCM.0000000000003650. View

20.

Helling H, Stephan B, Pindur G . Coagulation and complement system in critically ill patients. Clin Hemorheol Microcirc. 2015; 61(2):185-93. DOI: 10.3233/CH-151993. View