Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille, France.
J Thromb Haemost. 2022 Sep;20(9):2058-2069. doi: 10.1111/jth.15784. Epub 2022 Jul 3.
Intra-device thrombosis remains one of the most common complications during extracorporeal membrane oxygenation (ECMO). Despite anticoagulation, approximately 35% of patients develop thrombi in the membrane oxygenator, pump heads, or tubing. The aim of this study was to describe the molecular and cellular features of ECMO thrombi and to study the main drivers of thrombus formation at different sites in the ECMO circuits.
Thrombi (n = 85) were collected immediately after veno-arterial-(VA)-ECMO circuit removal from 25 patients: 23 thrombi from the pump, 25 from the oxygenator, and 37 from the tubing. Quantitative histological analysis was performed for the amount of red blood cells (RBCs), platelets, fibrin, von Willebrand factor (VWF), leukocytes, and citrullinated histone H3 (H3Cit). ECMO thrombi consist of a heterogenous composition with fibrin and VWF being the major thrombus components. A clustering analysis of the four major histological parameters identified two typical thrombus types: RBC-rich and RBC-poor/fibrin-rich thrombi with no significant differences in VWF and platelet content. Thrombus composition was not associated with the thrombus location, except for higher amounts of H3Cit that were found in pump and oxygenator thrombi compared to tubing samples. We observed higher blood leukocyte count and lactate dehydrogenase levels in patients with fibrin-rich thrombi.
We found that thrombus composition is heterogenous, independent of their location, consisting of two types: RBC-rich and a fibrin-rich types. We also found that NETs play a minor role. These findings are important to improve current anticoagulation strategies in ECMO.
体外膜肺氧合（ECMO）过程中，装置内血栓仍然是最常见的并发症之一。尽管进行了抗凝治疗，大约 35%的患者在膜式氧合器、泵头或管道中会形成血栓。本研究旨在描述 ECMO 血栓的分子和细胞特征，并研究 ECMO 回路不同部位血栓形成的主要驱动因素。
从 25 名患者中收集了 25 例 VA-ECMO 回路拆除后立即采集的血栓（n=85）：泵中有 23 个血栓，氧合器中有 25 个血栓，管道中有 37 个血栓。对红细胞（RBC）、血小板、纤维蛋白、血管性血友病因子（VWF）、白细胞和瓜氨酸化组蛋白 H3（H3Cit）的含量进行了定量组织学分析。ECMO 血栓由异质成分组成，纤维蛋白和 VWF 是主要的血栓成分。对这四个主要组织学参数的聚类分析确定了两种典型的血栓类型：富含 RBC 和 RBC 贫/富含纤维蛋白的血栓，VWF 和血小板含量无显著差异。血栓成分与血栓位置无关，但在泵和氧合器血栓中发现的 H3Cit 量高于管道样本。我们观察到富含纤维蛋白的血栓患者的白细胞计数和乳酸脱氢酶水平较高。
我们发现血栓的组成是异质的，与位置无关，由两种类型组成：富含 RBC 和富含纤维蛋白型。我们还发现 NETs 作用较小。这些发现对改善 ECMO 中的当前抗凝策略很重要。
