From the Departments of Medicine I.
Laboratory Medicine.
ASAIO J. 2024 Mar 1;70(3):217-223. doi: 10.1097/MAT.0000000000002085. Epub 2023 Oct 24.
During extracorporeal membrane oxygenation (ECMO) blood is exposed to artificial surfaces, resulting in contact activation of the intrinsic coagulation pathway initiated by coagulation factor XII (FXII). Little is known about the prevalence of acquired FXII-deficiency, especially during ECMO. The primary outcome was the prevalence of acquired FXII-deficiency (FXII activity <60%) during ECMO. Secondary outcomes included differences in hemorrhagic/thromboembolic complications, doses of unfractionated heparin administered, and time points of anticoagulation within target ranges between patients with and without FXII-deficiency. Of 193 adults receiving ECMO therapy between 2013 and 2021, FXII testing was performed in 64 (33%) patients. Of these, 89% ( n = 57) had an acquired FXII-deficiency. Median complication-free intervals were not different between patients with and without acquired FXII-deficiency (bleeding: 28 days [6-145] vs. 12 days [11-not available], p = 0.85; thromboembolism: 16 days [8-54] vs. 13 days [3-15], p = 0.053). Patients with acquired FXII-deficiency received less heparin (16,554 IU/day vs. 25,839 IU/day; p = 0.009) and were less likely to be within aPTT-target ranges (23.1% [14.3%-36.4%] vs. 37.8% [33.7%-58.3%], p = 0.005). Acquired FXII-deficiency is common during ECMO and may affect monitoring of anticoagulation. The impact of FXII-activity on complications needs to be determined in future studies.
在体外膜肺氧合（ECMO）过程中，血液会接触到人工表面，导致凝血因子 XII（FXII）引发的内源性凝血途径的接触激活。关于获得性 FXII 缺乏症的流行情况，尤其是在 ECMO 期间，知之甚少。主要结局是 ECMO 期间获得性 FXII 缺乏症（FXII 活性<60%）的流行率。次要结局包括 FXII 缺乏症患者与无 FXII 缺乏症患者之间出血/血栓栓塞并发症、未分馏肝素剂量和抗凝目标范围内的时间点的差异。在 2013 年至 2021 年间接受 ECMO 治疗的 193 名成年人中，对 64 名（33%）患者进行了 FXII 检测。其中，89%（n=57）患有获得性 FXII 缺乏症。有和没有获得性 FXII 缺乏症的患者之间无并发症间隔时间中位数无差异（出血：28 天[6-145]与 12 天[11-无可用]，p=0.85；血栓栓塞：16 天[8-54]与 13 天[3-15]，p=0.053）。患有获得性 FXII 缺乏症的患者接受的肝素较少（16554 IU/天与 25839 IU/天；p=0.009），且更不可能在 aPTT 目标范围内（23.1%[14.3%-36.4%]与 37.8%[33.7%-58.3%]，p=0.005）。获得性 FXII 缺乏症在 ECMO 期间很常见，可能会影响抗凝监测。FXII 活性对并发症的影响需要在未来的研究中确定。
