Ishikura Hiroyasu, Irie Yuhei, Nakashio Maiko, Maruyama Junichi, Nakamura Yoshihiko, Yamagaito Takahiro, Yoshida Maho, Hatomoto Hiroki, Yamasaki Shintaro, Hoshino Kota
Emergency and Critical Care Center, Rakuwakai Otowa Hospital, 2 Otowachinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan.
Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
Sci Rep. 2025 Jun 2;15(1):19321. doi: 10.1038/s41598-025-99786-z.
This study investigated the interplay between thrombosis and hemorrhage in critically ill COVID-19 patients, particularly those on extracorporeal membrane oxygenation (ECMO). Forty-three mechanically ventilated patients were divided into ECMO (n = 22) and non-ECMO (n = 21) groups. Thrombotic events occurred similarly in both groups (22.7% in ECMO, 28.6% in non-ECMO), both higher than the approximately 5% observed in patients hospitalized with viral respiratory illnesses other than COVID-19. However, bleeding events were significantly more frequent in the ECMO group (72.7%) compared to the non-ECMO group (14.3%) (P < 0.01). ECMO patients showed decreased platelet counts, fibrinogen, von Willebrand factor (VWF) activity using a ristocetin cofactor (VWF: RCo) assay, and developed acquired von Willebrand syndrome (AvWS) (VWF: RCo/VWF antigen (Ag) ratio < 0.7), along with increased D-dimer and lower high-molecular-weight VWF multimers. In contrast, the non-ECMO group showed no significant changes in platelet counts, fibrinogen, VWF: RCo, or D-dimer. Over time, both VWF: Ag and VWF: RCo increased significantly in both groups, but the VWF: RCo/VWF: Ag ratio remained above 0.7, and high-molecular-weight VWF multimers did not change significantly. These findings emphasize the need for vigilance regarding thrombotic and hemorrhagic complications, particularly in ECMO patients, where ECMO-induced shear stress may lead to AvWS, necessitating monitoring of VWF: Ag and VWF: RCo.
本研究调查了危重症新型冠状病毒肺炎（COVID-19）患者，尤其是接受体外膜肺氧合（ECMO）治疗的患者中血栓形成与出血之间的相互作用。43例机械通气患者被分为ECMO组（n = 22）和非ECMO组（n = 21）。两组血栓形成事件发生率相似（ECMO组为22.7%，非ECMO组为28.6%），均高于在非COVID-19病毒性呼吸道疾病住院患者中观察到的约5%。然而，与非ECMO组（14.3%）相比，ECMO组出血事件明显更频繁（72.7%）（P < 0.01）。ECMO患者血小板计数、纤维蛋白原、使用瑞斯托霉素辅因子（VWF:RCo）检测的血管性血友病因子（VWF）活性降低，并发生获得性血管性血友病综合征（AvWS）（VWF:RCo/VWF抗原（Ag）比值<0.7），同时D-二聚体升高，高分子量VWF多聚体降低。相比之下，非ECMO组血小板计数、纤维蛋白原、VWF:RCo或D-二聚体无显著变化。随着时间推移，两组VWF:Ag和VWF:RCo均显著升高，但VWF:RCo/VWF:Ag比值仍高于0.7，高分子量VWF多聚体无显著变化。这些发现强调了对血栓形成和出血并发症保持警惕的必要性，尤其是在ECMO患者中，ECMO诱导的剪切应力可能导致AvWS，因此需要监测VWF:Ag和VWF:RCo。
