PMID- 21965100
OWN - NLM
STAT- MEDLINE
DCOM- 20120420
LR  - 20220410
IS  - 1432-1238 (Electronic)
IS  - 0342-4642 (Linking)
VI  - 38
IP  - 1
DP  - 2012 Jan
TI  - Acquired von Willebrand syndrome in patients with extracorporeal life support 
      (ECLS).
PG  - 62-8
LID - 10.1007/s00134-011-2370-6 [doi]
AB  - PURPOSE: Extracorporeal life support (ECLS) is used for patients with refractory 
      heart failure with or without respiratory failure. This temporary support is 
      provided by blood pumps which are connected to large vessels. Bleeding episodes 
      are a typical complication in patients with ECLS. Recently, several studies 
      illustrated that acquired von Willebrand syndrome (AVWS) can contribute to 
      bleeding tendencies in patients with long-term ventricular assist devices (VAD). 
      AVWS is characterized by loss of the high molecular weight (HMW) multimers of von 
      Willebrand factor (VWF) as a result of high shear stress and leads to impaired 
      binding of VWF to platelets and to subendothelial matrix. Since ECLS and VAD 
      share several features, we investigated patients with ECLS for AVWS. METHODS: We 
      analyzed 32 patients with ECLS and 19 of them without support. To diagnose AVWS, 
      ratios of ristocetin cofactor activity (VWF:RCo) and collagen binding capacity 
      (VWF:CB) to VWF antigen (VWF:Ag) were employed in conjunction with multimeric 
      analysis. RESULTS: Reduced VWF:RCo/VWF:Ag ratios were identified in 28 ECLS 
      patients. Furthermore, VWF:CB/VWF:Ag ratios were decreased in 31 patients. HMW 
      multimers of VWF were missing in the same 31 patients. Thus, 31 of 32 ECLS 
      patients presented with AVWS. Twenty-two of the 32 patients suffered from 
      bleeding complications. Without support, AVWS was not detectable in any analyzed 
      patient. CONCLUSION: Our data indicate that AVWS is a typical disorder in 
      patients with ECLS. We hypothesize that AVWS could contribute to aggravation of 
      bleeding tendencies in ECLS patients.
FAU - Heilmann, Claudia
AU  - Heilmann C
AD  - Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad 
      Krozingen, Hugstetter Str. 55, 79106 Freiburg, Germany. 
      claudia.heilmann@uniklinik-freiburg.de
FAU - Geisen, Ulrich
AU  - Geisen U
FAU - Beyersdorf, Friedhelm
AU  - Beyersdorf F
FAU - Nakamura, Lea
AU  - Nakamura L
FAU - Benk, Christoph
AU  - Benk C
FAU - Trummer, Georg
AU  - Trummer G
FAU - Berchtold-Herz, Michael
AU  - Berchtold-Herz M
FAU - Schlensak, Christian
AU  - Schlensak C
FAU - Zieger, Barbara
AU  - Zieger B
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111001
PL  - United States
TA  - Intensive Care Med
JT  - Intensive care medicine
JID - 7704851
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Extracorporeal Membrane Oxygenation
MH  - Germany
MH  - Humans
MH  - Middle Aged
MH  - Prospective Studies
MH  - Syndrome
MH  - Young Adult
MH  - von Willebrand Diseases/complications/*diagnosis/physiopathology
EDAT- 2011/10/04 06:00
MHDA- 2012/04/21 06:00
CRDT- 2011/10/04 06:00
PHST- 2011/02/24 00:00 [received]
PHST- 2011/07/25 00:00 [accepted]
PHST- 2011/10/04 06:00 [entrez]
PHST- 2011/10/04 06:00 [pubmed]
PHST- 2012/04/21 06:00 [medline]
AID - 10.1007/s00134-011-2370-6 [doi]
PST - ppublish
SO  - Intensive Care Med. 2012 Jan;38(1):62-8. doi: 10.1007/s00134-011-2370-6. Epub 
      2011 Oct 1.