Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome
Abstract 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. Thromboti...
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Nature Portfolio
2025-06-01
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| Online Access: | https://doi.org/10.1038/s41598-025-99786-z |
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| author | Hiroyasu Ishikura Yuhei Irie Maiko Nakashio Junichi Maruyama Yoshihiko Nakamura Takahiro Yamagaito Maho Yoshida Hiroki Hatomoto Shintaro Yamasaki Kota Hoshino |
| author_facet | Hiroyasu Ishikura Yuhei Irie Maiko Nakashio Junichi Maruyama Yoshihiko Nakamura Takahiro Yamagaito Maho Yoshida Hiroki Hatomoto Shintaro Yamasaki Kota Hoshino |
| author_sort | Hiroyasu Ishikura |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-168385e7686d49338dba9cf435e72a3f |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-168385e7686d49338dba9cf435e72a3f2025-08-20T03:10:32ZengNature PortfolioScientific Reports2045-23222025-06-0115111310.1038/s41598-025-99786-zManagement of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndromeHiroyasu Ishikura0Yuhei Irie1Maiko Nakashio2Junichi Maruyama3Yoshihiko Nakamura4Takahiro Yamagaito5Maho Yoshida6Hiroki Hatomoto7Shintaro Yamasaki8Kota Hoshino9Emergency and Critical Care Center, Rakuwakai Otowa HospitalEmergency and Critical Care Center, Fukuoka University HospitalEmergency and Critical Care Center, Fukuoka University HospitalEmergency and Critical Care Center, Fukuoka University HospitalEmergency and Critical Care Center, Fukuoka University HospitalSysmex Product MarketingSysmex Scientific AffairsDepartment of Clinical Engineer Center, Fukuoka University HospitalDepartment of Clinical Engineer Center, Fukuoka University HospitalEmergency and Critical Care Center, Fukuoka University HospitalAbstract 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.https://doi.org/10.1038/s41598-025-99786-zAcquired von Willebrand syndromeCoagulopathyCOVID-19HemorrhageThrombosis |
| spellingShingle | Hiroyasu Ishikura Yuhei Irie Maiko Nakashio Junichi Maruyama Yoshihiko Nakamura Takahiro Yamagaito Maho Yoshida Hiroki Hatomoto Shintaro Yamasaki Kota Hoshino Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome Scientific Reports Acquired von Willebrand syndrome Coagulopathy COVID-19 Hemorrhage Thrombosis |
| title | Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome |
| title_full | Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome |
| title_fullStr | Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome |
| title_full_unstemmed | Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome |
| title_short | Management of COVID-19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome |
| title_sort | management of covid 19 associated coagulopathy in critically ill patients and the risk of acquired von willebrand syndrome |
| topic | Acquired von Willebrand syndrome Coagulopathy COVID-19 Hemorrhage Thrombosis |
| url | https://doi.org/10.1038/s41598-025-99786-z |
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