PB0474 - Acquired von-Willebrand-disease in ECMO or LVAD patients: a comparative cohort study

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

TB

Tido P. Bajorat

Consultant
University Hospital Schleswig-Holstein, Department for Hemostasis and Thrombosis, Institute for Clinical Chemistry
Kiel, Schleswig-Holstein, Germany

Co-Author(s)

JH

Jenny Hildebrandt

doctoral candidate
University Hospital Schleswig-Holstein, Department for Hemostasis and Thrombosis, Institute for Clinical Chemistry
Kiel, Schleswig-Holstein, Germany
BP

Bernd Pannholzer

Consultant
University Hospital Schleswig-Holstein, Department of Cardiac and Vascular Surgery
Kiel, Schleswig-Holstein, Germany
DK

Dorothee Kowalski

Consultant
University Hospital Schleswig-Holstein, Department for Hemostasis and Thrombosis, Institute for Clinical Chemistry
Kiel, Schleswig-Holstein, Germany
DJ

David Juhl

Consultant
University Hospital Schleswig-Holstein, Department of Transfusion medicine
Lübeck, Schleswig-Holstein, Germany
JK

Johannes Kalbhenn

Consultant
University of Freiburg, Department of Anesthesiology and Critical Care
Freiburg, Baden-Wurttemberg, Germany
AK

Arne Kowalski

Consultant
University Hospital Schleswig-Holstein, Department of Cardiac and Vascular Surgery
Kiel, Schleswig-Holstein, Germany
BZ

Barbara Zieger

Head of the Section Haemostaseology
Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg
Freiburg, Baden-Wurttemberg, Germany
AH

Assad Haneya

Consultant
University Hospital Schleswig-Holstein, Department of Cardiac and Vascular Surgery
Kiel, Schleswig-Holstein, Germany
UN

Ulrike Nowak-Göttl

MD, Head of Institute of Clinical Chemistry,
Thrombosis & Haemostasis Treatment Centre, University Hospital Schleswig-Holstein, Germany
Kiel, Schleswig-Holstein, Germany

Background: Approximately 100% of patients necessitating ECMO or LVAD conduits develop post interventional acquired von-Willebrand-disease (aVWD), with only a small proportion presented with clinically relevant bleeding.

Aims: The aim of the present comparative cohort study of consecutively enrolled patients admitted to the cardiac surgery department (CSD) was to collect demographic, medical and laboratory data possibly associated with i) development of clinically relevant bleeding and/or ii) death during a three-months follow-up.

Methods: 507 white patients (LVAD n=169) aged 18-89 years (median: 61; male 80.3%) were enrolled. 78 of 507 patients (19.7%) presented with clinically relevant bleeding. Logistic regression adjusted for age, gender, BMI and liver function was performed.

Results: The analysis showed that i) the presence of blood group 0 versus non-0 (OR/95%CI: 2.2/1.3-3.6) and worse outcome within 30 days following intervention (OR/95%CI: 2.63/1.4-5.0) was associated with symptomatic aVWD, and, vice versa, that patients with LVAD compared with ECMO insertion significantly less common develop clinically relevant aVWD (OR/95%CI: 0.55/0.33-0.98). The overall death rate within 30 days post intervention was 71.2%.
Furthermore we found that ii) ECMO versus LVAD implantation (OR/95%CI: 1.9/1.57-2,38), symptomatic aVWD (OR/95%CI: 2.8/1.5-5.4), the presence of blood group non-0 versus 0 (OR/95%CI:1 .7/1.06-2.7), and increasing age per year (OR/95%CI: 1.01/1.002-1.03) was independenly associated with worse outcome in the patients enrolled.

Conclusion(s): In the present comparative cohort study we found a clinical relevant bleeding rate of 19.7% in subjects with aVWD, with a significant higher proportion in patients receiving ECMO compared with LVAD devices. The development of symptomatic aVWD was associtated with the presence of blood group 0 and worse outcome.