Shear-induced acquired von Willebrand syndrome: an accomplice of bleeding events in adults on extracorporeal membrane oxygenation support

Haiwang Wang; Duo Li; Yuansen Chen; Ziquan Liu; Yanqing Liu; Xiangyan Meng; Haojun Fan; Shike Hou

doi:10.3389/fcvm.2023.1159894

Shear-induced acquired von Willebrand syndrome: an accomplice of bleeding events in adults on extracorporeal membrane oxygenation support

Front Cardiovasc Med. 2023 Jul 6:10:1159894. doi: 10.3389/fcvm.2023.1159894. eCollection 2023.

Authors

Haiwang Wang^#^{1

2

3}, Duo Li^#^{1

2

3}, Yuansen Chen^{1

2

3}, Ziquan Liu^{1

2

3}, Yanqing Liu^{1

2

3}, Xiangyan Meng^{1

2

3}, Haojun Fan^{1

2

3}, Shike Hou^{1

2

3}

Affiliations

¹ Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.
² Tianjin Key Laboratory of Disaster Medicine Technology, Tianjin University, Tianjin, China.
³ Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China.

^# Contributed equally.

Abstract

Extracorporeal membrane oxygenation (ECMO) is an increasingly acceptable life-saving mechanical assistance system that provides cardiac and/or respiratory support for several reversible or treatable diseases. Despite important advances in technology and clinical management, bleeding remains a significant and common complication associated with increased morbidity and mortality. Some studies suggest that acquired von Willebrand syndrome (AVWS) is one of the etiologies of bleeding. It is caused by shear-induced deficiency of von Willebrand factor (VWF). VWF is an important glycoprotein for hemostasis that acts as a linker at sites of vascular injury for platelet adhesion and aggregation under high shear stress. AVWS can usually be diagnosed within 24 h after initiation of ECMO and is always reversible after explantation. Nonetheless, the main mechanism for the defect in the VWF multimers under ECMO support and the association between AVWS and bleeding complications remains unknown. In this review, we specifically discuss the loss of VWF caused by shear induction in the context of ECMO support as well as the current diagnostic and management strategies for AVWS.

Keywords: acquired von Willebrand syndrome; bleeding; centrifugal blood pump; extracorporeal membrane oxygenation; von Willebrand factor.

Publication types

Review

Grants and funding

This study was supported by the Scientific Research Translational Foundation of Wenzhou Safety (Emergency) Institute of Tianjin University (TJUWYY2022002), Military Logistics Open Research Project (BLB19J006), and Wenzhou Science Bureau Major Scientific and Technological Innovation project (ZS2022007).