Journal of thrombosis and haemostasis : JTH · 2026
von Willebrand factor dynamics in trauma managed with extracorporeal life support.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Roberts Teryn R, Villalobos Pamela A, Bigon Eric B, Haden Grant A, Kill Halle J, Pratt Kathleen P, Batchinsky Andriy I
Аннотация
BACKGROUND: Extracorporeal life support (ECLS) can cause bleeding via excessive cleavage of multimeric protein von Willebrand Factor (VWF) by protease ADAMTS-13, a bleeding diathesis termed acquired von Willebrand syndrome. VWF high-molecular-weight multimers (HMWM) are more procoagulant than smaller multimers. Acute-phase responses generate high levels of VWF-HMWM and reduced ADAMTS-13 activity.
OBJECTIVES: Assess whether VWF-HMWM degradation is less pronounced and VWF:collagen binding activity (CB)/VWF:antigen (Ag) ratios are lower during ECLS in acute trauma vs noninjury settings.
METHODS: Anesthetized, mechanically ventilated swine (45-60 kg) were randomized to polytrauma (INJ CTRL, n = 14) managed with mechanical ventilation, uninjured receiving veno-venous extracorporeal carbon dioxide removal (ECLS CTRL, n = 20), or polytrauma managed with extracorporeal carbon dioxide removal (ECLS INJ, n = 22). In ECLS groups, 50% of animals received heparin anticoagulation, while 50% received no systemic anticoagulation. VWF:Ag, VWF:CB, VWF multimer size distribution, and ADAMTS-13 activity were evaluated at baseline, post-injury/intervention, and at 6, 24, 48, and 72 hours.
RESULTS: VWF-HMWM were depleted at 72 hours in ECLS CTRL (-19 ± 3%, P < .0001), but not in ECLS INJ (-10 ± 5%, P = .09). VWF:CB/VWF:Ag ratios relative to baseline were reduced at 48 to 72 hours in ECLS CTRL (0.84 ± 0.04, P = .002) and ECLS INJ (0.69 ± 0.05, P < .001) but not INJ CTRL. ADAMTS-13 activity decreased in all groups. Animals treated with heparin showed less pronounced VWF-HMWM degradation, higher VWF:CB/VWF:Ag ratios, and higher ADAMTS-13 activity vs matched non-anticoagulated animals.
CONCLUSION: Trauma managed with ECLS was associated with reduced VWF:CB/VWF:Ag ratios and lower ADAMTS-13 activity, but VWF-HMWM depletion was minimal. Thus, potential for acquired von Willebrand syndrome is a concern for trauma patients undergoing ECLS. Heparin partially countered effects of ECLS on VWF and ADAMTS-13.
OBJECTIVES: Assess whether VWF-HMWM degradation is less pronounced and VWF:collagen binding activity (CB)/VWF:antigen (Ag) ratios are lower during ECLS in acute trauma vs noninjury settings.
METHODS: Anesthetized, mechanically ventilated swine (45-60 kg) were randomized to polytrauma (INJ CTRL, n = 14) managed with mechanical ventilation, uninjured receiving veno-venous extracorporeal carbon dioxide removal (ECLS CTRL, n = 20), or polytrauma managed with extracorporeal carbon dioxide removal (ECLS INJ, n = 22). In ECLS groups, 50% of animals received heparin anticoagulation, while 50% received no systemic anticoagulation. VWF:Ag, VWF:CB, VWF multimer size distribution, and ADAMTS-13 activity were evaluated at baseline, post-injury/intervention, and at 6, 24, 48, and 72 hours.
RESULTS: VWF-HMWM were depleted at 72 hours in ECLS CTRL (-19 ± 3%, P < .0001), but not in ECLS INJ (-10 ± 5%, P = .09). VWF:CB/VWF:Ag ratios relative to baseline were reduced at 48 to 72 hours in ECLS CTRL (0.84 ± 0.04, P = .002) and ECLS INJ (0.69 ± 0.05, P < .001) but not INJ CTRL. ADAMTS-13 activity decreased in all groups. Animals treated with heparin showed less pronounced VWF-HMWM degradation, higher VWF:CB/VWF:Ag ratios, and higher ADAMTS-13 activity vs matched non-anticoagulated animals.
CONCLUSION: Trauma managed with ECLS was associated with reduced VWF:CB/VWF:Ag ratios and lower ADAMTS-13 activity, but VWF-HMWM depletion was minimal. Thus, potential for acquired von Willebrand syndrome is a concern for trauma patients undergoing ECLS. Heparin partially countered effects of ECLS on VWF and ADAMTS-13.