Key result
Adults on veno-arterial ECMO had significantly higher mean TFPI levels (81,877 vs 38,958 pg/mL on day 1/2) and longer thrombin generation lag times compared to healthy controls (P<0.001).
Why the study?
Tissue factor pathway inhibitor (TFPI) has anticoagulant properties, but no studies had measured TFPI levels in adult veno-arterial ECMO patients.
Does veno-arterial ECMO increase tissue factor pathway inhibitor levels and slow thrombin generation in adults compared to healthy controls?
Observational (n=20)
Does veno-arterial ECMO increase tissue factor pathway inhibitor levels and slow thrombin generation in adults compared to healthy controls?
Adults on VA ECMO have significantly elevated TFPI levels and slowed thrombin generation, which may contribute to the multifactorial coagulopathy observed during ECMO.
TFPI levels in adult VA ECMO are now measurable; leaves open their role in guiding anticoagulation or predicting bleeding.
Tissue factor pathway inhibitor (TFPI) has multiple anticoagulant properties. To our knowledge, no studies have measured TFPI levels in adult veno-arterial (VA) extracorporeal membrane oxygenation patients. We hypothesized that adult VA ECMO patients would have increased TFPI levels and slowed tissue factor triggered thrombin generation. Twenty VA ECMO patients had TFPI levels and thrombin generation lag time measured on ECMO day 1 or 2, day 3, and day 5. TFPI levels and thrombin generation lag time were compared against healthy control plasma samples. Mean TFPI levels were significantly higher in ECMO patients on ECMO day 1 or 2 = 81,877 ± 19,481 pg/mL, day 3 = 73,907 ± 26,690 pg/mL, and day 5 = 77,812 ± 23,484 pg/mL compared with control plasma = 38,958 ± 9,225 pg/mL (P < 0.001 for all comparisons). Median thrombin generation lag time was significantly longer in ECMO patients on ECMO day 1 or 2 = 10.0 minutes [7.5, 13.8], day 3 = 9.0 minutes [6.8, 12.1], and day 5 = 10.7 minutes [8.3, 15.2] compared with control plasma = 3.6 minutes [2.9, 4.2] (P < 0.001 for all comparisons). TFPI is increased in VA ECMO patients and tissue factor triggered thrombin generation is slowed. Increased TFPI levels could contribute to the multifactorial coagulopathy that occurs during ECMO.
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Mazzeffi et al. (2021) conducted an observational in Veno-arterial extracorporeal membrane oxygenation (n=20). Veno-arterial extracorporeal membrane oxygenation vs. Healthy control plasma samples was evaluated on Tissue factor pathway inhibitor (TFPI) levels and thrombin generation lag time (p=<0.001). Adults on veno-arterial ECMO had significantly higher mean TFPI levels (81,877 vs 38,958 pg/mL on day 1/2) and longer thrombin generation lag times compared to healthy controls (P<0.001).
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